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Health literacy and patient outcomes in acute care surgery: A systematic review
Jackson G Burns1, Mokunfayo O Fajemisin, Stephanie Martinez Ugarte
1From the Department of Surgery (J.G.B., M.O.F., S.M.U., L.S.K., K.M.M.), Center for Surgical Trials and Evidence-based Practice (M.O.F., S.M.U., L.S.K., K.M.M.), and Center for Translational Injury Research, Department of Surgery (M.O.F., S.M.U., L.S.K., K.M.M.), McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, Texas.
Background:
Health literacy (HL) is the ability to understand and use information for health decisions. Low HL is associated with poor surgical outcomes and disparities in care, but its impact on acute care surgery (ACS) populations is poorly understood. Health literacy is important in ACS populations where patients have complex medical needs, limited preoperative communication, and significant social vulnerabilities. We performed a systematic review aimed at assessing HL-related outcomes in ACS populations, evaluating the quality of existing evidence and examining equity-related variable collection using the PROGRESS+ framework.
Methods:
PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were queried up to May 25, 2023, and studies evaluating HL in ACS populations were included. Two reviewers independently extracted relevant articles and performed risk of bias analyses. Studies evaluating the association between HL and patient outcomes in ACS populations were included. Equity-related reporting within studies was evaluated with the PROGRESS+ checklist. Of 1,369 abstracts identified, 10 studies remained after full-text review.
Results:
All included studies were observational with a median patient enrollment of 128 (interquartile range, 58-199). Low HL was associated with worse knowledge of injuries, decreased adherence, and poorer follow-up in seven studies (70%). Moderate to high risk of bias was found in six studies (60%). No study reported all 10 PROGRESS+ variables, and 4 studies (40%) reported 3 or fewer.
Conclusion:
While studies evaluating HL-related outcomes in ACS populations are few, many found adverse outcomes related to low HL. However, these studies frequently lacked validated measures, comprehensive variable reporting, and consideration of social factors, with many at a high risk of bias. High-quality research using standardized HL instruments and improved equity data collection is needed to inform interventions and improve outcomes.
Level Of Evidence:
Systematic Review/Meta analyses; Level IV.
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