Rehabilitation Consumers' Use and Understanding of Quality Information: A Health Literacy Perspective

doi:10.1016/j.apmr.2008.07.023

Archives of Physical Medicine and Rehabilitation

Volume 90, Issue 2, February 2009, Pages 206-212

Presented to the American Congress of Rehabilitation Medicine and American Society of Neurorehabilitation Joint Conference, October 3–7, 2007, Washington, DC.

https://doi.org/10.1016/j.apmr.2008.07.023 Get rights and content

Abstract

Magasi S, Durkin E, Wolf MS, Deutsch A. Rehabilitation consumers' use and understanding of quality information: a health literacy perspective.

Objectives

To explore consumers' use and understanding of quality information about postacute rehabilitation facilities.

Design

Thematic, semistructured interviews.

Setting

Two skilled nursing facilities and 2 inpatient rehabilitation facilities in a large Midwestern city.

Participants

Rehabilitation inpatients (n=17) with stroke, hip fractures, and joint replacements and care partners (n=12) of rehabilitation inpatients.

Intervention

None.

Main Outcome Measure

None.

Results

Health literacy imposed barriers to participants' understanding of quality information. Using the Institute of Medicine's Health Literacy Framework, we identified specific barriers that limited participants' abilities to (1) obtain quality information, (2) process and understand quality information, and (3) make appropriate decisions about the quality of a rehabilitation facility. Participants tended to rely on informal and nonquality information when choosing a rehabilitation facility.

Conclusions

Given the barriers imposed by low health literacy, rehabilitation providers have a responsibility to present quality information in a way that consumers, especially those with low health literacy, can use and understand.

Section snippets

Study Design

This exploratory study used thematic, semistructured interviews to examine (1) the process of choosing a rehabilitation facility, (2) the comprehension of quality information, and (3) the perceived relationship between individual quality indicators and the overall quality of care provided by a facility. The interviews were conducted by 3 health service researchers (ED, MW, AD) with backgrounds in quality, rehabilitation, and health literacy; they were assisted by a research assistant with

Results

The participants' abilities to use quality indicators were compromised by health literacy barriers in (1) obtaining health information, (2) processing and understanding health information, and (3) making appropriate health decisions. Figure 1 presents a conceptual model of how reduced health literacy created barriers to consumers' use of quality information to inform decisions. Specific concerns related to each of these requisite functions of health literacy are summarized.

Discussion

This study identified health literacy barriers that limited consumers' ability to understand and use rehabilitation quality information. Figure 1 provides a conceptual model of the specific barriers that were identified to interfere with 3 requisite functions of health literacy: the ability to obtain, understand, and use health information. Selecting a rehabilitation setting is determined by multiple factors. Although the process could be informed by publicly reported quality information,

Conclusions

The study findings suggest that consumers' abilities to assess the quality of rehabilitation care are limited. Low health literacy limited participants' abilities to obtain, process, and understand individual quality indicators and their relationship to rehabilitation quality. Many consumers based their decisions on subjective information and informal sources, including word of mouth recommendations from friends and family, physician practice patterns, familiarity, and proximity. Although

Acknowledgments

The authors wish to acknowledge the contributions of Holly Demark, BA, and all of the participants and facilities who contributed to this research.

References (22)

B. Silverstein et al.
Usefulness of the nursing home quality measures and quality indicators for assessing skilled nursing facility rehabilitation outcomes
Arch Phys Med Rehabil
(2006)
J. Hibbard et al.
Why not give consumers a framework for understanding quality?
Jt Comm J Qual Saf
(2004)
Crossing the quality chasm: a new health system for the 21st century
(2001)
P.W. Beatty et al.
Use of outcomes information in acute inpatient rehabilitation
Am J Phys Med Rehabil
(2004)
Report to the Congress: Medicare Payment Policy
(2006)
Kaiser
National survey on consumer experiences with patient safety and quality information. November 2004
L. Nielsen-Bohlman et al.
Health literacy: a prescription to end confusion
(2004)
Healthy people 2010: understanding and improving health
(2000)
S. Ratzan et al.
Introduction
J.H. Hibbard et al.
Strategies for reporting health plan performance information to consumers: evidence from controlled studies
Health Serv Res
(2002)

Nursing Home Compare

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: Supported by the National Institute on Disability and Rehabilitation Research through a Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness (grant no. H133B040032).

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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Original articleRehabilitation Consumers' Use and Understanding of Quality Information: A Health Literacy Perspective

Abstract

Objectives

Design

Setting

Participants

Intervention

Main Outcome Measure

Results

Conclusions

Section snippets

Study Design

Results

Discussion

Conclusions

Acknowledgments

Arch Phys Med Rehabil

Jt Comm J Qual Saf

Crossing the quality chasm: a new health system for the 21st century

Use of outcomes information in acute inpatient rehabilitation

Am J Phys Med Rehabil

Report to the Congress: Medicare Payment Policy

National survey on consumer experiences with patient safety and quality information. November 2004

Health literacy: a prescription to end confusion

Healthy people 2010: understanding and improving health

Introduction

Strategies for reporting health plan performance information to consumers: evidence from controlled studies

Health Serv Res

Nursing Home Compare

Original article
Rehabilitation Consumers' Use and Understanding of Quality Information: A Health Literacy Perspective