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What Did the Doctor Say? Health Literacy and Recall of Medical Instructions

McCarthy, Danielle M. MD*; Waite, Katherine R. BA; Curtis, Laura M. MS; Engel, Kirsten G. MD*; Baker, David W. MD, MPH; Wolf, Michael S. PhD, MPH

doi: 10.1097/MLR.0b013e318241e8e1
Original Articles

Background: Limited literacy has repeatedly been linked to problems comprehending health information, although the majority of studies to date have focused on reading various print health materials. We sought to investigate patients’ ability to recall spoken medical instructions in the context of a hypothetical clinical encounter, and whether limited health literacy would adversely affect performance on the task.

Methods: A total of 755 patients aged 55 to 74 were recruited from 1 academic internal medicine clinic and 3 federally qualified health centers. Participants’ health literacy skills and recall of spoken medical instructions for 2 standard hypothetical video scenarios [wound care, gastroesophageal reflux disease (GERD) diagnosis] were assessed.

Results: The majority (71.6%) of participants had adequate health literacy skills, and these individuals performed significantly better in correctly recalling spoken information than those with marginal and low literacy in both scenarios: [wound care—mean (SD): low 2.5 (1.3) vs. marginal 3.5 (1.3) vs. adequate 4.6 (1.1); P<0.001), GERD: low 4.2(1.7) vs. marginal 5.2 (1.7) vs. adequate 6.5 (1.7); P<0.001]. Regardless of literacy level, overall recall of information was poor. Few recognized pain (28.5%) or fever (28.2%) as signs of infection. Only 40.5% of participants correctly recalled when to take their GERD pills.

Conclusions: Many older adults may have difficulty remembering verbal instructions conveyed during clinical encounters. We found those with lower health literacy to have poorer ability to recall information. Greater provider awareness of the impact of low health literacy on the recall of spoken instructions may guide providers to communicate more effectively and employ strategies to confirm patient understanding.

*Department of Emergency Medicine

Health Literacy and Learning Program, Division of General Internal Medicine

Division of General Internal Medicine, Northwestern University, Chicago, IL

Supported by National Institute of Aging Grant: R01AG030611 (M.S.W.).

The authors declare no conflict of interest.

Reprints: Danielle M. McCarthy, MD, Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 211 E. Ontario St, Suite 200, Chicago, IL 60611. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.