BACKGROUND: Many patients with chronic disease have limited health literacy (HL). Because physicians have difficulty identifying these
patients, some experts recommend instituting screening programs in clinical settings. It is unclear if notifying physicians
of patients’ limited HL improves care processes or outcomes.
OBJECTIVE: To determine whether notifying physicians of their patients’ limited HL affects physician behavior, physician satisfaction,
or patient self-efficacy.
DESIGN: We screened all patients for limited HL and randomized physicians to be notified if their patients had limited HL skills.
PARTICIPANTS: Sixty-three primary care physicians affiliated with a public hospital and 182 diabetic patients with limited HL.
MEASUREMENTS: After their visit, physicians reported their management strategies, satisfaction, perceived effectiveness, and attitudes
toward HL screening. We also assessed patients’ self-efficacy, feelings regarding HL screening’s usefulness, and glycemic
control.
RESULTS: Intervention physicians were more likely than control physicians to use management strategies recommended for patients with
limited HL (OR 3.2, P=.04). However, intervention physicians felt less satisfied with their visits (81% vs 93%, P=.01) and marginally less effective (38% vs 53%, P=.10). Intervention and control patients’ post-visit self-efficacy scores were similar (12.6 vs 12.9, P=6). Sixty-four percent of intervention physicians and 96% of patients felt HL screening was useful.
CONCLUSIONS: Physicians are responsive to receiving notification of their patients’ limited HL, and patients support the potential utility
of HL screening. However, instituting screening programs without specific training and/or system-wide support for physicians
and patients is unlikely to be a powerful tool in improving diabetes outcomes.
Key Words health literacy - screening - diabetes mellitus - physician-patient communication
The authors have no conflicts of interest, financial or otherwise, to report for this article or this research.
Portions of this work were presented in abstract form at the Society for General Internal Medicine regional (California) and
national meetings in 2001 and 2003.
See editorial by Montori, p. 1071
Dr. Seligman was supported by a DHHS-HRSA Research Fellowship Grant 5 D14HP00178-03-00. Dr. Piette is a VA Research Career
Scientist. Dr. Schillinger was supported by a NIH Mentored Clinical Scientist Award K-23 RR16539-03, UCSF Hellman Family Research
Award, and a Pfizer Inc. Health Literacy Research Award Electronic data were made available through the San Francisco General
Hospital GCRC grant M01RR00083-42.