Abstract: One Third of Plastic and Surgical Patients Have Limited Health Literacy: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Health literacy has been defined as the extent to which patients are able to understand and act upon health information.1 Limited or inadequate health literacy has been shown to have a negative impact on patient satisfaction, clinical outcomes, and risk of hospitalization.2,3 This complex concept is of high importance for surgeons as their patients have to comprehend the nature, risks and benefits of surgical procedures, adhere to strict perioperative rules, and make complex care decisions about interventions or lack thereof.4 The aim of this review was to evaluate the prevalence of reported inadequate health literacy levels and the measurement tools used in the plastic and surgical patient populations. METHODS: A systematic review and meta-analysis was conducted according to the Cochrane guidelines. Relevant studies reporting health literacy measurements in surgical patient populations were identified from MEDLINE and Embase published from inception until January 14th2017. Two-stage screening and data extraction were performed by two independent reviewers. Data on study design, sample size, patient population, health literacy measurement tool, and prevalence of inadequate health literacy were extracted and analyzed. RESULTS: A total of 934 abstracts were screened, 103 articles were reviewed and 57 met inclusion criteria. Five randomized controlled trials, 8 prospective cohorts, 36 cross-sectional studies were included including only 11 (19.0%) studies published before 2010. 18,894 surgical patients were included in these studies and the prevalence of inadequate health literacy was 32.8% (range 2.8–80.7%, 95%CI: 25.9–40.1). Fifteen (26.3%) studies did not present health literacy measurement results. Numerous health literacy measurement tools were used (16 validated, 6 non-validated). Only five studies pertained to the hand surgery and one to the plastic surgery literature. CONCLUSION: Our review demonstrates a high prevalence of limited health literacy within the plastic and overall surgical patient populations. While there is considerable variation in measurement tools currently being used, our review suggests a great need for patient-education and decision-aid tools for surgical patients with limited health literacy. Reference Citations: 1. Nielsen-Bohlman L, Institute of Medicine. Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press; 2004. 2. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K, et al. Health literacy interventions and outcomes: an updated systematic review. Evid Report Technology Assess. 2011;199:1–941. 3. Komenaka IK, Nodora JN, Machado L, Hsu CH, Klemens AE, Martinez ME, et al. Health literacy assessment and patient satisfaction in surgical practice. Surgery. 2014;155:374–383. 4. McCaffery KJ, Smith SK, Wolf M. The challenge of shared decision making among patients with lower literacy: a framework for research and development. Med Decis Making. 2010;30:35–44.