Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients

Joann Seo, Melody S. Goodman, Mary Politi, Melvin Blanchard, Kimberly A. Kaphingst

Research output: Contribution to journalArticlepeer-review


Introduction. 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. Methods. 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. Results. 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). Discussion. 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.

Original languageEnglish (US)
Pages (from-to)550-556
Number of pages7
JournalMedical Decision Making
Issue number4
StatePublished - 2015


  • health literacy
  • medically underserved patients
  • shared decision making

ASJC Scopus subject areas

  • Health Policy


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