The Role of Health Literacy and Patient Activation in Predicting Patient Health Information Seeking and Sharing

Commentary

Patient engagement plays an important role in health care [3]. Activated patients often have skills and confidence to engage in their health care and with their provider, which often contributes to better health outcomes and care experiences [2,4] as well as lower health care costs [5]. Health information is needed to make informed decisions, manage health, and practice healthy behaviors [6], and patients are increasingly taking an active role in seeking out medical or health information outside of the clinical encounter in order to make shared health decisions with their provider [7]. Indeed, one of the Healthy People 2020 goals is to “Use health communication strategies and health information technology  to improve population health outcomes and health care quality, and to achieve health equity” [8].

However, seeking POMI requires health literacy skills and supportive relationships, particularly when navigating the many channels and complexities of publicly available health information [8]. This is especially true on the internet, where there is often varying accuracy and clarity of information presented. According to 2011 data from the Pew Research Center [9], 74% of adults in the United States use the internet, and of those adults 80% have looked online for health information; 34% have read another person’s commentary or experience about health or medical issues on an online news group, website, or blog; 25% have watched an online video about health or medical issues; and 24% have consulted online reviews of particular drugs or medical treatments.

A general strength of this study was the cross-sectional design, which allowed for surveying patients around attitudes, motivations, and behaviors immediately before and after their clinical encounter. According to the authors, this study design was aimed to extend knowledge around information seeking and provider discussions that have occurred distally and relied on patient long-term recall. Additionally, this study surveyed a variety of patients (not limited to either primary or specialist appointments) at 2 different academic medical centers, and gave patients a choice to either take the survey on a computer tablet or traditional paper and pencil. Further, the authors assessed the reliability of scales used and included a number of predictor variables in the logistic regression models for hypothesis testing.

The authors acknowledged several limitations, including the use of convenience sampling and self-reported data with volunteer participants, which can result in self-selection bias and social desirability bias. As study participants were self-selecting, low health literacy patients may have been more likely to not volunteer to take the survey, which might explain the relatively high mean scores on the health literacy measures. Further, participants were mostly white, female, college-educated, health literate, and scheduled for a routine visit, which limits the generalizability of the study findings and the ability to identify significant predictors.

Regarding the study design, pre-/post-tests are usually used to measure the change in a situation, phenomenon, problem, or attitude. However, as the authors did not aim to measure any change during the clinical encounter itself, the use of only a post-test may have been more appropriate. The use of a pre-/post-test design may have increased the likelihood of patients both recalling POMI before the encounter and then sharing POMI with their provider. Also, in the post-survey, the authors only asked follow-up questions of patients that shared POMI with their provider. An open-response question could have been included to explore further why some patients chose not to introduce POMI during the clinical encounter. Lastly, the authors may have been able to reach more patients with lower health literacy if surveys were administered at public hospitals as opposed to academic medical centers. While some providers may perceive that patients in academic medical centers are more complex or may have limited access to care [10], patients at public hospitals and safety net hospitals tend to be of lower income and have limited or no insurance [11,12].

Applications For Clinical Practice

There are documented communication-enhancing techniques and strategies that providers and other health professionals use, particularly among patients with low health literacy [13]. Based on this study, the authors conclude that providers may try another strategy of directly asking or passively surveying any POMI, regardless of whether the patient initiates this conversation. Other research has acknowledged that recognition of health literacy status allows for the use of appropriate communication tools [14]. However, providers need to recognize barriers to health information seeking, particularly among minorities and underserved populations [15], as well as the potential for embarrassment that patients might experience as a result of revealing misunderstandings of health information or general reading difficulties [16]. This study highlights the need for further research to identify predictors of health information seeking and especially health information sharing by patients during the clinical encounter.

—Katrina F. Mateo, MPH