Résumé :
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[BDSP. Notice produite par INIST-CNRS 4JXKlR0x. Diffusion soumise à autorisation]. Health literacy deficits affect half the American patient population and are linked to poor health, ineffective disease management and high rates of hospitalization. Restricted literacy has also been linked with less satisfying medical visits and communication difficulties, particularly in terms of the interpersonal and informational aspects of care. Despite growing attention to these issues by researchers and policy makers, few studies have attempted to conceptualize and assess those aspects of dialogue that challenge persons with low literacy skills, i.e., the oral literacy demand within medical encounters. The current study uses videotapes and transcripts of 152 prenatal and cancer pretest genetic counseling sessions recorded with simulated clients to develop a conceptual framework to explore oral literacy demand and its consequences for medical interaction and related outcomes. Ninety-six prenatal and 81 cancer genetic counselors-broadly representative of the US National Society of Genetic Counselors-participated in the study. Key elements of the conceptual framework used to define oral literacy demand include : (1) use of unfamiliar technical terms ; (2) general language complexity, reflected in the application of Microsoft Word grammar summary statistics to session transcripts ; and, (3) structural characteristics of dialogue, including pacing, density, and interactivity. Genetic counselor outcomes include self-ratings of session satisfaction, informativeness, and development of rapport. The simulated clients rated their satisfaction with session communication, the counselor's effective use of nonverbal skills, and the counselor's affective demeanor during the session. Sessions with greater overall technical term use were longer and used more complex language reflected in readability indices and multi-syllabic vocabulary (measures averaging p<. sessions with a high proportionate use of technical terms were characterized by shorter visits readability demand slow speech speed fewer and more dense counselor speaking turns low interactivity the higher less interactive dialogue satisfied simulated clients lower their ratings counselors effectiveness affective demeanor relationships p informativeness also inversely related to just as print material can be made reader-friendly effective following established guidelines medical may patient-centered meaningful having providers monitor vocabulary language well structural characteristics interaction thereby lowering literacy routine dialogue. these consequences are important for all patients but even so restricted literacy.>
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