Those who currently participate in healthcare decision making tend to be younger, female, educated, articulate patients of higher socioeconomic status.5 While the range of methods for patient communication in clinical settings has grown, most are dependent on higher levels of literacy and numeracy. There is relatively little published evidence concerning attempts to encourage people from lower literacy backgrounds to make informed health decisions through the use of different types of decision support materials or approaches.6,7
Differences in literacy and numeric skills lead to marked variation in an individual's ability to obtain relevant health information, and in their opportunity and capability to apply that information in interactions with health professionals and services.8 It follows that without careful implementation, current government policies may inadvertently exacerbate existing inequalities in health by favouring those already advantaged as a consequence of their education and basic skills.9 It is possible that this is one of the reasons why, despite an overall increase in health in the UK population, the ‘inequalities gap’ between the most and least advantaged in society is widening.10