The Relationship Between Functional Health Literacy and Adherence to Emergency Department Discharge Instructions Among Spanish-Speaking Patients

Abstract

Adherence to emergency department (ED) discharge instructions among immigrant Spanish-speaking populations in the United States is suboptimal. Our objectives were to: (1) investigate associations between functional health literacy (FHL) and ED discharge instruction adherence in Spanish-speaking populations, and (2) compare the ED adherence rates of Spanish speakersto English speakers. Using a matched cohort design, the FHL of adult native Spanish speakers in a tertiary care ED was assessed using the Test of Functional Health Literacy of Adults in Spanish (TOHFLA-S). Gender-matched and age-matched native English speakers were assessed using TOHFLA. TOFHLA scores range from 1 to 100 with adequate FHL cutoff at 74. Excluded patients were those aged less than 19 years, unwilling, prisoners, institutionalized, extremely ill, with a psychiatric complaint, in receipt of nonspecific instructions for follow-up, or with poor vision. A second interview assessed adherence with follow-up appointments and filling prescriptions. Fifty matched pairs were enrolled. Spanish speakers were less likely to understand discharge instructions (Spanish speakers, 78%; English speakers, 94%; p < .0001) or to keep follow-up appointments (Spanish speakers, 46%; English speakers, 83%; p <.0001). TOFHLA for Spanish speakers averaged 62 vs 93 for English speakers (p < .0001). FHL was associated with understanding of and adherence to discharge instructions for Spanish speakers. Further, Spanish speakers reported lack of understanding as a primary reason for nonadherence. Spanish-speaking patients were less likely to comply with discharge instructions and scored lower on a test of FHL than English-speaking patients. Poor adherence to ED discharge instructions was associated with lower FHL scores for our Spanish-speaking population. Alternative methods of providing discharge instructions to this population of patients should be explored.