明智选择及其他方面的公平性：健康素养对医疗决策的影响以及支持关于医疗服务过度使用问题对话的方法
Equity in Choosing Wisely and beyond: the effect of health literacy on healthcare decision-making and methods to support conversations about overuse.
作者信息
Muscat Danielle M, Cvejic Erin, Smith Jenna, Thompson Rachel, Chang Edward, Tracy Marguerite, Zadro Joshua, Linder Robyn, McCaffery Kirsten
机构信息
Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
出版信息
BMJ Qual Saf. 2025 Mar 19;34(4):213-222. doi: 10.1136/bmjqs-2024-017411.
OBJECTIVE
To (a) examine whether the effect of the Choosing Wisely consumer questions on question-asking and shared decision-making (SDM) outcomes differs based on individuals' health literacy and (b) explore the relationship between health literacy, question-asking and other decision-making outcomes in the context of low value care.
METHODS
Preplanned analysis of randomised trial data comparing: the Choosing Wisely questions, a SDM video, both interventions or control (no intervention). Randomisation was stratified by participant health literacy ('adequate' vs 'limited'), as assessed by the Newest Vital Sign.
MAIN OUTCOME MEASURES
Self-efficacy to ask questions and be involved in decision-making, and intention to engage in SDM.
PARTICIPANTS
1439 Australian adults, recruited online.
RESULTS
The effects of the Choosing Wisely questions and SDM video did not differ based on participants' health literacy for most primary or secondary outcomes (all two-way and three-way interactions p>0.05). Compared with individuals with 'adequate' health literacy, those with 'limited' health literacy had lower knowledge of SDM rights (82.1% vs 89.0%; 95% CI: 3.9% to 9.8%, p<0.001) and less positive attitudes towards SDM (48.3% vs 58.1%; 95% CI: 4.7% to 15.0%, p=0.0002). They were also more likely to indicate they would follow low-value treatment plans without further questioning (7.46/10 vs 6.94/10; 95% CI: 0.33 to 0.72, p<0.001) and generated fewer questions to ask a healthcare provider which aligned with the Choosing Wisely questions (χ (1)=73.79, p<.001). On average, 67.7% of participants with 'limited' health literacy indicated that they would use video interventions again compared with 55.7% of individuals with 'adequate' health literacy.
CONCLUSION
Adults with limited health literacy continue to have lower scores on decision-making outcomes in the context of low value care. Ongoing work is needed to develop and test different intervention formats that support people with lower health literacy to engage in question asking and SDM.
目的
(a) 研究“明智选择”消费者问题对提问及共同决策（SDM）结果的影响是否因个体健康素养而异；(b) 在低价值医疗背景下，探究健康素养、提问与其他决策结果之间的关系。
方法
对随机试验数据进行预先计划的分析，比较：“明智选择”问题、一段SDM视频、两种干预措施或对照组（无干预）。随机分组按参与者的健康素养（通过最新生命体征评估为“充分”与“有限”）进行分层。
主要结局指标
提问及参与决策的自我效能感，以及参与SDM的意愿。
参与者
1439名澳大利亚成年人，通过网络招募。
结果
对于大多数主要或次要结局，“明智选择”问题和SDM视频的效果不因参与者的健康素养而有所不同（所有双向和三向交互作用p>0.05）。与健康素养“充分”的个体相比，健康素养“有限”的个体对SDM权利的知晓率较低（82.1%对89.0%；95%置信区间：3.9%至9.8%，p<0.001），对SDM的态度也不那么积极（48.3%对58.1%；95%置信区间：4.7%至15.0%，p=0.0002）。他们也更有可能表示会在不进一步询问的情况下遵循低价值治疗方案（7.46/10对6.94/10；95%置信区间：0.33至0.72，p<0.001），并且向医疗服务提供者提出的与“明智选择”问题相符的问题更少（χ(1)=73.79，p<.001）。平均而言，健康素养“有限”的参与者中有67.7%表示他们会再次使用视频干预措施，而健康素养“充分”的个体中这一比例为55.7%。
结论
在低价值医疗背景下，健康素养有限的成年人在决策结果方面得分仍然较低。需要持续开展工作来开发和测试不同的干预形式，以支持健康素养较低的人群进行提问和参与SDM。
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