The Impact of Health Literacy and Numeracy on Post-Transplantation Outcomes in Organ Transplant Recipients

Abstract

Background: Patients referred for solid organ transplant with limited health literacy have been shown to be less likely to have access to transplantation. We examined the association between health literacy, health numeracy and post-transplant clinical outcomes (i.e. graft failure, non-adherence, readmissions, self-efficacy, or mortality).
 Methods: A search of Medline for publications during the period January 1946 to July 2016 that examined health literacy, numeracy, and outcomes of transplant recipients. Titles and abstracts were independently examined by three reviewers for exclusion, and the full-text was then reviewed for inclusion.
 Results: Of 247 citations, 12 met inclusion criteria including one review article and five randomized control trials (RCTs). Health literacy of recipients was measured using Newest Vital Sign (NVS) (n=2), 
 Short Test of Functional Health Literacy in Adults (STOHFLA) (n=2), Rapid Estimate of Adult Literacy in Medicine (REALM-T) (n=1), and other knowledge questionnaires (n=5). Level of formal education was also examined as an assay of health literacy (n=3). Post-transplant outcomes were assessed through medication adherence (n=4), skin cancer incidence (n=2), graft loss (n=1), recipient mortality (n=1), kidney function (n=1), health-related quality of life (n=1), and self-efficacy (n=1). Eleven citations found limited health literacy to be associated with adverse post-transplant clinical outcomes, and one citation found no association between health literacy and non-adherence. Health numeracy was not studied in any of the citations.
 Conclusion: Health literacy is negatively associated with adverse post-transplant clinical outcomes. Future studies should analyze the association between health numeracy and clinical outcomes after transplant.