Health Literacy in Patients with Dupuytren's: a Cross-Sectional Study
Mélissa Roy, MDCM; Karen Okrainec, MD, MSc, FRCPC; Christine B Novak, PT, PhD; Herbert P von Schroeder, MD, MSc, FRCSC; David R Urbach, MD, MSc, FRCSC, FACS; Steven J McCabe, MD, MS
University of Toronto Toronto, ON, Canada
Introduction: Dupuytren's contracture is a hand pathology that has significant impact on patients' quality of life. Health literacy (HL) has been defined as the degree to which patients can understand and act upon health information. The importance of health literacy in health care and its relationship with clinical outcome are well-recognized concepts. Limited HL has negative effects on health status, risk of hospitalization, patient satisfaction and care of chronic diseases. It is therefore relevant to gain a better understanding of the prevalence and degree of HL to improve the delivery of medical care and outcomes. Our aim is to measure health literacy levels in patients diagnosed with Dupuytren's contracture.
Methods: This cross-sectional study was performed at a tertiary care hand program outpatient clinic. All patients with a clinical diagnosis of Dupuytren's and fluent in English were eligible for the study. The Newest Vital Sign (NVS) is a rapid, validated, reliable screening tool previously used in the hand surgery patient population and was selected to identify limited HL. The latter was defined as a marginal or inadequate score equivalent to 3 or less out of 6.
Results: Of the 86 patients recruited, 84 completed the study questionnaires. The participants were on average 64.3 (±11.6) years old and included 57 men and 27 women. Overall, English was the preferred language to communicate health care needs in 80 (95.2%) patients. 68 (81.0%) patients had a diploma or completed graduate studies, 12 (14.3%) had completed high school and 4 (4.8%) did not complete high school. A total of 35 patients (41.7%) had limited HL and 49 (58.3%) had adequate HL. The limited HL group displayed significant differences compared with the adequate HL one in terms of age (66.1±12.3 years versus 63.0±11.0 in the adequate group; p<0.001) and income (the total family income prior to taxes last year being <60,000$ in 34.8% for the limited group and 7.9% for the adequate one; p=0.02). Gender, education level, presence of other medical conditions and current employment status were not significantly different between both groups.
Conclusions: Our study demonstrates a high prevalence of limited health literacy within the Dupuytren's patients population (42%). Other mitigating factors such as older age and low income may be important to consider among individuals with limited HL. This suggests a great need for clear communication with Dupuytren's patients and the potential gain from patient-education support tools.
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