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

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.