Trial reportBMJ quality & safety2025
Equity in Choosing Wisely and beyond: the effect of health literacy on healthcare decision-making and methods to support conversations about overuse.
Trial report in BMJ quality & safety, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed.
- Association Between Health Literacy and Outpatient Expenditure in Korea.Journal of Korean medical science · 2026Article
- Online Resources for Migraine Surgery: Readability and Patient Understanding.Plastic and reconstructive surgery. Global open · 2026Article
- Unravelling complex relationships between health literacy and shared decision-making: a cross-sectional study in patients attending rheumatology rehabilitation.EULAR rheumatology open · 2026Article
- Challenges and possibilities of enabling person-centred engagement in medication safety with older people living at home.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026Article
- The Relationship Between Communicative Health Literacy and Patient Loyalty in China: A Chain Mediation Study Based on Social Exchange Theory.Journal of multidisciplinary healthcare · 2026Article
- The Greek Versions of the HLSHealthcare (Basel, Switzerland) · 2025Article
- A novel intelligent approach for infection protection using a multidisciplinary collaboration in regional general hospitals.Scientific reports · 2025Article
- Is low-value care for persistent musculoskeletal pain more common in rural than urban areas? A scoping review.BMC health services research · 2025Article
- Assessment of decision-making autonomy in chronic pain patients: a pilot study.BMC medical ethics · 2024Article
- Exploratory Analysis of Health Literacy and Genetic Testing Awareness, Uptake, and Desire for Genetic Risk Information: Findings From a Cross-Sectional Community Survey.Cancer control : journal of the Moffitt Cancer CenterArticle
- Evaluating A Patient-Led Health Literacy Program for People Living With Metastatic Breast Cancer.Cancer control : journal of the Moffitt Cancer CenterArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo (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.
methodsPreplanned 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 measuresSelf-efficacy to ask questions and be involved in decision-making, and intention to engage in SDM.
participants1439 Australian adults, recruited online.
resultsThe 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
conclusionAdults 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.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.