An Evaluation of Health Literacy in Plastic Surgery Patients

INTRODUCTION

Health literacy encompasses a patient's literacy, comprehension and participation [1,2]. Low health literacy is associated with $106–$236 billion annually [3] in increased hospitalizations [4]. Currently, there is no data on levels of health literacy in plastic surgery patients. A recent survey of ASPS members demonstrated that plastic surgeons overestimate the health literacy of their patients [5]. Our goal is to assess health literacy of patients in academic plastic surgery practice and identify patients at risk for low health literacy.

METHODS

This study was approved by our Institutional Review Board. Patients who underwent surgical repair of facial trauma, hand trauma, and breast reconstruction were included. Separate questionnaires (Table 1) were created for each group. Questionnaires were collected during patients' first post-operative visits. The health literacy assessment was graded by comparing patient responses with their medical records, and a health literacy score was calculated for each patient. Logistic regression and the Student's t-Test were used for associations between demographic variables and mean health literacy scores.

RESULTS

Ninety-eight patients who underwent reconstruction from May 2014 to Feb 2015 were included. Table 2 summarizes demographic data. Mean health literacy scores were 2.0 ± 0.9 out of 3 for the facial trauma patients, 2.4 ± 1.5 out of 5 for hand trauma patients, and 3.8 ± 0.4 out of 4 for breast reconstruction patients. Table 3 shows that in the facial trauma and hand trauma groups, patients receiving a college education or higher had significantly higher mean health literacy scores. In the hand trauma group, there was a significant difference between mean health literacy scores of Medicaid patients [1.75 (SD: 1.66)] versus those on private health insurance [3.0 (SD: 1.0)] (P=0.0262). In the breast reconstruction group, the mean health literacy score of patients with Medicaid [3.25 (SD: 0.50)] was significantly lower than patients with private insurance [3.85 (SD: 0.37)] (p=0.005).

Table 1.

Conclusion: This study demonstrates that in an academic plastic surgery setting, patients with traumatic injuries, low education level, and public insurance may be at risk for low health literacy. Identifying risk factors for low health literacy will enable future efforts to enhance the quality and efficiency of healthcare.

Legend:

Table. 1 Sample questionnaires

Table 2. Demographic data

Table 3. Health literacy scores