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Patient Literacy and Question-asking Behavior During the Medical Encounter: A Mixed-methods Analysis

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Abstract

Background

Although patient participation in the medical encounter confers significant benefits, many patients are reluctant to ask questions of their physicians. Patients’ literacy level may affect their level of participation and question-asking behaviors.

Objective

To examine the effect of literacy on the number and types of questions asked by patients during primary care office visits.

Design

Convenience sample recruited between April and November 2004. Physician–patient visits were audiotaped, and patient questions from complete encounters (N = 57) were coded using an adaptation of the Roter Interaction Analysis System.

Patients

Participants were predominantly middle-aged (mean age = 56.7 years), female (75.4%), and African American (94.7%). Low literacy skills (≤6th grade reading level) were present in 38.6%.

Measurements

We hypothesized prospectively that low-literacy patients would ask fewer total questions and fewer questions about key aspects of their medical care.

Results

Low-literacy adults asked significantly fewer questions about medical care issues (median = 4 vs 6 among patients with higher literacy levels, p = .014). They also tended to ask fewer questions overall (median = 7 vs 10, p = .070). Low-literacy patients were more likely to ask the physician to repeat something (p = .013), indicating an initial lack of understanding. They were less likely to use medical terminology, refer to medications by name, request additional services, or seek new information. Question-asking behavior was not significantly related to patient gender, age, years of education, or physician–patient gender concordance.

Conclusions

Literacy level appears to be an important determinant of patients’ participation in the medical encounter. Low-literacy patients ask fewer questions about their medical care, and this may affect their ability to learn about their medical conditions and treatments.

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Acknowledgments

We thank Samatha Brown and Melissa Love-Ghaffari for their assistance with data collection and management. Supported by a Pfizer Health Literacy Scholar Award, a K12 grant from NIH National Center for Research Resources (K12 RR017643), a K23 Mentored Patient-Oriented Research Career Development Award (K23 HL077597) to Dr. Kripalani, and in part by the National Center on Minority Health and Health Disparities Project EXPORT and the Georgia Cancer Center for Excellence at Grady Health System (NMCHD 5P60-MD000525).

Conflict of Interest

None disclosed.

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Correspondence to Sunil Kripalani MD, MSc.

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Katz, M.G., Jacobson, T.A., Veledar, E. et al. Patient Literacy and Question-asking Behavior During the Medical Encounter: A Mixed-methods Analysis. J GEN INTERN MED 22, 782–786 (2007). https://doi.org/10.1007/s11606-007-0184-6

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  • DOI: https://doi.org/10.1007/s11606-007-0184-6

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