Health Literacy in Surgery

Abstract

Background: Low health literacy is associated with poor health outcomes in many chronic diseases and may have an important role in determining surgical outcomes. This study aims to comprehensively review the current state of science on adult health literacy in surgery and to identify knowledge gaps for future research.

Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was conducted to identify all studies from January 2002 through May 2018 that used validated instruments to assess health literacy among adult patients undergoing surgery. Studies were assessed for quality using the Newcastle-Ottawa scale and evaluated on findings by their focus on identifying health literacy levels, understanding associations with surgical outcomes, and/or developing interventions to address low health literacy.

Key results: There were 51 studies on health literacy with data from 22,139 patients included in this review. Low health literacy was present in more than one-third of surgical patients (34%, interquartile range 16%-50%). The most commonly used validated instrument for assessment of health literacy in the surgical population was the Newest Vital Sign. Most studies were focused on identifying the prevalence of low health literacy within a surgery population (84%, n = 43). Few studies focused on understanding the association of health literacy to surgical outcomes (12%, n = 6) and even fewer studies developed interventions to address health literacy (4%, n = 2).

Discussion: Low health literacy is common among surgical patients. Important opportunities exist to better understand the role of health literacy in determining surgical outcomes and to develop more health literacy-sensitive models of surgical care. [HLRP: Health Literacy Research and Practice. 2020;4(1):e45-e65.] PLAIN LANGUAGE SUMMARY: Health literacy has not been well-studied in surgery but likely plays an important role. In this article, we reviewed all current research on health literacy in surgery to help us understand where we are at and where we need to go. We found that low health literacy is common and we need more ways to address it in surgery.

Figure 1.

Flowchart describing selection of included studies. PCI = percutaneous coronary intervention.

Figure 2.

Trends in studies on health literacy and health literacy assessment tools in surgery patient populations (January, 2002 to May, 2018). Asterisk denotes disease-specific health literacy measurement tool. BHLS = Brief Health Literacy Screener; DMCAT = Decision Making Capacity Assessment Tool; eHEALS = Electronic Health Literacy Scale; FCCHL = Functional Communicative Critical Health Literacy; FHL = Functional Health Literacy; GLS = Graphic Literacy Scale; HeLMS = Health Literacy Management Scale; HLQ = Health Literacy Questionnaire; HLS = Health Literacy Screen; HLS-EU = European Health Literacy Scale; LiMP = Literacy In Musculoskeletal Patients; NLAI = Nutrition Literacy Assessment Instrument; NVS = Newest Vital Sign; REALM = Rapid Estimate of Adult Literacy; REALM-SF = Rapid Estimate of Adult Literacy in Medicine–Short Form; REALM-T = Rapid Estimate of Adult Literacy in Medicine–Transplant; REALM-VS = Rapid Estimate of Adult Literacy in Medicine–Vascular Surgery; SILS = Single Item Literacy Screener; SNS = Subjective Numeracy Scale; S-TOFHLA = Short Form Test of Functional Health Literacy in Adults; THLS = Taiwan Health Literacy Scale; TOFHLA = Test of Functional Health Literacy in Adults.

Figure 3.

Number of studies in health literacy from 2002 to 2018 by surgery subspecialty. ENT = ears, nose, throat.

Figure 4.

Different health literacy tools used by surgical specialties. Asterisk denotes disease specific health literacy measurement tool. BHLS = Brief Health Literacy Screener; DMCAT = decision making capacity assessment tool; eHEALS = Electronic Health Literacy Scale; FCCHL = functional communicative critical health literacy; FHL = Function Health Literacy; GLS = Graphic Literacy Scale; HeLMS = Health Literacy Management Scale; HLQ = Health Literacy Questionnaire; HLS = Health Literacy Screener; HLS-EUS = European Health Literacy Scale; LiMP = literacy in musculoskeletal patients; NLAI = Nutrition Literacy Assessment Instrument NVS = Newest Vital Sign; REALM = Rapid Estimate of Adult Literacy in Medicine; REALM-SF = Rapid Estimate of Adult Literacy in Medicine–Short Form; REALM-T = Rapid Estimate of Adult Literacy in Medicine–Transplant; REALM-VS = Rapid Estimate of Adult Literacy in Medicine–Vascular Surgery; S-TOFHLA = Short Form–Test of Function Health Literacy in Adults; SILS = Single Item Literacy Screener; SNS = Subjective Numeracy Scale; THLS = Taiwan Health Literacy Scale; TOFHLA = Test of Functional Health Literacy in Adults.