Words to the wise patient: Measuring effects of doctors' instructions about diet, nutrition and exercise on patients' health literacy, self-reported health status, and ratings of care quality, among low-income patients in a large and diverse Medicaid health plan, 2011-2014
(1) Design, data, and setting: Patients in a large and diverse Medicaid health plan were surveyed regarding doctors’ advice about diet, nutrition, exercise, non-smoking, and getting age-appropriate tests and vaccinations. The study used CAHPS patient experience surveys from 2011 to 2014 (n=3,257 adults, n=4,314 parents of pediatric patients).
(2) Analysis: The study examines the prevalence and thoroughness of health education by doctors to low-income patients, and tests the association between such training and patients’ self-reported health status. The study also examines the association between doctors’ advice on health practices and patients’ health literacy, and explores whether that advice is credited by patients in ratings of doctor-patient communication and health care quality. Demographic analysis identifies which groups noticed and valued doctors’ advice, versus groups that either received none or needed different content or methods.
(3) Implications: Evidence that patients notice doctors’ instructions on healthy living, reveals that such advice is fairly common, but that sizable subsets of patients get missed. The impact of such instructions on patients’ health literacy and ratings of health care, provide insight toward improving poor scores on measures of quality in health systems that serve the urban poor.
Learning Areas:Administer health education strategies, interventions and programs
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Describe five fundamental categories of advice that doctors provide to patients on health practices and behaviors of healthy living. Identify which category of doctors’ advice is most associated with patients’ subsequent self-reported health status. Compare the percent of Medicaid patients who recall receiving physician advice on diet, nutrition, and exercise, versus the percent who report receiving no such advice. Identify which demographic groups (age, gender, language, ethnicity) are most or least likely to report getting instruction from doctors on healthy living. Describe one indicator of health literacy that relates to doctors’ instructions on health practices. Identify two measures of health service quality that are logically associated with doctors’ instructions to patients on healthy living.
Keyword(s): Health Promotion and Education, Health Literacy
Qualified on the content I am responsible for because: For the past eight years as the Director of Health Education, Cultural and Linguistic Services for the nation's largest public health plan, I have been overseeing the development, implementation and evaluation of perinatal services program for low-income Medicaid beneficiaries. During the past four years, the organization developed and implemented mailing campaign to pregnant women and outreach program to address low rate of post partum care.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.