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184 Exploring the relationship between health literacy and SDM outcomes in the context of low value care
  1. Danielle Marie Muscat1,2,
  2. Erin Cvejic3,
  3. Jenna Smith1,2,
  4. Rachel Thompson4,
  5. Edward Hoi-Fan Chang1,
  6. Marguerite Tracy1,
  7. Joshua Zadro5,
  8. Robyn Lindner6,
  9. Kirsten J McCaffery1,2
  1. 1University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, New South Wales, Australia
  2. 2University of Sydney, Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, New South Wales, Australia
  3. 3University of Sydney, Faculty of Medicine and Health, School of Public Health, New South Wales, Australia
  4. 4University of Sydney, Faculty of Medicine and Health, School of Health Sciences, New South Wales, Australia
  5. 5University of Sydney, Faculty of Medicine and Health, School of Public Health, Institute for Musculoskeletal Health, New South Wales, Australia
  6. 6NPS Medicinewise, New South Wales, Australia

Abstract

Background Adults with lower health literacy have poorer health outcomes, but also have shorter medical visits and ask fewer questions when seeing healthcare providers.

The aim of this study was to explore the relationship between health literacy and SDM outcomes in the context of low value care, i.e. care that is ineffective, harmful or confers marginal benefit at disproportionately high cost.

Methods This is a pre-planned main-effects secondary analysis of a randomised controlled trial. Australian adults were recruited online, with quota sampling for lower health literacy, and presented with a hypothetical low value care low back pain scenario. Primary outcomes were self-efficacy to ask questions and be involved in healthcare decision-making (0–100) and intention to engage in SDM (0- 6), measured alongside a range of secondary outcomes (reported below).

Results 1439 participants (45.6% with inadequate health literacy) were included in the final analysis.

Compared to individuals with adequate health literacy, those with inadequate health literacy were less likely to (a) have complete knowledge of SDM rights (82.1% vs 89.0%; p<.001), (b) have positive attitudes towards SDM (48.3% vs 58.1%; p=.002), and (c) identify questions to ask a doctor which aligned with the Choosing Wisely low value care questions (χ2(1)=73.79, p<.001). They were also more likely to indicate they would follow low-value treatment plans without further questioning (7.46/10 vs 6.94/10; p<.001). However, there was no statistical evidence of a main effect of health literacy for either primary outcome.

Conclusions In the context of low value care, SDM outcomes differed based on participants’ health literacy. Findings are discussed in the context of interventional approaches which we tested to support individuals with lower health literacy be involved in healthcare decisions related to low value care.

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