Defining the strategies to advance health-literacy-friendly patient decision aids based on the ICA-NRM approach

Patient decision aids (PtDAs) are evidence-based tools that guide patients in making thoughtful healthcare choices. However, there is a notable shortage of PtDAs that are tailored to the needs of adults with low health literacy (HL). The purpose of this study was to recognize and analyze the standards of HL-friendly PtDAs, thus helping effective shared decision-making (SDM) implementation.

This study considered five dimensions and 20 sub-dimensions for the HL-friendly PtDA standard via a literature review and expert consultations. Healthcare professionals familiar with SDM from two hospitals in Taiwan completed a questionnaire survey. We used the importance-coincidence analysis (ICA) to evaluate the status of dimensions and sub-dimensions. The decision-making trial and evaluation laboratory (DEMATEL) method evaluated the causal relationships among the proposed dimensions and sub-dimensions and created the network relationship map (NRM). We integrated the ICA-NRM method to develop HL-friendly PtDA improvement strategies.

A total of 84 valid questionnaires were collected, with 43 participants (54.8%) having experience developing a PtDA. The survey results indicated that the content presentation (CP) is the dominant dimension, and the information analysis (IA) is the central dimension affected. The CP dimension aspect impacts the SC (source citation), EA (effectiveness assessment), CS (content settings), and IA dimensions, while the SC dimension influences the EA, CS, and IA dimensions. Then, the EA dimension affects the CS and IA dimensions. The CS dimension only impacts the IA dimension. The dominant sub-dimensions for each dimension are the balanced presentation of options (CS3), options with equal detail (IA2), timely version (SC4), layout structure (CP2), and decision information quality (EA1).

This study demonstrated that content presentation is a critical driving factor for HL-friendly PtDA and gives healthcare professionals insights to better implement SDM on HL-friendly PtDA in clinical settings. Using the ICA-NRM method helps clarify the success items of HL-friendly PtDA promotion and provides improvement strategies.

Not applicable.