Impact of Health Literacy on Self-Reported Health Outcomes in Spine Patients

Abstract

Study Design. Cross-sectional survey study. Objective. The aim was to determine if health literacy level is associated with patient-reported outcomes and self-reported health status among patients presenting to an academic outpatient spine center. Summary of Background Data. Patient reports are critical to assessing symptom severity and treatment success in orthopedic spine patients. Patient-reported outcome measures (PROMs) are important instruments commonly used for this purpose. However, the influence of patient health literacy on PROMs has not yet been given much consideration in spine literature. Materials and Methods. Consecutive English-speaking patients over the age of 18 years and new to our clinic verbally completed the Newest Vital Sign health literacy assessment tool and a sociodemographic survey, including self-reported health status. In addition, seven Patient-Reported Outcomes Measurement Information System scores were extracted from patient records. Regression modeling was performed with PROMs considered as dependent variables, health literacy level as the primary predictor, and all other factors (age, sex, race, ethnicity, native English speaker, highest educational degree, grade-level reading, marital status, employment status, annual household income, and type of insurance) as covariates. Results. Among the 318 included patients, 33% had limited health literacy. Adjusted regression analysis demonstrated that patients with limited health literacy had worse PROM scores across all seven domains (Physical Function: P=0.028; Depression: P=0.035; Global Health—Physical: P=0.001; Global Health—Mental: P=0.007; Pain Interference: P=0.036; Pain Intensity: P=0.002; Anxiety: P=0.047). In addition, patients with limited health literacy reported worse self-reported health status (P<0.001). Conclusions. Spine patients with limited health literacy have worse baseline PROM scores confounders and report worse general health. Further investigations are necessary to elucidate if limited health literacy is a marker or the root cause of these disparities. Findings from this study urge the consideration of patient health literacy when interpreting PROMs as well as the implications for patient assessment and discussion of treatment options.

Health Literacy in Orthopaedics

“…However, a relationship between health literacy and self-reported health outcomes among new patients seen at an outpatient orthopaedic spine center has previously been demonstrated by Lans et al 4 When controlling for multiple confounding variables, their analysis revealed that patients with limited health literacy reported markedly worse baseline Patient-reported Outcome Measure Scores across seven different domains (Physical Function, Depression, Global Health-Physical, Global Health-Mental, Pain Interference, Pain Intensity, and Anxiety).…”

“…3 Limited health literacy is associated with worse overall physical and mental health, inadequate self-management of chronic disease, higher mortality, higher rates of hospitalization, greater healthcare expenditure, and worse patientreported outcome measure scores. [4][5][6][7][8][9] The 2003 US Department of Education National Assessment of Adult Literacy survey found that 36% of the adult US population (approximately 87 million adults) had basic or below basic health literacy levels. 10 Unlike the intermediate literacy and proficiency literacy levels defined by the survey, basic literacy and below basic literacy levels are considered insufficient for function within the healthcare setting.…”

Are Social Deprivation and Low Traditional Health Literacy Associated With Higher PROMIS CAT Completion in Orthopaedic Surgery?

“…Hence, identifying mechanisms to mitigate barriers of health literacy will be an important consideration for the physical collection aspect of clinically implementing PROMIS in orthopaedic settings both for clinical care and future outcomes research. This is critical as studies have shown that patients with low health literacy have worse patient-reported outcome scores within orthopaedic surgery, yet it is challenging for clinicians to recognize low health literacy in patients [18,21,37]. Furthermore, there is a paucity of research on health literacy in the context of orthopaedic surgery outcomes even though prior work has shown that limited musculoskeletal health literacy is more common than general health literacy, especially among patients with lower levels of education and minority identities [22,29].…”

Readability of Patient-Reported Outcomes in Spine Surgery and Implications for Health Literacy

“…4 Limited ability to understand reading materials, patient education, discharge instructions, and informed consent all adversely affect the continuum of care. [5][6][7][8][9] This costs the American health system an estimated 106 to 208 billion dollars annually. 10 Despite widespread inadequate health literacy, this limitation in health care is not routinely evaluated by health care practitioners.…”

“…11 Moreover, these patients were significantly more likely to report worse baseline PROMs and general health. 6 Although the literature is limited, the majority of PROM questionnaires are written above the average reading level of the targeted population. 12,13 Readability is an important component of health literacy.…”