Health Literacy Among Surgical Patients: A Systematic Review and Meta‐analysis

Abstract

Health literacy is the extent to which patients are able to understand and act upon health information. This concept is important for surgeons as their patients have to comprehend the nature, risks and benefits of surgical procedures, adhere to perioperative instructions, and make complex care decisions about interventions. Our review aimed to determine the prevalence of limited health literacy of the surgical patient population. A search of MEDLINE and EMBASE was performed from inception until January 14th 2017 for experimental and observational studies reporting surgical patients' health literacy measurement. Overall pooled proportion of surgical patients with limited health literacy was calculated using a random-effects model and methodologic quality was assessed. A total of 40 studies representing 18,895 surgical patients were included in our quantitative synthesis. Pooled estimate of limited health literacy was 31.7% (95%CI 24.7-39.2%, I 99.0%). There was low risk of bias among the majority of the 51 studies included in the qualitative synthesis. Statistical heterogeneity could not be fully accounted for by methodologic quality or patient and surgical characteristics. However, some of the heterogeneity was accounted by measurement tool [combined proportions with the REALM and NVS of 35.6 (95%CI 31.5-39.9, I 73.0%)]. A number of different health literacy measurement tools were used (19 overall). Our review demonstrates a high prevalence of limited health literacy among surgical patients with considerable heterogeneity. Our findings suggest the importance of recognizing and addressing surgical patients with limited health literacy and the need for standardization in measurement tools.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

“…Cognitive function, language barriers, health literacy, and other social determinants of health also significantly influence postoperative pain management and recovery [51,[80][81][82]. Validated health literacy assessments have been applied to surgical populations [83][84][85][86][87]. Prospective identification of these challenges, including the application of standardized cognitive and psychosocial assessments, can allow for appropriate preoperative referral, patient optimization, and future study of risk mitigation strategies [15,18,52,75,78,80,88].…”

Factors influencing day surgery patients’ quality of postoperative recovery and satisfaction with recovery: a narrative review

“…Subgroups with increased risk of limited HL include older persons (Berkman et al, 2011) and people with low income (Jessup et al, 2017) and a low educational level (Protheroe et al, 2017). The results from a meta-analysis on the prevalence of HL among surgical patients ( n = 18,895) showed that 31.7% had limited HL (Roy et al, 2019). Similarly, a study reported that 39.4% of day surgery patients had limited HL skills, which were found to be associated with poorer quality of postoperative recovery (Halleberg Nyman et al, 2018).…”

Learning What I Need to Know: Experiences of Rural Cardiac Surgery Patients

“…There are, however, a few closely related studies about the health literacy needs of surgical patients. One systematic review and meta-analysis reported heterogeneity in health literacy among surgical patients (Roy et al, 2019). A qualitative systematic review indicated a possible association between low health literacy and low comprehension of surgical procedures, and poor adherence to preoperative instructions (Oliveira, McCarthy, Wolf, & Holl, 2015).…”