Translating risk into everyday language: health literacy, uncertainty, and patient decision-making in Indonesian clinical encounters
DOI:
https://doi.org/10.67490/ijml.v1i3.1045Keywords:
clinical encounters, health literacy, patient decision-making, risk communication, uncertaintyAbstract
Background: Risk communication in Indonesian clinical encounters remains shaped by unequal health literacy, medical uncertainty, professional authority, and uneven access to patient-centred explanation. Objective: This study examines how clinical risk, uncertainty, and treatment-relevant information are translated into everyday Indonesian language and how such translation enables or constrains patient decision-making. Method: This study applies qualitative discourse-pragmatic analysis to a 25-item corpus of public patient-facing health materials, consent-related texts, hospital education documents, and regulatory-context sources, coded through risk translation, uncertainty management, and decision-participation indicators. Results: Risk is most frequently translated as everyday manageability through chronic disease control, warning signs, treatment adherence, and professional escalation rather than abstract probability. Uncertainty is commonly organised through conditional boundaries, patient profiles, safety thresholds, and institutional procedures that make indeterminate clinical futures practically navigable. Patient decision-making appears as guided participation, where patients are encouraged to act responsibly but are less frequently invited to compare options, express preferences, or deliberate over alternatives. Implication: This study argues that health literacy should be understood as a communicative condition of clinical justice rather than merely as an individual patient capacity. Novelty: This study contributes an integrated Indonesian framework for analysing risk translation, uncertainty disclosure, and patient participation within one consistent discourse corpus.
Downloads
References
[1] D. Muscat, J. Smith, O. A. Mac, T. Cadet, A. Giguere, A. J. Housten, A. T. Langford, S. Smith, M.-A. Durand, and K. McCaffery, "Addressing health literacy in patient decision aids: An update from the International Patient Decision Aid Standards," Medical Decision Making, vol. 41, pp. 848-869, 2021.
[2] L. Murugesu, M. Heijmans, J. Rademakers, and M. Fransen, "Challenges and solutions in communication with patients with low health literacy: Perspectives of healthcare providers," PLOS ONE, vol. 17, 2022.
[3] R. Richter, J. Jansen, J. Van Der Kraan, W. Abbaspoor, I. Bongaerts, F. Pouwels, C. Vilters, J. Rademakers, and T. Van Der Weijden, "How inclusive are patient decision aids for people with limited health literacy? An analysis of understandability criteria and the communication about options and probabilities," Medical Decision Making, vol. 45, pp. 143-155, 2024.
[4] C. Bonner, L. Trevena, W. Gaissmaier, P. Han, Y. Okan, E. Ozanne, E. Peters, D. Timmermans, and B. Zikmund-Fisher, "Current best practice for presenting probabilities in patient decision aids: Fundamental principles," Medical Decision Making, vol. 41, pp. 821-833, 2021.
[5] M. J. Hashim, "Verbal probability terms for communicating clinical risk: A systematic review," The Ulster Medical Journal, vol. 93, pp. 18-23, 2024.
[6] E. Peters, P. K. J. Han, and C. N. Lee, "Communicating numeric risk information to patients," Journal of General Internal Medicine, vol. 40, pp. 3228-3231, 2025.
[7] M. Dahm, W. Cattanach, M. Williams, J. M. Basseal, K. Gleason, and C. Crock, "Communication of diagnostic uncertainty in primary care and its impact on patient experience: An integrative systematic review," Journal of General Internal Medicine, vol. 38, pp. 738-754, 2022.
[8] M. Khazen, E. Sullivan, J. A. Ramos, M. Mirica, M. Linzer, G. Schiff, and A. P. Olson, "Anatomy of diagnosis in a clinical encounter: How clinicians discuss uncertainty with patients," BMC Primary Care, vol. 23, 2022.
[9] N. M. Medendorp, A. Stiggelbout, C. Aalfs, P. Han, E. Smets, and M. Hillen, "A scoping review of practice recommendations for clinicians' communication of uncertainty," Health Expectations, vol. 24, pp. 1025-1043, 2021.
[10] N. Laila, "Medical jargon and patient comprehension: A linguistic analysis of informed consent practices in Indonesian hospitals," Indonesian Journal of Medical Linguistics, vol. 1, no. 1, pp. 13-25, 2026.
