The health literacy of hospitalized trauma patients: We should be screening for deficiencies

Abstract

Although the impact of health literacy (HL) on trauma patient outcomes remains unclear, recent studies have demonstrated that trauma patients with deficient HL have poor understanding of their injuries, are less likely to comply with follow-up, and are relatively less satisfied with physician communication. In this study, we sought to determine if HL deficiency was associated with comprehension of discharge instructions. In this prospective study, hospitalized trauma patients underwent evaluation of HL prior to discharge. Newest Vital Sign (NVS) instrument was used to score HL as deficient, marginal, or proficient. Three days postdischarge, patients were telephonically administered a six-point scored questionnaire regarding comprehension of discharge instructions. A general linear model was used to determine the association between HL and comprehension of discharge instructions. Sixty-three patients were administered both NVS and discharge instruction questionnaire. Ten (15.9%) patients scored as deficient in HL on the NVS screen, 16 (25.4%) as marginally proficient, and 37 (58.7%) as proficient. The HL proficiency significantly predicted follow-up score with increasing proficiency associated with higher scores on the discharge comprehension assessment (p < 0.001). Adjusted mean scores (± SE) for deficient, marginal, and proficient patients were 2.8 ± 0.5, 3.2 ± 0.4, and 4.7 ± 0.2. Post hoc comparisons demonstrated significant differences between proficient with marginal proficiency (p = 0.002) and deficient proficiency (p = 0.001). Performance on bedside test of HL among trauma inpatients predicted ability to comprehend instructions following hospital discharge. This study supports the value of HL screening prior to discharge. The HL-deficient patients may benefit from a transitional care program to improve comprehension of discharge instructions after leaving the hospital. Therapeutic/Care Management, level III.