IS HEALTH LITERACY ASSOCIATED WITH DIFFICULTY UNDERSTANDING AND COMPLETING HEALTH STATE VALUATION TASKS?
Author(s)
Annika L. Pickard, MS, Jonathan L. Nazari, PharmD, Aaron N. Winn, MPP, PhD, A Simon Pickard, PhD;
University of Illinois Chicago, Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA
University of Illinois Chicago, Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA
OBJECTIVES: Approximately half of US adults have low health literacy. Health state valuation tasks are typically conducted using TTO or DCE, which can be challenging to understand. The aim of this study was to examine whether health literacy has a role in the perceived difficulty of TTO and DCE tasks.
METHODS: Secondary analysis of the 2017 US EQ-5D-5L valuation study data was conducted on n=1133 participants. Data were collected in-person with interviewer assistance, beginning with health and sociodemographic questions followed by TTO and DCE tasks. Health literacy was categorized as inadequate or marginal/adequate based on the 3-item Brief Health Literacy Screener. DCE and TTO task difficulty was characterized by three items for each valuation task related to difficulty understanding the task, ability to differentiate between health states, and deciding on the preferred health state. Ordinal logistic regression models were run with task difficulty as the dependent variable, health literacy as the independent variable, and controlling for age, education, and survey language.
RESULTS: Individuals with higher health literacy reported less difficulty understanding TTO (OR= 0.71, [95% CI: 0.53-0.94]) and DCE (OR=0.63, [0.46-0.86]) tasks. Higher health literacy individuals had less difficulty differentiating between health states; TTO (OR=0.73, [0.55-0.96]) and DCE (OR=0.70, [0.53-0.92]). However, health literacy was not associated with difficulty deciding on the preferred health state using TTO or DCE (OR= 0.99, [0.76-1.30]); (OR=0.83, [0.64-1.07]), respectively.
CONCLUSIONS: Results suggest that in-person interviewer administration of valuation tasks may mitigate challenges with understanding and differentiating health states reported by those with lower health literacy, as health literacy was not associated with difficulty completing valuation tasks. Additional research is needed to understand whether individuals with low health literacy rely on simplifying heuristics to complete tasks to overcome difficulties in comprehension.
METHODS: Secondary analysis of the 2017 US EQ-5D-5L valuation study data was conducted on n=1133 participants. Data were collected in-person with interviewer assistance, beginning with health and sociodemographic questions followed by TTO and DCE tasks. Health literacy was categorized as inadequate or marginal/adequate based on the 3-item Brief Health Literacy Screener. DCE and TTO task difficulty was characterized by three items for each valuation task related to difficulty understanding the task, ability to differentiate between health states, and deciding on the preferred health state. Ordinal logistic regression models were run with task difficulty as the dependent variable, health literacy as the independent variable, and controlling for age, education, and survey language.
RESULTS: Individuals with higher health literacy reported less difficulty understanding TTO (OR= 0.71, [95% CI: 0.53-0.94]) and DCE (OR=0.63, [0.46-0.86]) tasks. Higher health literacy individuals had less difficulty differentiating between health states; TTO (OR=0.73, [0.55-0.96]) and DCE (OR=0.70, [0.53-0.92]). However, health literacy was not associated with difficulty deciding on the preferred health state using TTO or DCE (OR= 0.99, [0.76-1.30]); (OR=0.83, [0.64-1.07]), respectively.
CONCLUSIONS: Results suggest that in-person interviewer administration of valuation tasks may mitigate challenges with understanding and differentiating health states reported by those with lower health literacy, as health literacy was not associated with difficulty completing valuation tasks. Additional research is needed to understand whether individuals with low health literacy rely on simplifying heuristics to complete tasks to overcome difficulties in comprehension.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR156
Topic
Patient-Centered Research
Topic Subcategory
Health State Utilities, Patient-reported Outcomes & Quality of Life Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas