Improving Health Literacy Responsiveness: A Randomized Study on the Uptake of Brochures on Doctor-Patient Communication in Primary Health Care Waiting Rooms

Carel J. M. Jansen*, Ruth Koops van't Jagt, Sijmen A. Reijneveld, Ellen van Leeuwen, Andrea F. de Winter, John C. J. Hoeks

*Corresponding author for this work

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Presenting attractive and useful health education materials in waiting rooms can help improve an organization's health literacy responsiveness. However, it is unclear to what extent patients may be interested in health education materials, such as brochures. We conducted a three-week field study in waiting rooms of three primary care centers in Groningen. Three versions of a brochure on doctor-patient communication were randomly distributed, 2250 in total. One version contained six short photo stories, another version was non-narrative but contained comparable photos, and the third version was a traditional brochure. Each day we counted how many brochures were taken. We also asked patients (N = 471) to participate in a brief interview. Patients who consented (N = 390) were asked if they had noticed the brochure. If yes (N = 135), they were asked why they had or had not browsed the brochure, and why they had or had not taken it. Interview responses were categorized by two authors. Only 2.9% of the brochures were taken; no significant association with brochure version was found. Analysis of the interview data showed that the version with the photo narrative was noticed significantly more often than the non-narrative version or the traditional version. These results suggest that designing attractive and comprehensible health materials is not enough. Healthcare organizations should also create effective strategies to reach their target population.

Original languageEnglish
Article number5025
Number of pages17
JournalInternational Journal of Environmental Research and Public Health
Issue number9
Publication statusPublished - May-2021


  • health literacy responsiveness
  • organizational health literacy
  • health literacy
  • health information
  • health communication
  • waiting room
  • doctor-patient communication
  • photo story
  • fotonovela
  • narrative health communication

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