title: Patient activation and advocacy: which literacy skills matter most?
abstract: Attention to the effect of a patient's literacy skills on health care interactions is relatively new. So, too, are studies of either structural or personal factors that inhibit or support a patient's ability to navigate health services and systems and to advocate for their own needs within a service delivery system. Contributions of the structural environment, of interpersonal dynamics, and of a variety of psychological and sociological factors in the relationship between patients and providers have long been under study. Less frequently examined is the advocacy role expected of patients. However, the complex nature of health care in the United States increasingly requires a proactive stance. This study examined whether four literacy skills (reading, numeracy, speaking, and listening) were associated with patient self-advocacy--a component of health literacy itself--when faced with a hypothetical barrier to scheduling a medical appointment. Although all literacy skills were significantly associated with advocacy when examined in isolation, greater speaking and listening skills remained significantly associated with better patient advocacy when all four skills were examined simultaneously. These findings suggest that speaking and listening skills and support for such skills may be important factors to consider when developing patient activation and advocacy skills.
authors.affiliation: RAND Corporation, Santa Monica, California 22202, USA. lamartin@rand.org
authors.forename: Laurie T
authors.initials: LT
authors.lastname: Martin
authors.forename: Matthias
authors.initials: M
authors.lastname: Schonlau
authors.forename: Ann
authors.initials: A
authors.lastname: Haas
authors.forename: Kathryn Pitkin
authors.initials: KP
authors.lastname: Derose
authors.forename: Lindsay
authors.initials: L
authors.lastname: Rosenfeld
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Buka
authors.forename: Rima
authors.initials: R
authors.lastname: Rudd
mesh_terms: D000328:Adult; D032882:Comprehension; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D011939:Mental Recall; D010344:Patient Advocacy; D010358:Patient Participation; D010817:Physician-Patient Relations; D011932:Reading; D013223:Statistics as Topic