Abstract: Universal Measures of Support Are Needed: A Cross-Sectional Study of Health Literacy in Dupuytren's Patients (Plastic Surgery The Meeting (September 28

Sunday, September 30, 2018: 11:15 AM

Melissa Roy, MDCM , Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

Karen Okrainec, MD, MSc, FRCPC , Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada

Christine B Novak, MSc, PhD , Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

Herbert P von Schroeder, MD, MSc, FRCSC , Divisions of Plastic and Reconstructive and Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada

David R Urbach, MD, MSc, FRCSC, FACS , Division of General Surgery, University of Toronto, Toronto, ON, Canada

Steven J McCabe, MD, MSc, FRCSC , Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada

Purpose: Health literacy (HL) represents the degree to which patients can understand and act upon health information.¹ An association between limited HL and poor health status, and all-cause mortality only partially illustrates the profound impact of HL on surgical patients.² Confronted with a disease that is chronic in nature, associated with frequent recurrences, and has numerous treatment options, Dupuytren’s patients’ understanding of medical information becomes crucial. Our aims were 1) to determine the prevalence of limited HL in Dupuytren’s patients and 2) to identify independent predictors of limited HL.

Methods: This cross-sectional study was performed in a tertiary care center. Patients with a clinical diagnosis of Dupuytren’s and self-reported fluency in English were included. The Newest Vital Sign (NVS), a rapid, validated, and reliable screening tool previously used in the hand surgery literature, was selected to measure HL.^3,4 Limited HL was defined as a score of ≤ 3 out of 6. An exploratory multivariable logistic regression model was used to identify possible predictors.

Results: A total of 185 patients met eligibility criteria and from those, 44% (n=82) had limited HL. Univariate analyses showed that patients with limited HL were more likely to be older (p=0.006), have a maternal language other than English (p=0.003), and have less education (p=0.002). Multivariable regression analysis revealed that being in the lower three income quintiles had a nearly 5-fold increase in the odds of having limited HL. Having immigrated increased the odds of limited HL by a factor of 3.6. Age, maternal language, education, comorbidities and employment were not independent predictors of limited HL.

Conclusions: Our study reveals a high prevalence of limited HL (44%) amongst Dupuytren’s patient. It is clear that universal measure of support would be of high value when communicating and caring for all Dupuytren’s patients and potentially in hand surgery and beyond.

References:

Institute of Medicine (US) Committee on Health Literacy, Nielsen-Bohlman L, Panzer AM, et al. Health Literacy: A Prescription to End Confusion. Washington (DC): The National Academies Press; 2004.
Berkman ND, Sheridan SL, Donahue KE, et al. Health literacy interventions and outcomes: an updated systematic review. Evid Rep Technol Assess. 2011:1–941.
Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3:514–522.
Shah LC, West P, Bremmeyr K, Savoy-Moore RT. Health literacy instrument in family medicine: the ‘newest vital sign’ ease of use and correlates. J Am Board Fam Med. 2010;23:195–203.

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