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. 2021 Jun 14:15:1269-1279.
doi: 10.2147/PPA.S311470. eCollection 2021.

Enhancing Specific Health Literacy with a Digital Evidence-Based Patient Decision Aid for Hypertension: A Randomized Controlled Trial

Kai Wehkamp #  1   2   3 , Felicia Beatrice Kiefer #  4 , Friedemann Geiger  1   5 , Fueloep Scheibler  1 , Jens Ulrich Rueffer  6 , Norbert Donner-Banzhoff  7 , Cornelia Betsch  4
Affiliations

Enhancing Specific Health Literacy with a Digital Evidence-Based Patient Decision Aid for Hypertension: A Randomized Controlled Trial

Kai Wehkamp et al. Patient Prefer Adherence. .

Abstract

Introduction: Health literacy is an important competency to make informed, shared decisions in line with patient's preferences. On the other hand, lower health literacy is associated with poorer health outcomes. Evidence-based patient decision aids (EbPDA) are validated instruments to support informed medical decisions and empower patients for relevant involvement in their care. This study aimed to investigate the effect of a digital EbPDA for hypertension on health literacy.

Methods: In a randomized controlled trial, 124 participants were presented with a web-based scenario related to a newly diagnosed condition of arterial hypertension. The intervention group was provided with an online decision aid, while the control group was prompted to search for related information without support. Specific health literacy for hypertension was operationalized based on the European survey for health literacy (HLS-EU-Q47).

Results: The intervention group showed a statistically significant increase in subjectively perceived overall specific health literacy regarding hypertension (p=0.02, Cohen's d=0.44). The effect was also statistically significant for the subcategories understanding, appraising, and applying health-related information (all p<0.05). At least equal results could be shown for participants with a lower level of education compared to participants with a high level.

Conclusion: The findings suggest that digital EbPDAs can be an effective and easily scalable instrument to improve populations' specific health literacy. A possible advantage of the measure could be that patients are addressed concerning important and pressing personal decisions, fostering awareness of the individual's need for health literacy to reflect one's options and preferences. EbPDAs may also be a promising approach to target vulnerable populations, as the investigated EbPDA seems to perform equally in less versus more educated individuals. For future research, it may be interesting to investigate whether EbPDAs have effects on general health literacy that go beyond the disease specifically addressed.

Keywords: decision aids; equity; health literacy; preferences; shared decision-making.

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Conflict of interest statement

CB and FBK declare no conflicts of interest. FG, FS, KW and JUR are shareholders of SHARE TO CARE, Patientenzentrierte Versorgung GmbH (Cologne/Germany). KW reports fee for a lecture on shared decision-making from Roche Germany GmbH. FG reports personal fees from Roche and Chugai Pharma. NDB is shareholder of the GPZK gGmbH/non-profit corporation (Rostock/Germany). The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study design. Participants were 1:1 randomly assigned. *Only participants that completed the scenario are displayed. Exclusion criteria invalid age range and medical education applied for 50 participants. A higher dropout-rate in the intervention group resulted in differently sized groups.
Figure 2
Figure 2
Assessment of general health literacy before intervention based on HLS-EU-QQ47 survey for health literacy. Control and intervention group showed no significant differences.
Figure 3
Figure 3
Specific health literacy in the intervention and control group (error bars represent standard deviations).
Figure 4
Figure 4
Specific health literacy in the intervention and control group, split into the subgroups of participants with low vs high level of education (error bars represent standard deviations).
See this image and copyright information in PMC

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