Health literacy and decision making styles for complex antithrombotic therapy among older multimorbid adults

Aanand D. Naik, Richard L. Street, Diana Castillo, Neena S. Abraham

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Objectives: To evaluate the effect of functional health literacy (FHL) on preferences for decision-making; and among those initially preferring a passive decision-making role, to explore how preferences change if their physician actively encourages their involvement. Methods: Consecutive older adults with cardiovascular disease receiving complex antithrombotic therapy completed a comprehensive assessment including measures of FHL and preferences for shared decision making. Results: Half of all participants had inadequate or marginal FHL. Those with inadequate FHL were more likely (P= 0.01) to prefer passive rather than active decision making styles even after controlling for age, education, and numeracy. However, 40% of patients preferring passive styles had adequate FHL and these patients were significantly more likely to change their preference to more active styles (odds ratio = 7.17, P< .01) if their physician "was more supportive or encouraged participation" Conclusions: Screening FHL can provide insight into patients' preferences for active participation in decision making. Clinicians' encouragement of participation can increase engagement by patients with adequate FHL. Practice implications: We propose an algorithm for screening FHL and preferences for participating in decisions about complex medication regimens.

Original languageEnglish (US)
Pages (from-to)499-504
Number of pages6
JournalPatient Education and Counseling
Issue number3
StatePublished - Dec 2011


  • Aging
  • Doctor-patient relationship
  • Drugs
  • Literacy
  • Prevention

ASJC Scopus subject areas

  • General Medicine


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