The effectiveness of photo stories about doctor-patient communication for older adults with limited health literacy.

he objective of this study is to evaluate a photo story intervention that supports and empowers patients with lower levels of health literacy in communicating with their General Practitioner. The effectiveness and appreciation of the intervention and its content will be evaluated in an RCT in the Netherlands, comparing the photo story intervention with a comparable traditional brochure. Primary outcomes include self-reported self-efficacy, behavioural intentions , evaluations and preference. Secondary outcomes include self-reported self-referencing, identification and transportation.

We expect higher participant scores for self-efficacy, behavioral intentions and evaluation for the photo story intervention compared to a comparable traditional brochure.

We expect that the majoritiy of participants prefers the photo story intervention over a comparable traditional brochure.

All outcomes are measures immediately after reading one of two brochures. Preference is measured at the end of the interview, after which the participant is exposed to the other condition (e.g. brochure) as well.



- domainspecific self-efficacies (e.g. Imagine you do not understand your doctor, is it easy for you to ask your doctor for an explanation?)

- domainspecific behavioral intentions (e.g. Imagine you do not understand your doctor, will you ask your doctor for an explanation next time?)

- evaluation (e.g. Did you find the booklet... difficult, interesting, instructive, etc.)

- preference (for one of two brochures; e.g. Which booklet did you like the most?)

- self-referencing (Self-referencing was measured using three items, adapted from an earlier study -De Graaf et al., 2014- e.g. Did the booklet make you think about yourself and your own conversations with your doctor?)

- identification (Identification was measured using eight items, adapted from another study -Moyer-Gusé & Nabi, 2010- e.g. Do you think you understand the main characters well?

- transportation (Transportation was assessed using seven items adapted from the same study as the identification items, e.g. While you were reading the booklet, did you only think about what was being told in the booklet?)

participants read a brochure on doctor-patient communication, either a photo story brochure (intervention) or a traditional brochure (control). The brochure consists of seven themes, based on the outcomes of focus group discussions and role play exercises with the target group.