title: Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients.
abstract: Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population.
  
  
  
  We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician directed or patient involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association.
  
  
  
  Adequate health literacy (odds ratio [OR] = 1.7;P= 0.009) was significantly associated with preferring patient-involved decision making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision making (OR = 0.65;P= 0.024).
  
  
  
  Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy.
authors.affiliation: Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA (JS, MSG, MP)
authors.forename: Joann
authors.initials: J
authors.lastname: Seo
authors.affiliation: Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA (JS, MSG, MP)
authors.forename: Melody S
authors.initials: MS
authors.lastname: Goodman
authors.affiliation: Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA (JS, MSG, MP)|Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA (MB)
authors.forename: Mary
authors.initials: M
authors.lastname: Politi
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA (MB)
authors.forename: Melvin
authors.initials: M
authors.lastname: Blanchard
authors.affiliation: Department of Communication, University of Utah, Salt Lake City, UT, USA (KAK)|Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA (KAK).
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kaphingst
mesh_terms: D000328:Adult; D000367:Age Factors; D003657:Decision Making; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010358:Patient Participation / Q000706:statistics & numerical data*; D057240:Patient Preference; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: health literacy; medically underserved patients; shared decision making