Limited health literacy in primary care physiotherapy: Does a physiotherapist use techniques to improve communication?

Objectives: Research shows that health professionals should adapt their communication when addressing patients with limited health literacy (HL). However, the extent to which physiotherapists apply recommended commu-nication techniques is unclear.Methods: We conducted a two phase mixed-method study, first holding focus group interviews among patients and experts on communication to explore the need for adjusted communication in physiotherapist-patient interaction. Second, we manually coded audio recordings of primary care physiotherapy consultations to investigate the extent to which physiotherapists applied these recommended communication techniques, and adjusted their communication towards patients with lower education.Results: Focus group interviews identified four categories of communication elements: the teach-back method, medical jargon explanation, summarizing patient's narratives, and checking patient's understanding. In 50 audio recordings we identified 2670 clauses. We report limited use of the recommended communication techniques; the teach-back method was used in 2% of consultations (95%CI: 0.4%-10.5%) while medical jargon explanation was used in 84% (95%CI: 71.5%-91.7%). Mixed effects logistic regression models showed no association be-tween lower education and communication techniques.Conclusion: Although physiotherapists need to adjust their communication to patients with lower education, they rarely apply the recommended communication techniques. Practice implications: Knowledge about limited HL among physiotherapists needs to be increased.