Are Patient Demographics, Linguistic Tones and Patient Reported Outcome Measures Associated with Health Literacy?

Objectives Limited ability to obtain, process, and understand health information that enables patients to make health decisions (low health literacy) is associated with worse health and an increased risk of hospitalization. There is evidence that patients’ word choice can reflect illness behavior and care experience. Correlation of linguistic tones and health literacy could help identify opportunities to ensure patient understanding and participation in decision-making during outpatient visits among patients with musculoskeletal illness. Methods A secondary analysis of transcripts of video and audio recordings of 65 adult patients seeking musculoskeletal specialty care was performed. Patients also completed questionnaires quantifying symptoms of depression (PROMIS [Patient-Reported Outcomes Measurement Information System] Depression computerized adaptive test [CAT]), PROMIS Pain Interference CAT (PI), PROMIS Upper Extremity CAT (UE), the Newest Vital Sign (NVS) health literacy questionnaire, and a basic demographics survey. Linguistic Inquiry and Word Count ( LIWC) was used to detect the relative strength of various emotional tones, cognitive processes, and core drives and needs. We tested for associations between health literacy and patient demographics, each of the LIWC domains, and PROMIS Depression, PROMIS PI, and PROMIS UE. Results Accounting for potential confounding in multivariable analysis, higher health literacy was associated with greater years of education, greater tones reflecting anxiety, and greater tones describing risk. There were correlations between more limited health literacy and greater pain interference and greater symptoms of depression, but not with upper extremity-specific capability. Conclusion The observation that patient linguistic tones are associated with health literacy can be used to develop effective health strategies consistent with what matters most to patients.