What did the doctor say?: Health literacy and retention of verbal health information

Objective: The relationship between low health literacy and poor health outcomes has been well documented. The problem of low health literacy has led to increased attention towards how individuals access, understand, and retain health information. In this study, we sought to investigate a patient's ability to recall orally communicated medical diagnoses and instructions. We hypothesized that patients with low literacy skills would have greater difficulty remembering information conveyed verbally in a medical encounter.

Methods: One hundred and one adults, ages 55-74, were shown a video simulating a physician verbally diagnosing gastroesophageal reflux disease (GERD). A 10-point functional knowledge assessment was administered both immediately and twenty minutes after the viewing. Literacy skills were measured using the Test of Functional Health Literacy in Adults (TOFHLA).

Results: Overall, information retention averaged 5.9(1.8) out of 10 possible knowledge points. Those with inadequate and marginal literacy recalled significantly less than those with adequate literacy (3.0(1.4), 4.8(1.7), 6.0(1.7) respectively, p<.001). After adjusting for age, gender, education, chronic conditions, and prior exposure to GERD, patients with lower literacy were still less likely to have recalled the information shared during the verbal medical encounter compared to those with higher literacy scores (β=1.05 95% Confidence Interval 1.00-1.10).

Conclusion: Individuals, especially those with low literacy skills, would benefit from dissemination of tangible materials that simply express medical instructions to supplement recommendations discussed during a medical encounter. Clinical screening of patient literacy level should also be considered to identify those at greatest risk for poor retention of verbally conveyed information.