Evaluating the impact of easy-to-understand patient letters after discharge on patients’ health literacy: a randomized controlled study

TL;DR

This study found that easy-to-understand patient letters after hospital discharge improved health literacy in heart patients.

Contribution

It demonstrates that automatically generated patient letters can enhance post-discharge health understanding in cardiology patients.

Findings

Patients receiving easy-to-understand letters had significantly higher health literacy scores.

Over 90% of patients found the letters helpful, comprehensible, and informative.

Qualitative feedback showed positive attitudes and suggestions for content improvements.

Abstract

More than half of the German population has considerable difficulties in understanding health information, reflecting limited health literacy, which is associated with poorer health outcomes. Personalized, automatically generated, easy-to-understand discharge letters (patient letters) are designed to improve patients’ comprehension of medical information after hospital discharge. This study investigated whether these letters improve health literacy in cardiologic patients and explored their perceptions.

This randomized controlled study included 738 patients discharged from a heart center in Dresden, Germany. The control group (CG; n = 375) received a conventional discharge letter only, whereas the intervention group (IG; n = 363) additionally received a software-generated patient letter by post. Five to nine days later, participants received a sociodemographic survey and the HLS-EU-Q16 health literacy questionnaire. IG participants additionally evaluated the patient letter, and n = 15 were interviewed qualitatively to gain deeper insights.

Post-intervention, IG participants had significantly higher health literacy than CG participants (p = .002, Mann-Whitney U test). Over 90% of IG participants rated the patient letter as helpful, comprehensible and informative. Qualitative interviews revealed a largely positive attitude toward patient letters, along with some suggestions for content improvement.

Patient letters were associated with higher post-intervention health literacy in cardiologic patients and were well received. These results suggest that broad implementation of patient letters may benefit both patients and healthcare providers by enhancing patients’ understanding of medical information regarding diagnoses and treatment, potentially contributing to improved health-related outcomes.

The study was retrospectively registered in the German Clinical Trials Register on December 13, 2024 under the number DRKS00035706.

The online version contains supplementary material available at 10.1186/s12913-025-13464-4.

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