Patients’ Perceptions of Physicians’ Health Literacy Competencies and “Good” Communication in Family Medicine: A Q Methodology Study

Health literacy competencies enable physicians to communicate effectively, fostering patients' understanding, trust, and shared decision-making. However, research has largely emphasized physicians' views rather than patients'. This study examined how patients perceive physicians' health literacy competencies and how these perceptions shape their views of "good communication" in family medicine. Forty-four Q-statements were developed based on established indicators of physician health literacy and professional competencies. A total of 62 patients were randomly invited from family medicine outpatient clinics at 2 medical centers in northern Taiwan, with 42 completing the Q-sorting task. Data were analyzed using Q-factor analysis, combining quantitative statistical methods with qualitative interview data to identify distinct groups of patient perspectives. The Q-factor analysis identified 5 distinct patient perspectives, accounting for 50.88% of the total variance. These perspectives were categorized as: (1) Paternalistic Model - Physician-Dependent, characterized by patient reliance on physician authority; (2) Interpretive Model - Self-Empowered, emphasizing patient autonomy and active participation; (3) Interpretive Model - Shared Decision-Making, reflecting a balance of physician expertise and patient autonomy; (4) Informative Model - Patient-Centered, prioritizing clear communication and patient rights; and (5) Deliberative Model - Physician-Respecting, balancing professional competence with empathetic patient engagement. Patients perceive "good communication" in various ways influenced by health literacy, cultural values, and expectations of the physician's role. The findings emphasize the need for communication training that adjusts to patients' different health literacy levels and preferences, incorporating these perspectives into physician education and practice to encourage patient-centered, health literacy-oriented care.