Does Patients' Ability to Find, Understand, and Use Health Information Predict Involvement in Shared Decision Making?

Theoretical Background and research questions/hypothesis: Although increasing shared decision making (SDM) is a Healthy People 2020 objective, adults who reported their health care provider(s) (HCP) always involved them in SDM decreased from 61.1% in 2003 to 51.4% in 2013.  We examined the ability to find, understand, and use health information as predictors of increased SDM. The Evidence Informed Decision Making Engagement Modelinformed the development of the following research questions: (1) Are adults who always take health information to doctor visits more involved in SDM? (2) Are adults who are more confident about health information seeking more involved in SDM? (3) Are adults who do not find health information hard to understand more involved in SDM? We hypothesized that the ability to find, understand, and use health information will be positively associated with SDM.

Methods: For this secondary data analysis we utilized the Health Information National Trends Survey (HINTS 4 Cycle 3), a self-administered, mailed survey (N=3,185). Data were collected from September-December 2013. SDM (dependent variable) was operationalized as a patient’s perception that HCP involved them in healthcare decisions. Taking health information to doctor visits was the main independent variable. Observations with missing data (n=1,553) were excluded. This included 585 participants who have never looked for health information and 425 participants with no non-emergency room health visits in the past year. Chi-square tests and logistic regression analyses were performed using StataIC 13.1 Variables were added in a forward stepwise fashion.

Results:  There was a twofold increase in always being involved in SDM among adults who “always” versus “usually/sometimes/never” take health information to doctor visits (OR=2.22;95%CI:1.03-4.78). Adults who were “completely/very confident” versus “somewhat/a little/not confident” about ability to find health information were almost twice as likely to always be involved in SDM (OR=1.86;95%CI:1.20-2.89). Albeit marginally statistically significant, adults who did not find health information hard to understand were one and a half times more likely to always be involved in SDM than those who had difficulty understanding health information (OR=1.52;95%CI:1.00-2.32). These associations are based on our full model (i.e., after controlling for age, gender, and race/ethnicity). All of our hypotheses were supported.

Conclusions: Although it has been suggested that SDM may positively impact health outcomes, only about half of adults in the United States reported that their HCP always involved them in SDM. Even more alarming is the fact that this has not increased over a 10-year period from 2003-2013. Our study’s findings suggest that improving adults’ ability to find, understand, and use health information has the potential to increase SDM.

Implications for research and/or practice: To realize the Healthy People 2020 objective for SDM (HC/HIT-3), 56.8% of adults will need to report that their HCP always involved them in decisions about their healthcare. According to the 10-year trend data from HINTS, there is much work to be done if we are to realize this goal over the next five years. Our findings suggest that improving patients’ ability to find, understand, and use health information has the potential to increase SDM.