In decision-making is the basic principle of autonomy and

various clinical settings and hospitals, it is seen that there is a large
variation in patient’s involvement in medical decision-making. Patient
participation in medical decision-making is the basic principle of autonomy and
process of informed consent. In a
General Social survey conducted at US in 2002, it was found that 52% of the
population preferred paternalism, to leave the final decision to their doctors.
However, about 96% of participants wanted a shared decision- making approach
where they could discuss and share their opinions about clinical management of
their disease with doctors 1.

In the New England Journal of Medicine 2012,
Charles Bardes states that over the half past century, patient-centered care is
the main and next focus of general trend in the medical profession 2.
Patients’ opinions and involvement has now become a political necessity in many
countries and healthcare systems all around the world 3. A large
population-based survey in Europe indicates that 51% of patients prefer shared
decision making, 23% prefer doctors to be the main decision maker followed by
21% of patients having autonomy role in decision making 4. This
shows the increasing desire of European patients to be more autonomous and play a responsible role in

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Even though studies show an increasing trend
and preference in the involvement of patients’ in decision-making, research so
far doesn’t explain the variation in participation observed. This varying
difference in participation could be due to the need for different competences
for the active participation of patients’. Competences includes the knowledge, ability to understand,
express a choice, rationalize the choice for a reasonable outcome, appreciation
of the situation and its consequences. 5. This ability of patients to
understand and use information to promote and maintain good health is known as
health literacy. Health literacy is defined as “The individuals capacity to obtain,
process and understand the basic health information and services needed to make
appropriate health decisions 6. Nearly half of the European population (47%) has
inadequate and problematic health literacy skills 7. Health literacy skill is
the strongest predictor of individual health status compared to age, income, employment
status, and education level or racial/ethnic group. 8 However, it is unknown
if increased participation of patient involvement is due to the direct impact
of higher health literacy rate and it could be one of the main limiting factors
preventing patients from participating in decision making.

1.1 Relevance  

This study has policy, practical and scientific
relevance. The policy relevance of this study is of great importance as the
relationship between health literacy and patient involvement is becoming more
and more important in the Netherlands and other Western Europe countries. Many
legal reforms like the Dutch Law of agreement to Medical Treatment (WGBO) and
other reforms transforming the Dutch healthcare system such as the Health
Insurance Act and Act on Market Regulation in Healthcare are introduced to the system
to emphasise the role and responsibility of citizens in health and healthcare and
to improve the patients position in the healthcare. .Also due to the increase
in old age people and chronically ill patients in the Netherlands, there is a
burgeoning pressure on the utilization 
healthcare resources .Policymakers in order to rationalize between
healthcare needs and demands and scare health care resources, strongly call for
healthcare interventions like patient self-management. However, patient self-management
requires active participation of the patient to make choices to avoid illness
and stay healthy 9

Research to understand the impact of health
literacy among patients’ is important as increased patients’ participation in
healthcare decision making have numerous advantages. It enables individual
self-determination and autonomy by allowing patients to actively take part in
their own health and make reasoned informed choices, increase patient knowledge
and satisfaction, better treatment adherence, and helps to choose treatment
wisely by taking fewer risks.10 Furthermore, it is needed for
non-maleficence, avoiding harm, and beneficence, balancing the benefits of
treatment against the risks and costs. 11 It is also needed to improve the
quality of life and reduce costs 12

The academic relevance of this study lies is in
the further understanding in the relationship between health literacy and
patient involvement in medical decision-making and the validation of its
insights in the Dutch context.

1.2 Goal, research question and research

The main aim of
this paper is to study the relationship between health literacy and patient
involvement in medical decision making, particularly to determine whether health
literacy 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 some
important insight in the potential value that health literacy could contribute
in the patients’ active participation in medical decision-making.In this study,
the main research question that will be answered:

What is the
relationship between health literacy and patient involvement in medical decision-making?

Sub-questions for
this research are:

is the impact of health literacy rate on patients’ participation in medical

To what extent does higher health literacy rate contribute to active participation
of patients’ in medical decision-making. Does it add potential value or not?


Overall research
approach /paradigm,

A cross-sectional
design approach is used where an observational study is done among the sample
of healthcare users in the Netherlands. It is a survey-based study which
analyses the data collected at the Dutch Health consumer panel of NIVEL,
Netherlands. The central focus of this paper is to analyze the competences of
medical decision-making and its impact on the increased level of participation
among the sample group.


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