Patient literacy and question-asking behavior during the medical encounter: a mixed-methods analysis.
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.


METHODS
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.


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


METHODS
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.
Katz
Marra G
MG
Emory University School of Medicine, Atlanta, Georgia 30303, USA.
Jacobson
Terry A
TA
Veledar
Emir
E
Kripalani
Sunil
S
D001519:Behavior; D003142:Communication; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010342:Patient Acceptance of Health Care; D010358:Patient Participation; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011446:Prospective Studies