Prospective evaluation of low health literacy and its impact on outcomes in trauma patients

BACKGROUND Health literacy is an emerging focus of interest in public health and is evolving as an important component of national health policy. Low health literacy (LHL) is associated with poor outcomes. We aimed to identify factors associated with LHL and its relationship with health outcomes in trauma patients. METHODS We prospectively enrolled all adult trauma patients (age, > 18 years) in our analysis. Patients were surveyed at discharge and followed up at 4 weeks postdischarge. At discharge, patient's health literacy was assessed using the Short-Assessment of Health Literacy score. Low health literacy was defined as Short-Assessment of Health Literacy score less than 14. Patients were surveyed regarding their understanding of their injuries, treatment received, discharge instructions, and interaction with the physician. Four weeks postdischarge, all patients were inquired about clinic follow-up details and recovery. RESULTS We enrolled 140 patients, of which 70% were white. Mean age was 45 ± 20 years, and median Injury Severity Score was 10 (6-12). Overall, 24% (34) patients had LHL. There was no difference in the Injury Severity Score between LHL and health literate (HL) patients (p = 0.41). The LHL patients were more likely to be Hispanic-white (78% vs. 41%, p = 0.02), had lower socioeconomic status (91% vs. 51%, p = 0.01), uninsured (45% vs. 18%, p = 0.01), and were less likely to have graduated (0% vs. 49%, p = 0.01) compared with the HL patients. At discharge, both groups were satisfied with the time spent by a physician to explain the condition, however, the LHL patients were less likely to recall their injuries (p = 0.03) or how they were treated (p = 0.01). Patients with LHL had lower follow-up rates (p = 0.01) with no difference in the readmission rate (p = 0.71) compared with HL. CONCLUSION Every 1 in 4 trauma patients have LHL. Low health literacy is associated with poor understanding of injuries and treatment provided to them, leading to a decrease in compliance with discharge instructions and longer time to recovery. Identifying LHL in high-risk patients and developing appropriate intervention before discharge may help improve outcomes. LEVEL OF EVIDENCE Prognostic study, level I.