Health Literacy and Control in the Medical Encounter: A Mixed-Methods Analysis

• Type of Material: Article
• Authors: Safiya A. Arthur, Emory University; Hanah R. Geiser, Emory University; Kimberly R Jacob Arriola, Emory University; Sunil Kripalani, Vanderbilt University
• Language: English
• Date: 2009-07-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2009 National Medical Association. Published by Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/s0027-9684(15)30976-7
• Title of Journal or Parent Work: Journal of the National Medical Association
• ISSN: 1943-4693
• Volume: 101
• Issue: 7
• Start Page: 677
• End Page: 683
• Grant/Funding Information: This work was supported by a Pfizer Health Literacy Scholar Award, a K12 grant from the NIH National Center for Research Resources (K12 RR017643), and a K23 Mentored Patient-Oriented Research Career Development Award (K23 HL077597) to Dr. Kripalani.
• Keywords: CARE; MORTALITY; PATIENT-PHYSICIAN COMMUNICATION; KNOWLEDGE; Life Sciences & Biomedicine; General & Internal Medicine; PARTICIPATION; SHARED DECISION-MAKING; Science & Technology; Medicine, General & Internal; DIABETES PATIENTS; diabetes; patient-physician relationship
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery

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%). Conclusion: Patients with inadequate health literacy appear more likely to have paternalistic interactions with their physicians.