Debra Roter|Lori H. Erby|Susan Larson|Lee Ellington
Assessing oral literacy demand in genetic counseling dialogue: Preliminary test of a conceptual framework
Johns Hopkins University|Johns Hopkins University|Johns Hopkins University|University of Utah
health literacy deficits affect half american patient population linked poor health ineffective disease management high rates hospitalization restricted literacy also linked less satisfying medical visits communication difficulties particularly terms interpersonal informational aspects care despite growing attention issues researchers policy makers studies attempted conceptualize assess aspects dialogue challenge persons low literacy skills ie oral literacy demand within medical encounters current study uses videotapes transcripts 152 prenatal cancer pretest genetic counseling sessions recorded simulated clients develop conceptual framework explore oral literacy demand consequences medical interaction related outcomes ninetysix prenatal 81 cancer genetic counselorsbroadly representative us national society genetic counselorsparticipated study key elements conceptual framework used define oral literacy demand include 1 use unfamiliar technical terms 2 general language complexity reflected application microsoft word grammar summary statistics session transcripts 3 structural characteristics dialogue including pacing density interactivity genetic counselor outcomes include selfratings session satisfaction informativeness development rapport simulated clients rated satisfaction session communication counselors effective use nonverbal skills counselors affective demeanor session sessions greater overall technical term use longer used complex language reflected readability indices multisyllabic vocabulary measures averaging p05 sessions high proportionate use technical terms characterized shorter visits high readability demand slow speech speed fewer dense counselor speaking turns low interactivity p05the higher use technical terms dense less interactive dialogue less satisfied simulated clients lower ratings counselors nonverbal effectiveness affective demeanor relationships p05 counselors selfratings informativeness also inversely related use technical terms p05 print material made readerfriendly effective following established guidelines medical dialogue may also made patientcentered meaningful providers monitor vocabulary language well structural characteristics interaction thereby lowering literacy demand routine medical dialogue consequences important patients may even patients restricted literacy