How accessible are Dutch patient decision aids to people with limited health literacy?

Details

Patient decision aids can support shared decision making. Researchers explored how inclusive these aids are for people with limited health literacy by assessing their understandability against established criteria, how they communicated options and outcome probabilities, and how closely they followed risk communication guidelines.

In a descriptive document analysis, the researchers examined Dutch patient decision aids available in 2021 that met the International Patient Decision Aid Standards. They developed and pilot tested a data extraction form based on key risk communication and health literacy literature.

Most aids (151/198) met most layout understandability criteria, scoring 7–8 out of 8 items, including aspects such as font size. Content criteria were met less often: 121/198 scored 5–7 out of 12 items, including aspects such as defining medical terms. Only 31/198 used short, simple sentence structures. Most presented 2 to 4 treatment options.

Many followed risk communication recommendations: 160/198 used numerical strategies such as percentages or natural frequencies, and 91/198 used visual formats such as icon arrays. Only 10/198 used neutral framing. When uncertainty was presented, it was communicated verbally in 134/198 aids or in ranges in 58/198. Four aids were co-created with patients with limited health literacy and used only verbal risk communication or no risk communication.

The researchers concluded that most aids met most layout criteria, but content and adherence to risk communication strategies could improve. Many used long sentences and mostly verbal risk communication, making them likely to be inappropriate for patients with limited health literacy; the long sentences likely impede comprehension. Most followed established risk communication recommendations, but framing and clear reference to the time frame were among the areas for improvement. Further research is needed on aid characteristics and risk communication strategies suited to people with limited health literacy.