Therapeutic relationships can facilitate personal growth. Barrett-Lennard provides a useful measure. Psychological Reports 2: Psychological Reports 50 1: There was a problem filtering reviews right now. If you are a seller for this product, would you like to suggest updates through seller support? This worklaunches the study of the relationship conditions into newterritory and provides a significant contribution to the study ofhuman relationships.

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This study investigated the moderating effect of patient-perceived empathy on the relationship between health literacy and understanding of preoperative information. Hierarchical multiple regression analysis provided a test of moderator effects. The finding that the interaction term was significant suggests perceived empathy is a relevant factor when considering the relationship between health literacy and the understanding of information by patients. The relationship between the health literacy and understanding of information was stronger and positive among patients who perceived greater empathy from their physicians.

Conclusion Our study demonstrates that a focus on improving physician—patient empathy skills could be beneficial in helping to overcome the negative consequences associated with limited health-literacy capabilities. Healthcare providers who wish to improve the understanding of information by low health-literacy patients should first identify components of their empathic communication mechanisms, and then try to refine these skills to better serve their patients.

Peer Review reports Background Health literacy is increasingly recognized as a critical factor affecting patient-physician communication and health outcomes [ 1 ]. The terminology health care providers use to communicate with patients can present a barrier for patients who cannot sufficiently comprehend health vocabulary. The consequences of low health literacy include difficulties navigating the health care system, receiving fewer preventive services, inaccurate or incomplete histories, missed appointments, failing to follow medication instructions, lack of informed consent, and worse health outcomes [ 2 — 7 ].

Patients with low health literacy often do not understand the information given to them. As a consequence, they often feel short of information, which can lead to vagueness, nervousness and anxiety. The literature recommends that patient-centered approaches generally are associated with better feelings of understanding [ 8 ]. Of all the factors involved in effective patient-centered communication, empathy seems to be the element most influential, yet also easily ignored [ 9 , 10 ].

Empathy is a process involving facets of cognitive, behavioral, and affective actions on the part of physicians [ 13 ]. Appropriate use of empathy as a communication tool has multiple benefits in the patient-physician dynamic, including: 1 encouraging patients to better describe their symptoms and concerns; 2 enhancing the efficiency of collecting and understanding health information leading to a more accurate diagnosis; 3 aiding patients in participating in their treatment and recovery; and 4 honoring and soothing patients in a therapeutically beneficial manner [ 10 , 14 ].

Despite the growing research base documenting the extent and impact of low health literacy, there is a lack of research examining patient-perceived empathy and its effect on the understanding of health information by patients with low-literacy.

Our study used a sample of orthopedic patients from a medical center in southern Taiwan to investigate the moderating effect of patient-perceived empathy on the relationship between health literacy and understanding of preoperative information. Methods Participants All patients visiting the inpatient orthopedic clinic to receive total hip THA or knee TKA replacement medical services and meeting the eligibility criteria in one of the medical centers in southern Taiwan during the 2-month period from April 15, , to June 15, were asked to participate.

Prior to their decision to participate, patients were given a brief verbal overview of the aim and methods of the study. Participants provided informed consent before they joined the study, which had been previously approved by the Institutional Review Board of Chang Gung Medical Center.

Forward and backward translation skills were employed when appropriate to ensure no misinterpretation existed owing to language issues. This is because the original scales came from Western literature. Content validity was assured by means of a careful expert review and a pilot test.

Content validity index CVI for overall questionnaire from six experts reached 0. Internal consistency reliability coefficients were calculated for the questionnaire. The REALM was designed to identify patients who may need help with health care instructions because of low literacy [ 16 ].

Fisher asserted that REALM is useful for screening individuals who are at risk because of their inability to read [ 17 ]. The 66 common medical terms in the Chinese-edition of the REALM were chosen by a group of health care researchers in their study of different levels of health literacy.

Perceived empathy was measured using the item Empathy Understanding subscale of the Barrett-Lennard Relationship Inventory BLRI , which has been robustly used in psychotherapy outcome research and had several advantages over other available instruments: patient centered, appropriate validity and reliability, uses multiple items, inexpensive and free of technical complexity [ 18 ].

