The remaining three themes were also found to align with health literacy as defined by Nutbeam [44] and reflected the role played by the decision coach to support health literacy: Theme 5 (“I need to fully participate in making my decisions”) reflected the participants’ functional health literacy skill, reflected by their ability to engage in the decision making process and use the adapted OPDG with the decision coach; theme 6 (“I need to explore my decision in a way that is meaningful
to me”) identified participants’ interactive health literacy skill by using the adapted OPDG with coaching to foster
decision making processes they defined as meaningful;and theme 7 (“I need respect for my traditional learning and communication style”) relates to participants’ critical literacy skills and their awareness of contextual features factoring into their decision making process when using the adapted OPDG with decision coaching. In our study the addition of decision coaching addressed health literacy skills (functional, interactive, critical), leading to a better understanding and use of information.