Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
School of Social Work, Simmons University, Boston MA, USA.
Med Decis Making. 2021 Oct;41(7):848-869. doi: 10.1177/0272989X211011101. Epub 2021 May 29.
There is increasing recognition of the importance of addressing health literacy in patient decision aid (PtDA) development.
An updated review as part of IPDAS 2.0 examined the extent to which PtDAs are designed to meet the needs of people with low health literacy/socially-disadvantaged populations.
Reference lists of Cochrane reviews of randomized controlled trials (RCTs) of PtDAs (2014, 2017, and upcoming 2021 versions).
RCTs that assessed the impact of PtDAs on low health literacy or other socially-disadvantaged groups (i.e., ≥50% participants from socially-disadvantaged groups and/or subgroup analysis in socially-disadvantaged group/s).
Two researchers independently extracted data into a standardized form including PtDA development and evaluation details. We searched online repositories and emailed authors to access PtDAs to verify grade reading level, understandability, and actionability.
Twenty-five of 213 RCTs met the inclusion criteria, illustrating that only 12% of studies addressed the needs of low health literacy or other socially-disadvantaged groups. Grade reading level was calculated in 8 of 25 studies (33%), which is recommended in previous IPDAS guidelines. We accessed and independently assessed 11 PtDAs. None were written at sixth-grade level or below. Ten PtDAs met the recommended threshold for understandability, but only 5 met the recommended threshold for actionability. We also conducted a post hoc subgroup meta-analysis and found that knowledge improvements after receiving a PtDA were greater in studies that reported using strategies to reduce cognitive demand in PtDA development compared with studies that did not (χ = 14.11, = 0.0002, I = 92.9%).
We were unable to access 13 of 24 PtDAs. Greater attention to health literacy and socially-disadvantaged populations is needed in the field of PtDAs to ensure equity in decision support.
人们越来越认识到在患者决策辅助工具（PtDA）开发中解决健康素养问题的重要性。
作为 IPDAS 2.0 的一部分，本次更新的综述检查了 PtDA 的设计在多大程度上满足了低健康素养/社会弱势群体人群的需求。
对 Cochrane 随机对照试验（RCT）的 PtDA 评价的参考文献列表（2014 年、2017 年和即将于 2021 年发布的版本）。
评估 PtDA 对低健康素养或其他社会弱势群体影响的 RCT（即，≥50%参与者来自社会弱势群体，或在社会弱势群体/亚组中进行亚组分析）。
两位研究人员独立将数据提取到一个标准化表格中，包括 PtDA 开发和评估细节。我们搜索了在线知识库并给作者发电子邮件以获取 PtDA，以验证阅读水平、可理解性和可操作性的等级。
213 项 RCT 中有 25 项符合纳入标准，表明只有 12%的研究解决了低健康素养或其他社会弱势群体的需求。在 25 项研究中有 8 项（33%）计算了阅读水平等级，这是之前 IPDAS 指南中推荐的。我们访问并独立评估了 11 项 PtDA，没有一项是六年级或以下的水平。有 10 项 PtDA 符合可理解性的推荐标准，但只有 5 项符合可操作性的推荐标准。我们还进行了事后亚组荟萃分析，发现与未使用 PtDA 开发中降低认知需求策略的研究相比，在接受 PtDA 后知识有提高的研究（χ=14.11， =0.0002，I=92.9%）更多。
我们无法访问 24 项 PtDA 中的 13 项。PtDA 领域需要更加关注健康素养和社会弱势群体，以确保决策支持的公平性。
