Identification of verbal indicators of health literacy during telephone counseling

Background: Comprehension of spoken information, oral literacy, is an acknowledged but poorly studied component of health literacy. Increasingly, medical and education interventions take place by telephone, making oral literacy even more critical. The goal of this pilot study was to explore whether verbal indicators of health literacy can be identified in the course of telephone counseling and used as cues to tailor the conversation. The study is part of a trial to test phone counseling by a nurse educator with newly diagnosed cancer patients who are eligible for cancer clinical trials. Communication with patients about clinical trials is a complex, information-intensive process, and the ability to assess patients' health literacy and tailor communication accordingly could be valuable. Methods: Recorded telephone conversations between patients and nurse educators were transcribed, then coded using the qualitative software program ATLAS.ti. The recordings and transcripts were analyzed using an inductive process of listening to the recordings and reading the transcripts to identify verbal indicators of health literacy. The observed indicators were compared with scores from self-administered surveys using a 3-question measure of health literacy. Results: We identified a number of verbal indicators of patient health literacy, e.g., sentence length and language complexity; proper and improper grammar, correct and incorrect use of medical terminology; patient reports of asking their providers questions and seeking information about their diagnosis and treatment on their own. Conclusion: This project demonstrates a promising approach to assessing health literacy in telephone conversations and offers guidance on tailoring communications about clinical trials participation.