Hypothesis / aims of study
To examine the association between health literacy and patient satisfaction with clinical consultation. The population under investigation was women attending for consultation with any clinician in an obstetrics/gynaecology outpatient hospital setting.
The association between health literacy and patient satisfaction has been examined by previous authors, with inconsistent results. Health literacy refers to the ability to read, understand and interpret written text (print literacy), understand measurements and numbers (numeracy) and be able to speak and understand the spoken word (oral literacy) (1). Poor health literacy is a common barrier to effective healthcare. People with low health literacy are known to have poorer health outcomes than those with higher health literacy.
Study design, materials and methods
A cross-sectional observational study was undertaken. Women aged 18 years or older, who spoke English fluently and were attending for consultation in an obstetrics/ gynaecology clinic were eligible for inclusion. Women with severe vision or cognitive impairment, those who declined to provide written consent or used an interpreter were ineligible. A sample size of 222 women was calculated. The exposure measured was health literacy and the outcome measured was patient satisfaction with consultation.
Outpatient areas included Urogynaecology Clinic, Well Women’s Clinic, Pre-Admission Clinic and Physiotherapy Clinic. Study measures were Short Assessment of Patient Satisfaction (SAPS), Rapid Estimate of Adult Literacy in Medicine–Revised (REALM-R) and Australian Pelvic Floor Questionnaire. Study measures had been extensively used and had sound psychometric properties. Short Assessment of Patient Satisfaction scores were categorised into satisfied/highly satisfied and dissatisfied/highly dissatisfied. Health literacy was determined immediately prior to consultation. Low health literacy was defined as a REALM-R score of equal to or less than six. Patient satisfaction was determined immediately following consultation. SAPS scores were categorised into satisfied/highly satisfied (SAPS score of 21 or more) and dissatisfied/highly dissatisfied (SAPS score of 20 or less), as described by Goyal, (2018) (2). Additionally, we collected the following potential confounders - age, parity, body mass index (BMI), education, work status, clinic attended, clinician and consultation duration.
Results
Recruitment occurred between September-December 2018. There were 589 women booked to attend clinics involved, with 277 offered participation. Of the 277 offered inclusion, 31(11%) were ineligible and 24(8.6%) declined participation. Two hundred and twenty-two women were enrolled. One woman withdrew. Participants included women from Urogynaecology Clinic (n=120,54%), Well Women’s Clinic (n=46,21%), Physiotherapy Clinic (n=39,18%) and Pre-Admission Clinic (n=17,8%). Women consulted with doctors (n=99), nurses (n=83) and physiotherapists (n=40).
In our unadjusted model mean age was 54 years (range 19-93), mean BMI was 28 (range 16-48), mean school attendance was 14 years (range 4-25). The mean REALM-R score was 6.95 (range 0-8), with 56 (25.4%) scores indicating low health literacy (REALM-R score of six or less). SAPS scores were high, with a mean score of 24.6 (range 2-28). Patient satisfaction relating to type of clinician varied, with scores high for all clinicians. Nurses had a mean score of 26 (range 19-28), physiotherapists 26 (range 19-28) and doctors 24 (range 2-28). Satisfaction with clinics was high with Urogynaecology Clinic score 24 (range 2-28), Physiotherapy Clinic 26 (range 19-28), Well Women's Clinic 26 (range 11-28) and Pre-Admission Clinic 25 (range 19-28). Two hundred and nine (94%) women completed all study measures. In our adjusted model, data were divided into REALM-R pass and REALM-R fail (Table 1 - Demographic and clinical characteristics of participants, by health literacy group) (Table 1).
Overall, women who passed the REALM-R test were younger, more highly educated and were more likely to work outside the home than women who failed the test. Simple linear regression and multiple regression analyses were performed. This study failed to identify an association between patient satisfaction and health literacy (p = .61).
Interpretation of results
This study population of adult women attending for obstetrics/gynaecological care is not seen to differ from other study populations. Clinical variables described in recent publications were similar to our study population in terms of age, BMI and parity. In our study, women had high levels of education and literacy levels. Satisfaction scores were high for all clinics and clinicians, regardless of health literacy. This study was unable to identify an association between health literacy and patient satisfaction.
Concluding message
Identification of people with low health literacy may enable organisations to develop and implement alternative strategic approaches to communicating important clinical information to patients to improve patient outcomes. Although low health literacy is common, broad based mass health literacy testing may not be necessary. Rather, a patient-centred care approach, personally tailored to the abilities, needs, values and preferences of individual patients, is the most effective approach to clinical consultations. A patient-centred care approach acknowledges the preferences, ideas, values and beliefs of each individual, regardless of health literacy.