ArticleMedical decision making : an international journal of the Society for Medical Decision Making2025
How Inclusive Are Patient Decision Aids for People with Limited Health Literacy? An Analysis of Understandability Criteria and the Communication about Options and Probabilities.
Article in Medical decision making : an international journal of the Society for Medical Decision Making, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- From Clinical Reality to Blueprint Designing: A Qualitative Study Exploring Communication Challenges and Unmet Needs for Patient Decision Aid Development in Early-Stage Breast Cancer.Psycho-oncology · 2026Observational
- Shared Decision-Making in the Management of Deep Partial-Thickness Burns: Development and Implementation of a Multicomponent Decision Aid.Journal of medical Internet research · 2026Article
- Prioritizing Equity in Design and Implementation of Consumer-Facing Digital Resources to Support Engagement and Shared Decision-Making.Journal of medical Internet research · 2026Article
- Article
- 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
- Option talk and risk communication with people with limited health literacy: A qualitative focus group study with key stakeholders.PloS one · 2025Article
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Authors and funding
9 authors.
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Abstract
objectivePatient decision aids (PtDAs) can support shared decision making. We aimed to explore how inclusive PtDAs are for people with limited health literacy (LHL) by analyzing 1) the understandability of PtDAs using established criteria, 2) how options and probabilities of outcomes are communicated, and 3) the extent to which risk communication (RC) guidelines are followed.
methodsIn a descriptive document analysis, we analyzed Dutch PtDAs available in 2021 that met the International Patient Decision Aid Standards. We developed and pilot tested a data extraction form based on key RC and health literacy literature.
resultsMost PtDAs (151/198) met most of the understandability criteria on layout (7-8 out of 8 items) such as font size but not on content aspects (121/198 PtDAs scored 5-7 out of 12 items) such as defining medical terms. Only 31 of 198 PtDAs used a short and simple sentence structure. Most PtDAs presented 2 to 4 treatment options. Many followed RC recommendations such as the use of numerical RC strategies such as percentages or natural frequencies (160/198) and visual formats such as icon arrays (91/198). Only 10 used neutral framing (10/198). When presented, uncertainty was presented verbally (134/198) or in ranges (58/198). Four PtDAs were co-created together with patients with LHL and used only verbal RC or no RC.
conclusionMost PtDAs met most of the understandability criteria on layout, but content aspects and adherence to RC strategies can be improved. Many PtDAs used long sentences and mostly verbal RC and are therefore likely to be inappropriate for patients with LHL. Further research is needed on PtDA characteristics and RC strategies suitable for people with LHL. HIGHLIGHTS: Despite meeting most criteria for understandability, many of the Dutch PtDAs use long sentences, which likely impede comprehension for patients with LHL.Most of the Dutch PtDAs follow established recommendations for risk communication, with room for improvement for some strategies such as framing and a clear reference to the time frame.Overall, more research is needed to tailor PtDAs to the needs of people with LHL.
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