Health literacy and control in the medical encounter: a mixed-methods analysis.
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.
Arthur
Safiya A
SA
Emory University, Atlanta, Georgia, USA.
Geiser
Hanah R
HR
Arriola
Kimberly R Jacob
KR
Kripalani
Sunil
S
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