PS 4-4 WEIGHING UP RISKS AND BENEFITS: BARRIERS AND FACILITATORS FOR HEALTH CONSUMERS WITH LOWER LITERACY

Wednesday, October 26, 2016
Bayshore Ballroom ABC, Lobby Level (Westin Bayshore Vancouver)
Poster Board # PS 4-4

Danielle Muscat, BPsych(Hons)1, Suzanne Morony, PhD1, Heather Shepherd, PhD2, Sian Smith, PhD3, Haryana Dhillon, MA, PhD4, Lyndal Trevena, MBBS, MPhilPH, PhD1, Andrew Hayen, PhD5, Karen Luxford6, Don Nutbeam, PhD1 and Kirsten McCaffery, BSc, PhD1, (1)School of Public Health, University of Sydney, University of Sydney, Australia, (2)Psycho-oncology Co-operative Research Group, University of Sydney, University of Sydney, Australia, (3)Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia, (4)Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), University of Sydney, Australia, (5)School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia, (6)Patient-based care, Clinical Excellence Commission, Sydney, Australia
Purpose:

Weighing up the risks and benefits of test and treatment options is an important component of shared decision-making (SDM). Qualitative interviews were conducted to provide insight into the barriers and facilitators to teaching adult consumers with lower literacy about SDM including how to understand and weigh up risk/benefit information.

Method:

We created a 6-hour SDM training program for adults with lower literacy, delivered in Australian adult education centres in 2014 (n=308) as part of a broader health literacy program. The program utilised the AskShareKnow questions and aimed to develop students’ skills and self-efficacy to understand quantitative risk and benefit information and the concept of outcome likelihood so that they could meaningfully consider risks and benefits in healthcare.

Semi-structured interviews were conducted with all teachers (n=11) and a sample of students (n=25) to explore their experience of teaching and learning about SDM and health risks/benefits.  Maximum variation purposive sampling captured students from English-speaking and non-English-speaking backgrounds (NESB) from regional and metropolitan areas.

Interviews were transcribed verbatim and analysed using the Framework Analysis method. 

Result:

Learners were often unaware that asking questions about test and treatment options and their associated risks/benefits is permitted during healthcare encounters. They were unfamiliar with SDM terminology (e.g. “benefits” and “harms”) and valued the explanations and language reinforcement embedded within the program. Students reported feeling empowered to ask questions about risks/ benefits following training.

Conceptually, the third AskShareKnow question (How likely are each of those benefits and harms to happen to me?) was challenging for learners and developing understanding of likelihood concepts took time.

Developmental progression of knowledge and skills embedded within numeracy activities (e.g. moving from verbal risk descriptions to numerical and graphical representations of risk and, finally, comparing risk estimates) was seen as a key facilitator of numerical risk understanding by teachers. 

Conclusion:

Adults with lower literacy face significant barriers to meaningful participation in SDM. Training to develop SDM vocabulary and understanding of consumers’ right to ask questions can be empowering for this population.

For SDM to be accessible to all, those with lower literacy require support to understand conceptual and numerical aspects of likelihood. Developmental progression of skills may facilitate greater understanding of numerical likelihood estimates needed to meaningfully weigh up options and reach an informed, shared decision.

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