Augmenting Survey Completion and Rates of Returns for Patients with Low Literacy: A Randomized Control Trial of Telephone Follow-up

Keywords: Keywords, health, hospital, literacy, patient perspective, patient satisfaction, quality of care, survey




Aim.  The aim of the study was to determine the best possible means to achieve survey-item completion and high rates of return among low-literacy patients in regard to their perspectives on their health and quality of care post-hospital discharge.

Background.  The Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) is designed for individuals with a sixth-grade reading level.  One hospital, however, who had mailed the HCAHPS to discharged patients had low return rates and low item completion, which hospital personnel felt were due to low literacy levels.  

Design.  An experimental design was used to conduct this descriptive/comparative study.

Methods.  A total of 286 adult patients with low literacy volunteered to participate in the study.  The survey was disseminated in English or Spanish to individuals with low literacy, using two different modes of dissemination (mailing of the survey or telephone with follow-up reading/clarification of the survey items, if needed) to patients with low literacy who were hospital discharged.

Results.  Participants in the telephone group were 7.4 times more likely to complete the HCAHPS as compared to those who received the HCAHPS by mail.  These telephone participants also were more likely to complete all items compared to those who were mailed the survey.  

Discussion.  Assessing the health literacy of patients is important to ensure that HCAHPS is understood and that the survey is returned and items are completed.  Telephone dissemination should be considered for patients with low literacy.  

Keywords:  health, hospital, literacy, patient perspective, patient satisfaction, quality of care, survey 

Author Biography

Geraldine Cynthia Fike, California State University San Bernardino
DNP and a CCRN Assistant Professor at CSUSB for the nursing program. Previous experience as a Chief Nursing Officer for a 343-bed hospital. Expertise in ICU and ED.



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How to Cite
Fike, G. C. (2019). Augmenting Survey Completion and Rates of Returns for Patients with Low Literacy: A Randomized Control Trial of Telephone Follow-up. International Journal of Nursing, 5(2). Retrieved from
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