Augmenting Survey Completion and Rates of Returns for Patients with Low Literacy: A Randomized Control Trial of Telephone Follow-up

Keywords: Keywords, health, hospital, literacy, patient perspective, patient satisfaction, quality of care, survey

Abstract

Abstract

 

Aim.  The aim of the study was to determine the best possible means to achieve survey-item completion and high rates of return among low-literacy patients in regard to their perspectives on their health and quality of care post-hospital discharge.

Background.  The Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) is designed for individuals with a sixth-grade reading level.  One hospital, however, who had mailed the HCAHPS to discharged patients had low return rates and low item completion, which hospital personnel felt were due to low literacy levels.  

Design.  An experimental design was used to conduct this descriptive/comparative study.

Methods.  A total of 286 adult patients with low literacy volunteered to participate in the study.  The survey was disseminated in English or Spanish to individuals with low literacy, using two different modes of dissemination (mailing of the survey or telephone with follow-up reading/clarification of the survey items, if needed) to patients with low literacy who were hospital discharged.

Results.  Participants in the telephone group were 7.4 times more likely to complete the HCAHPS as compared to those who received the HCAHPS by mail.  These telephone participants also were more likely to complete all items compared to those who were mailed the survey.  

Discussion.  Assessing the health literacy of patients is important to ensure that HCAHPS is understood and that the survey is returned and items are completed.  Telephone dissemination should be considered for patients with low literacy.  

Keywords:  health, hospital, literacy, patient perspective, patient satisfaction, quality of care, survey 

Author Biography

Geraldine Cynthia Fike, California State University San Bernardino
DNP and a CCRN Assistant Professor at CSUSB for the nursing program. Previous experience as a Chief Nursing Officer for a 343-bed hospital. Expertise in ICU and ED.

References

References

Al-Tayyib, A. A., Rogers, S. M., Gribble, J. N., Villarroel, M., & Turner, C. F. (2002). Effect of low medical literacy on health survey measurements. American Journal of Public Health, 92(9), 1478–1480.

Baker, D. W., Gazmararian, J. A., Williams, M. V., Scott, T., Parker, R.M., Green, D., & Peel, J. (2002). Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. American Journal of Public Health, 92(8), 1278–1283.

Bennett, D. (2003). Low literacy, high risk: The hidden challenge facing health in California. Retrieved from http://cahealthliteracy.org/pdffiles/healthliteracylongreport012704_3.pdf

Berkman, N. D., DeWalt, D. A., Pignone, M. P., Sheridan, S. L., Lohr, K. N., Lux, L., . . . Bonito, A. J. (2004). Literacy and health outcomes (AHRQ Publication No. 04-E007-2). Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://archive.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacy.pdf

Bickmore, T., Pfeifer, L., & Paasche-Orlow, M. (2009). Using computer agents to explain medical documents to patients with low health literacy. Patient Education and Counseling, 75(3), 315–320.

Centers for Medicare & Medicaid Services. (2007). The CAHPS hospital survey (HCAHPS): Fact sheet. Retrieved from http://www.hcahpsonline.org/files/Final-HCAHPS%20fact%20sheet_100307.pdf

Centers for Medicare & Medicaid Services. (2010). HCAHPS fact sheet. Retrieved from http://www.hcahpsonline.org/files/HCAHPS%20Fact%20Sheet%202010.pdf

Community Hospital of San Bernardino. (2014). Community benefit report, 2014. San Bernardino, CA: Dignity Health.

Fineman, M. A. (2010). The vulnerable subject and responsive state (Emory Public Law Research Paper No. 10-130). Retrieved from Social science research network website: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1694740##

Flaskerud, J., & Winslow, B. (1998). Conceptualizing vulnerable populations: Health-related research. Nursing Research, 47, (2) 69-78.

Hintze, J. (2007). Number Cruncher Statistical Systems (Version 2007) [Computer Software]. Kaysville, UT: NCSS.

Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The health literacy of America’s adults: Results of the 2003 National Assessment of Health Literacy. (NCES Report No. 2006-483). Retrieved from National Center for Education Statistics website:

http://nces.ed.gov/pubs2006/2006483.pdf

Lasek, R, J., Barkley, W., Harper, D. L., & Rosenthal, G. E. (1997). An evaluation of the impact of nonresponse bias on patient satisfaction surveys. Medical Care, 35, 646–652.

Paasche-Orlow, M. K., Parker, R. M., Gazmararian, J. A., Nielsen-Bohlman, L. T., & Rudd, R. R. (2005). The prevalence of limited health literacy. Journal of General Internal Medicine, 20(2), 175–184.

Sitzia, J., & Wood, N. (1997). Patient satisfaction: A review of issues and concepts. Social Science & Medicine, 45(12), 1829–1843.

Sofaer, S., Crofton, C., Goldstein, E., Hoy, E., & Crabb, J. (2005). What do consumers want to know about the quality of care in hospitals? Health Services Research, 40(6, Pt. 2), 2018–2036.

Statistical Package for the Social Science, Inc. (Version 12.0) [Computer software]. (2003). Chicago, IL: Author.

U.S. Department of Health & Human Services, Agency of Healthcare Research & Quality. (2011). Frequently asked questions: For what reading level are CAHPS surveys designed? Retrieved from https://www.cahps.ahrq.gov/About-CAHPS/FAQs/FAQ-Search-Results?category={2479D47A-0A1E-4E1F-BA17-80448AEC3791}#747159DB-F8DB-422B-B0CA-DD04774A4B9C

Published
2019-11-24
How to Cite
Fike, G. C. (2019). Augmenting Survey Completion and Rates of Returns for Patients with Low Literacy: A Randomized Control Trial of Telephone Follow-up. International Journal of Nursing, 5(2). Retrieved from https://ijnonline.com/index.php/ijn/article/view/291
Section
Nursing Administration