In decision-making is the basic principle of autonomy and

Invarious clinical settings and hospitals, it is seen that there is a largevariation in patient’s involvement in medical decision-making. Patientparticipation in medical decision-making is the basic principle of autonomy andprocess of informed consent. In aGeneral Social survey conducted at US in 2002, it was found that 52% of thepopulation preferred paternalism, to leave the final decision to their doctors.

However, about 96% of participants wanted a shared decision- making approachwhere they could discuss and share their opinions about clinical management oftheir disease with doctors 1.In the New England Journal of Medicine 2012,Charles Bardes states that over the half past century, patient-centered care isthe main and next focus of general trend in the medical profession 2.Patients’ opinions and involvement has now become a political necessity in manycountries and healthcare systems all around the world 3. A largepopulation-based survey in Europe indicates that 51% of patients prefer shareddecision making, 23% prefer doctors to be the main decision maker followed by21% of patients having autonomy role in decision making 4. Thisshows the increasing desire of European patients to be more autonomous and play a responsible role indecision-making.

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Even though studies show an increasing trendand preference in the involvement of patients’ in decision-making, research sofar doesn’t explain the variation in participation observed. This varyingdifference in participation could be due to the need for different competencesfor the active participation of patients’. Competences includes the knowledge, ability to understand,express a choice, rationalize the choice for a reasonable outcome, appreciationof the situation and its consequences. 5. This ability of patients tounderstand and use information to promote and maintain good health is known ashealth literacy. Health literacy is defined as “The individuals capacity to obtain,process and understand the basic health information and services needed to makeappropriate health decisions 6. Nearly half of the European population (47%) hasinadequate and problematic health literacy skills 7.

Health literacy skill isthe strongest predictor of individual health status compared to age, income, employmentstatus, and education level or racial/ethnic group. 8 However, it is unknownif increased participation of patient involvement is due to the direct impactof higher health literacy rate and it could be one of the main limiting factorspreventing patients from participating in decision making.1.1 Relevance  This study has policy, practical and scientificrelevance. The policy relevance of this study is of great importance as therelationship between health literacy and patient involvement is becoming moreand more important in the Netherlands and other Western Europe countries.

Manylegal reforms like the Dutch Law of agreement to Medical Treatment (WGBO) andother reforms transforming the Dutch healthcare system such as the HealthInsurance Act and Act on Market Regulation in Healthcare are introduced to the systemto emphasise the role and responsibility of citizens in health and healthcare andto improve the patients position in the healthcare. .Also due to the increasein old age people and chronically ill patients in the Netherlands, there is aburgeoning pressure on the utilization healthcare resources .Policymakers in order to rationalize betweenhealthcare needs and demands and scare health care resources, strongly call forhealthcare interventions like patient self-management. However, patient self-managementrequires active participation of the patient to make choices to avoid illnessand stay healthy 9Research to understand the impact of healthliteracy among patients’ is important as increased patients’ participation inhealthcare decision making have numerous advantages.

It enables individualself-determination and autonomy by allowing patients to actively take part intheir own health and make reasoned informed choices, increase patient knowledgeand satisfaction, better treatment adherence, and helps to choose treatmentwisely by taking fewer risks.10 Furthermore, it is needed fornon-maleficence, avoiding harm, and beneficence, balancing the benefits oftreatment against the risks and costs. 11 It is also needed to improve thequality of life and reduce costs 12The academic relevance of this study lies is inthe further understanding in the relationship between health literacy andpatient involvement in medical decision-making and the validation of itsinsights in the Dutch context.1.2 Goal, research question and researchobjectivesThe main aim ofthis paper is to study the relationship between health literacy and patientinvolvement in medical decision making, particularly to determine whether healthliteracy is an asset for the increased role of patients in decision-making.

This study tries to fill in the gap within the current study by offering someimportant insight in the potential value that health literacy could contributein the patients’ active participation in medical decision-making.In this study,the main research question that will be answered:What is therelationship between health literacy and patient involvement in medical decision-making?Sub-questions forthis research are:1.Whatis the impact of health literacy rate on patients’ participation in medicaldecision-making? 2.

To what extent does higher health literacy rate contribute to active participationof patients’ in medical decision-making. Does it add potential value or not?  Overall researchapproach /paradigm,A cross-sectionaldesign approach is used where an observational study is done among the sampleof healthcare users in the Netherlands. It is a survey-based study whichanalyses the data collected at the Dutch Health consumer panel of NIVEL,Netherlands. The central focus of this paper is to analyze the competences ofmedical decision-making and its impact on the increased level of participationamong the sample group.