Higher scores represented more empathy perceived by patients. Gurman found that BLRI had good internal consistency with alpha of 0. Understanding of preoperative information was measured using an item researcher-developed Preoperative Information Understanding Scale PIUS based on suggestions from a preoperative teaching questionnaire and the literature [ 19 — 21 ].

All participants were assessed for understanding of preoperative information in three areas: operation information 5 items , anesthesia information 4 items , and nursing instructions information 9 items. Responses for each area were scored numerically and divided into four levels of understanding: information not provided 0 , information provided but not understood 1 , information provided and partly understood 2 , and information provided and well understood 3.

A higher total score represented better understanding of preoperative information. We used a number of statistical methods to detect moderator variables. The general strategy is to test for an interaction using hierarchical multiple regression analysis [ 22 ].

In the first step, we entered the independent variables including the control variables and the moderator into the regression model to verify the main effects of the independent variables. Then, in a separate step, the product of the independent variables, which represents the moderator effect, was entered. Note that in order to eliminate the effect of multicollinearity of variables, the product item was formed by multiplying together the two centered variables i.

Cohen had stated that this hierarchical approach provides an unambiguous test of moderator effects [ 25 ]. To further describe the moderating effect, the subgrouping strategy of Arnold was executed to show the strength or degree of relationship between a moderator variable i.

The slopes of the regression lines from these subgroups were plotted to identify the form of the moderator effect [ 27 ]. Results Of the eligible patients, a total of agreed to participate and finish the survey during a 2-month period. Table 1 shows demographic data for the participants. Participants were generally older Of the participants, 86 Most were married , Table 2 demonstrates the moderating effect of perceived empathy on the association between health literacy and understanding of information, controlling for the demographic variables.

We entered demographic variables age as a continuous variable; sex, marital status, education level, and religion as dummy variables , perceived empathy, and health literacy as the predictor variables in Step 1. Then, we added the two-way interaction between centered perceived empathy and centered health literacy as the predictor variable in Step 2. The finding that the interaction term was significant suggests the moderator i.

As shown in Figure 1 , the graph indicates that the relationship between information understanding and health literacy was stronger and positive among patients who perceived higher empathy from their physicians.

The relationship was weak and positive among patients who perceived low empathy from their physicians. Figure 1 Full size image Figure 2 Graphical presentation of the slope change between the health literacy and information understanding among patients who perceive low empathy. The graph of the regression lines verified the moderator effect of perceived empathy.

For patients whose perceived empathy was greater, their understanding of information exhibited stronger positive relationships with their health literacy. Patients who perceived comparatively low empathy from their physicians exhibited an opposite pattern of relationship between health literacy and understanding of information. Research has revealed that when opportunities for empathy are repeatedly ignored or missed, visits tend to be more time-consuming and frustrating for both physicians and patients [ 28 , 29 ].

The findings of the present study further demonstrate that, in addition to facilitating the clinical interview and honoring the patient, empathy may improve the efficiency of understanding information. Owing to poor health literacy often being associated with a lack of medical knowledge, inferior health status, and a higher use of medical services, efforts ought to be undertaken to address the needs of populations with limited health literacy.

With the intention of altering the old-world view that physicians are trained in a system where empathetic communication is only an afterthought, many medical schools have developed curricula with a solid focus on physician—patient communication and empathy.

Our study has several limitations. First, the data may be subject to common method variance as they all came from a unique source. Second, replication in other medical departments is desirable to allow a more accurate appraisal.

Third, other factors were not measured and controlled but may have affected the relationship between health literacy and understanding of information e.

Fourth, studies are needed to replicate these findings using alternative measures of health literacy and perceived empathy because different measures may yield different results. Finally, further evaluation on the validity and reliability of the translated questionnaire is highly recommended so as to assure the tools used are reliable and have adequate validity. Conclusions A variety of methods have been advocated for communicating with patients who have low literacy skills.

Whereas there is abundant research documenting the prevalence of low health literacy and its correlation with insufficient health knowledge, and less-optimal health outcomes, our study shows that a focus on improving physician—patient empathy skills could be substantially beneficial in helping to overcome the negative consequences associated with limited health-literacy capabilities.

Dealing with a patient who has low literacy takes time and money. Our study demonstrates that patients with higher perceived empathy exhibited stronger understanding of preoperative information. References 1. Fam Med. Google Scholar 2.


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