Existing literature suggests Urogynecologic patients tend to demonstrate adequate levels of health literacy[1,2]. However, these studies predominately examine English-speaking White women[2], despite data that indicates Hispanic women carry a larger disease burden from pelvic floor disorders[3]. Other studies have found that predominantly Spanish-speaking women tend to have lower levels of health literacy and inadequate understanding of their diagnoses and treatment options. Our study aims to explore the relationship between health literacy and surgical decision-making of urogynecologic care in our Hispanic minority-majority population. We hypothesize that while numerous psychological, sociological, education, and cultural factors affect a patient’s decision to undergo surgery, patients with higher rates of health literacy will prefer surgical treatment despite these factors. We hope to ascertain both the literacy and social factors that influence patients’ surgical decision-making, with the ultimate goal of identifying potential areas of interventions that can be addressed to improve health literacy and strengthen patient ability to play an active role in shared decision-making.

This is an IRB-approved prospective study. English and Spanish speaking patients are recruited from the Urogynecology clinic at our tertiary center. Patients who are offered a Urogynecologic surgery and either accepted or declined were offered enrollement. For patients that met study criteria, the Short Assessment of Health Literacy (SAHL) was used to assign an objective health literacy score. Participants also completed a basic demographic questionairre and participated in a recorded, semi-structured interview exploring the factors influencing to their medical decision-making. Once recruitment is finished, qualitative analysis of the interview transcripts will be done using grounded theory and affinity diagramming. For objective data, continuous and categorical variables were analyzed using a t-test and chi-square test, respectively. A p-value <0.05 was considered statistically significant.

To date, 28 participants have been enrolled in the study. Preliminary results found that the SAHL score does not appear to differ between the patients who elected for surgical (16.67 +/- 1.94) and non-surgical intervention (16.63 +/- 1.99). Regarding race, 40% of Black patients chose to undergo surgery, while 71% of White patients chose surgery (p = 0.21). As for ethnicity, 55% of non-Hispanic patients had surgery, while 75% of Hispanic patients had surgery (p=0.27). 81% of new patients and 45% of follow up patients elected for surgery (p=0.053). 81% of patients born outside of the US opted for surgery, whereas 45% of patients born in the US did (p=0.053). Further, more patients with a diagnosis of stress urinary incontinence (SUI) elected for surgery at 75%, compared to those with overactive bladder (OAB) at 29% (p = 0.072). The average SAHL score for white patients was 16.1 and 17.6 for black patients (p=0.17). Hispanic patients had a mean score of 16.1 and non-Hispanic patients had a mean of 17.5 (p=0.07). For English and Spanish speakers, the mean SAHL score was 16.75 and 16.50, respectively (p=0.78).

Based on our interim results, new patients, patients with stress urinary incontinence and patients born outside of the US trended towards higher rates choosing surgery than non-surgical intervention. Additionally, Hispanic and Spanish-speaking patients tended to have lower SAHL scores. While these results did not reach statistical significance, we are still recruiting participants for the study and have not yet reached our goal number.

Preliminary analysis of objective data suggests that there may be trends in the types of patients choosing to undergo surgery, however, further data collection and more detailed analysis of qualitative data is needed to identify specific factors that influence medical decision-making in the setting of Urogynecological care.

Kiyosaki K, Ackerman A, Histed S, et al. Patients’ Understanding of Pelvic Floor Disorders: What Women Want to Know. Female pelvic medicine & reconstructive surgery. 2012;18(3):137-142. doi:10.1097/SPV.0b013e318254f09c
Sripad A, Rupp B, Gage J, Feliciano K, Willis-Gray M, Wu J. Health Literacy in Women Presenting to a Urogynecology Practice. Female pelvic medicine & reconstructive surgery. 2018;24(6):435-439. doi:10.1097/SPV.0000000000000494
Khan A, Sevilla C, Wieslander C, et al. Communication Barriers Among Spanish-Speaking Women With Pelvic Floor Disorders: Lost in Translation? Female pelvic medicine & reconstructive surgery. 2013;19(3):157-164. doi:10.1097/SPV.0b013e318288ac1c