[11] I. L. Nazulpa, "Doctor-patient communication in rural Indonesia: A pragmatic study of directive speech acts in clinical consultations," Indonesian Journal of Medical Linguistics, vol. 1, no. 1, pp. 1-12, 2026.
[12] M. Nurtyas, "Language barriers in healthcare delivery: A sociolinguistic case study of multilingual patients in Indonesian urban clinics," Indonesian Journal of Medical Linguistics, vol. 1, no. 1, pp. 26-38, 2026.
[13] N. F. A. Anandasari, "Lost between languages and symptoms: Multilingual communication breakdowns and patient safety in Indonesian emergency care," Indonesian Journal of Medical Linguistics, vol. 1, no. 2, 2026.
[14] M. Shaban, "Can telemedicine hear the patient? Interactional asymmetry, symptom narration, and diagnostic uncertainty in Indonesian virtual consultations," Indonesian Journal of Medical Linguistics, vol. 1, no. 2, 2026.
[15] I. M. R. Islami, "From radiology report to patient narrative: Comparing expert- and AI-generated simplifications of Indonesian medical information," Indonesian Journal of Medical Linguistics, vol. 1, no. 2, 2026.
[16] J. Noordman, M. Oosterveld-Vlug, and J. Rademakers, "Shared decision making in clinical practice," European Journal of Health Communication, 2022.
[17] C. D. R. Himmelfarb, T. M. Beckie, L. Allen, Y. Commodore-Mensah, P. Davidson, G. Lin, B. Lutz, and E. Spatz, "Shared decision-making and cardiovascular health: A scientific statement from the American Heart Association," Circulation, vol. 148, pp. 912-931, 2023.
[18] C. Tang, A. Wang, and J. Yan, "Exploring motivations and resistances for implementing shared decision-making in clinical practice: A systematic review based on a structure-process-outcome model," Health Expectations, vol. 25, pp. 1254-1268, 2022.
[19] L. Birkelund, K. Dieperink, M. Sodemann, J. Lindell, K. Steffensen, and D. Nielsen, "Communicating without a shared language: A qualitative study of language barriers in language-discordant cancer communication," Journal of Health Communication, vol. 29, pp. 187-199, 2024.
[20] D. Cipta, D. Andoko, A. Theja, A. Utama, H. Hendrik, D. William, N. Reina, M. Handoko, N. Lumbuun, S. Papadakis, F. Anastasiou, D. Cipta, U. Ave, D. William, and M. Handoko, "Culturally sensitive patient-centered healthcare: A focus on health behavior modification in low and middle-income nations-insights from Indonesia," Frontiers in Medicine, vol. 11, 2024.
[21] D. Schillinger, N. D. Duran, D. McNamara, S. Crossley, R. Balyan, and A. Karter, "Precision communication: Physicians' linguistic adaptation to patients' health literacy," Science Advances, vol. 7, 2021.
[22] P. J. Fitzpatrick, "Improving health literacy using the power of digital communications to achieve better health outcomes for patients and practitioners," Frontiers in Digital Health, vol. 5, 2023.
[23] Y.-H. Tang, C.-T. Lin, and L.-C. Wu, "Understanding health literacy through patients' interpretation of health education leaflets: A thematic narrative review," Health Expectations, vol. 28, 2025.
[24] C. E. Holden, S. Wheelwright, A. Harle, and R. Wagland, "The role of health literacy in cancer care: A mixed studies systematic review," PLOS ONE, vol. 16, 2021.
[25] N. Toapanta, K. Salas-Gama, P. E. Pantoja, and M. J. Soler, "The role of low health literacy in shared treatment decision-making in patients with kidney failure," Clinical Kidney Journal, vol. 16, pp. i4-i11, 2023.
[26] H. Gray, T. Kittos, and D. M. Muscat, "'It's putting all the burden on the patient': A qualitative study of health literacy and shared decision-making in rural Australian communities," The Australian Journal of Rural Health, vol. 33, 2025.
[27] D. Sagi, S. Spitzer-Shohat, M. Schuster, L. Daudi, and M. Rudolf, "Teaching plain language to medical students: Improving communication with disadvantaged patients," BMC Medical Education, vol. 21, 2021.
