Health Literacy among General and Plastic and Reconstructive Interest Population

Abstract

PURPOSE: The United States population has varying levels of health literacy (HL), which impacts patient care and clinical outcomes. However, little is known regarding the levels of HL among plastic and reconstructive surgery (PRS) patients compared to the general population. Therefore, this study aims to characterize HL of PRS patients and those interested in PRS. Moreover, this study aims to assess potential risk factors for low levels of HL among this population. METHODS: Amazon’s Mechanical Turk (MTurk) platform was used through October 2021 in an IRB-approved cross-sectional study to survey adults aged 18 or older residing in the U.S. Respondents self-reported their experience or interests in PRS, and their HL was assessed using the validated Chew’s Brief Health Literacy Screener. The cohort was broadly divided into two groups: (1) a no-PRS group containing participants with no background nor interest in PRS; and (2) a PRS group containing participants interested in or who previously had any PRS. Two subgroups were created with interest or experience in: (1) cosmetic surgery or (2) reconstructive surgery, and two additional subgroups with no interest or experience in: (3) cosmetic surgery, and (4) reconstructive surgery. Differences were evaluated using unpaired t-test and Fisher’s Exact tests for continuous and categorical variables, respectively. A multivariable logistic regression model was constructed to assess associations between levels of HL and socio-demographic characteristics. RESULTS: A total of 510 responses were included and analyzed in this study. 159 (69%) participants pertain to the PRS group and 351 (31%) to the non-PRS group. The mean age was 38.3 SD 13.0 and 39.0 SD 11.9 for the PRS and non-PRS groups, respectively. The non-PRS group had more males (60%) compared to the PRS group (43%). Most of the cohort self-identified as white (83% in the PRS group vs. 84% in the non-PRS group), and non-Hispanics (80% in the PRS group and 79% in the PRS group). Gender (<0.001) and ethnicity (p 0.048) showed a statistically significant difference between groups. Low levels of HL in the non-PRS and PRS groups showed no statistically significant difference (p 0.718). Notably, a statistically significant difference in HL levels was evidenced between non-reconstructive vs. reconstructive groups [0.29 OR, 95% CI (0.15 – 0.58), p <0.001), not seen between the non-cosmetic and cosmetic groups. Age [1.03 OR, 95% CI (1.01 – 1.04), p <0.001) and being non-Hispanic (0.60 OR, 95% CI (0.37 – 0.94, p 0.028) were significant. CONCLUSION: PRS patients’ HL is representative the U.S. population, with almost half of the participants having low HL. This highlights the importance of adequately assessing HL levels among PRS patients in both clinics and the hospital setting. Reconstructive patients had notably higher levels of HL than patients who had not undergone any reconstructive procedures, potentially indicating that experience in reconstructive surgery can improve HL. This could also partly be attributed to the inherent complexity of reconstruction necessitating increased patient education for informed consent. Our study encourages providers to assess patient HL with evidence-based techniques, such as the teach-back method, to provide appropriate level patient counseling.