title: Health literacy and control in the medical encounter: a mixed-methods analysis.
abstract: BACKGROUND
  Physician-patient communication can be described according to 4 prototypes of control--paternalism, mutuality, consumerism, or default. Patients with inadequate health literacy skills may be less-active participants in their care and more likely to have paternalistic encounters.
  
  
  METHODS
  Two independent coders analyzed 31 transcribed outpatient medical visits between physicians and African American patients with diabetes according to the 4 prototypes of control. Differences in communication and the balance of power by level of patients' health literacy were analyzed by quantitative and qualitative methods.
  
  
  RESULTS
  Fourteen patients (45%) had inadequate health literacy, and most of them (N=8, 57%) had paternalistic encounters. Among patients with marginal or adequate health literacy skills, only 4 (23%) had paternalistic visits (p = .06), and encounters marked by mutuality were most common (N= 9, 53%).
  
  
  CONCLUSIONS
  Patients with inadequate health literacy appear more likely to have paternalistic interactions with their physicians.
authors.affiliation: Emory University, Atlanta, Georgia, USA.
authors.forename: Safiya A
authors.initials: SA
authors.lastname: Arthur
authors.forename: Hanah R
authors.initials: HR
authors.lastname: Geiser
authors.forename: Kimberly R Jacob
authors.initials: KR
authors.lastname: Arriola
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D003142:Communication; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D011209:Power, Psychological