[28] A. W.-Y. Chia, W. Teo, S. Acharyya, Y. Munro, and R. Dalan, "Patient-physician communication of health and risk information in the management of cardiovascular diseases and diabetes: A systematic scoping review," BMC Medicine, vol. 23, 2025.
[29] M. Shaker, "Shared decision-making, communicating risk, and food allergy in 2023," Journal of Food Allergy, vol. 5, pp. 3-9, 2023.
[30] A. S. Nugroho, "Verbal strategies for delivering bad news in oncology settings: A discourse-pragmatic approach," Indonesian Journal of Medical Linguistics, vol. 1, no. 1, pp. 39-51, 2026.
[31] J. Noordman, D. Noordam, J. Van Treeck, K. Prantl, P. Pennings, P. Borsje, M. Heinen, Y. Emond, E. A. Rake, G. Boland, and S. Van Dulmen, "Visual decision aids to support communication and shared decision-making: How are they valued and used in practice?" PLOS ONE, vol. 19, 2024.
[32] R. Richter, E. Giroldi, M. Jonkmans, J. Linskens, J. Rademakers, T. Van Der Weijden, and J. Jansen, "Option talk and risk communication with people with limited health literacy: A qualitative focus group study with key stakeholders," PLOS ONE, vol. 20, 2025.
[33] E. M. A. Geurts, C. Pittens, G. Boland, S. Van Dulmen, and J. Noordman, "Persuasive communication in medical decision-making during consultations with patients with limited health literacy in hospital-based palliative care," Patient Education and Counseling, 2021.
[34] J. S. Brooks, D. Muller, P. Campbell, A. T. Yu, B. G. Southwell, and M. Korin, "Teaching medical students to communicate risks like military intelligence analysts," Journal of Medical Education and Curricular Development, vol. 11, 2024.
[35] O. Lian, S. Nettleton, H. Grange, and C. Dowrick, "'I'd best take out life insurance, then.' Conceptualisations of risk and uncertainty in primary care consultations, and implications for shared decision-making," Health, Risk & Society, vol. 25, pp. 234-251, 2023.
[36] C. J. McMahon, M. Spooner, M. Sibbald, and M. Asoodar, "How do paediatricians manage comfort with uncertainty in clinical decision-making," Perspectives on Medical Education, vol. 13, pp. 527-539, 2024.
[37] R. Pel-Littel, M. Snaterse, N. M. Teppich, B. Buurman, F. V. Van Etten-Jamaludin, J. V. Van Weert, M. Minkman, and W. S. O. J. Reimer, "Barriers and facilitators for shared decision making in older patients with multiple chronic conditions: A systematic review," BMC Geriatrics, vol. 21, 2021.
[38] S. Jacobs, N. Davies, K. L. Butterick, J. L. Oswell, K. Siapka, and C. Smith, "Shared decision-making for children with medical complexity in community health services: A scoping review," BMJ Paediatrics Open, vol. 7, 2023.
[39] M. D. Van Eick, M. Binnendijk, H. V. Van Laarhoven, E. Smets, D. R. M. Timmermans, M. I. Van Berge Henegouwen, M. Melles, and O. Damman, "Less shared decision-making in consultations with lower health literate cancer patients: An observational mixed-methods study," Health Literacy and Communication Open, 2025.
[40] F. Funer, D. Schneider, N. B. Heyen, H. Aichinger, A. D. Klausen, S. Tinnemeyer, W. Liedtke, S. Salloch, and T. Bratan, "Impacts of clinical decision support systems on the relationship, communication, and shared decision-making between health care professionals and patients: Multistakeholder interview study," Journal of Medical Internet Research, vol. 26, 2023.
[41] C. Anyaegbuna, N. Steele, A. S. Liang, S. P., I. López, N. Chilukuri, K. Patel, K. Schulman, and J. H. Chen, "Artificial intelligence translation in healthcare: An urgent call for evidence-informed policy frameworks," BMJ Health & Care Informatics, vol. 33, 2026.
[42] N. Ahmed, S. Barlow, L. Reynolds, N. Drey, F. Begum, E. Tuudah, and A. Simpson, "Mental health professionals' perceived barriers and enablers to shared decision-making in risk assessment and risk management: A qualitative systematic review," BMC Psychiatry, vol. 21, 2021.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Wulan Kurnia Sari (Author)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Creative Commons Attribution 4.0 International License