Equity in Choosing Wisely and beyond: the effect of health literacy on healthcare decision-making and methods to support conversations about overuse.

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Danielle M Muscat, Erin Cvejic, Jenna Smith, Rachel Thompson, Edward Chang, Marguerite Tracy, Joshua Zadro, Robyn Linder, Kirsten McCaffery
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引用次数: 0

Abstract

Objective: To (a) examine whether the effect of the Choosing Wisely consumer questions on question-asking and shared decision-making (SDM) outcomes differs based on individuals' health literacy and (b) explore the relationship between health literacy, question-asking and other decision-making outcomes in the context of low value care.

Methods: Preplanned analysis of randomised trial data comparing: the Choosing Wisely questions, a SDM video, both interventions or control (no intervention). Randomisation was stratified by participant health literacy ('adequate' vs 'limited'), as assessed by the Newest Vital Sign.

Main outcome measures: Self-efficacy to ask questions and be involved in decision-making, and intention to engage in SDM.

Participants: 1439 Australian adults, recruited online.

Results: The effects of the Choosing Wisely questions and SDM video did not differ based on participants' health literacy for most primary or secondary outcomes (all two-way and three-way interactions p>0.05). Compared with individuals with 'adequate' health literacy, those with 'limited' health literacy had lower knowledge of SDM rights (82.1% vs 89.0%; 95% CI: 3.9% to 9.8%, p<0.001) and less positive attitudes towards SDM (48.3% vs 58.1%; 95% CI: 4.7% to 15.0%, p=0.0002). They were also more likely to indicate they would follow low-value treatment plans without further questioning (7.46/10 vs 6.94/10; 95% CI: 0.33 to 0.72, p<0.001) and generated fewer questions to ask a healthcare provider which aligned with the Choosing Wisely questions (χ2 (1)=73.79, p<.001). On average, 67.7% of participants with 'limited' health literacy indicated that they would use video interventions again compared with 55.7% of individuals with 'adequate' health literacy.

Conclusion: Adults with limited health literacy continue to have lower scores on decision-making outcomes in the context of low value care. Ongoing work is needed to develop and test different intervention formats that support people with lower health literacy to engage in question asking and SDM.

明智选择中的公平及其他:健康知识对医疗决策的影响,以及支持就过度使用进行对话的方法。
目的目的:(a)研究 "明智选择 "消费者问题对提问和共同决策(SDM)结果的影响是否因个人健康素养而异;(b)探索低价值医疗背景下健康素养、提问和其他决策结果之间的关系:对随机试验数据进行预先计划的分析,比较:明智选择问题、SDM 视频、两种干预或对照(无干预)。根据最新生命体征(Newest Vital Sign)评估的参与者健康素养("足够 "与 "有限")进行分层随机化:提出问题和参与决策的自我效能以及参与 SDM 的意愿:结果:选择明智(Choosing Wisely)问答的效果与参与决策的意愿有关:结果:在大多数主要或次要结果中,"明智选择 "问题和 SDM 视频的效果并不因参与者的健康素养而异(所有双向和三向交互作用 p>0.05)。与健康素养 "足够 "的人相比,健康素养 "有限 "的人对 SDM 权利的了解较少(82.1% vs 89.0%;95% CI:3.9% to 9.8%,p2 (1)=73.79, p结论:健康素养有限的成年人在低价值护理背景下的决策结果得分仍然较低。需要不断开发和测试不同的干预形式,以支持健康素养较低的人参与提问和 SDM。
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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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