(56) Health Literacy Among the Oral and Maxillofacial Surgery Patient Population

Abstract:

Purpose: In the United States, more than 43 million people have inadequate functional health literacy (HL). HL is the degree to which individuals can find, understand, and use information and/or services to inform health-related decisions. Low HL is directly associated with increased emergency department visits, length of stay, mortality, postoperative complications, and cost of treatment. Studies have shown that low income, fewer years in education, unemployment, and older age are associated with low HL. The purpose of this study was to measure the association between patient’s income and HL.
Materials and

Methods: This was a cross-sectional study. The study cohort was derived from the population of subjects presented to the OMS outpatient clinic at the University of Rochester Medical Center (URMC) between September to November 2023, for evaluation of an OMS-related concern. The study inclusion criteria were subjects 18 years or older, presented to OMS outpatient clinic for a consultation appointment, spoke fluent English, and agreed to participate in the study. The study exclusion criteria were subjects younger than 18 years old, non-English speakers, part of a vulnerable population, diagnosed with intellectual disability, cannot perform ADLs, and refused to participate in the study.
The primary predictor variable was patients’ income (low or high). The primary outcome variable was HL (low or high), measured by the Short Test of Functional Health Literacy in Adults (STOFHLA, Figure 1). Additional covariates were demographics, best description of the primary residency, zip code, highest level of completed education, work status, estimated annual income, and social history. Subjects who met the inclusion criteria were stratified into two groups according to income: low-income and high-income (Figure 2). Descriptive and bivariate analyses were performed. A chi-square test was used for categorical variables. Mann-Whitney U test was used for continuous variables. Statistical significance was P < .05

Results: During the study period, 1124 subjects were evaluated. Of them, 225 subjects met our inclusion criteria. The low-income group had 128 subjects. The high-income group had 97 patients. Our data showed that subjects who were in the high-income group were statistically significantly more likely to be in their 3rd decade (P = .0001) and had a full-time job (P < .0001). In contrast, subjects with low income were more likely to have a high school diploma as the highest level of education (P < .0001). Subjects with low HL group were more likely to be unable to work (P < .0001). There were no statistical differences between the high and low HL groups regarding age, sex, race, geographic area, highest level of education, social history, and income.
Outcomes Data:Our study found that age and job status are directly associated with being high income. However, there was no association between level of income and health literacy, indicating that most patients are likely to have adequate HL regardless of their income level.

Conclusion: Our study found that the low HL group was mainly composed of subjects who were unable to work, working part-time, or were retired. By understanding that patients who do not have the ability or means to work full-time may have low HL, surgeons can put time and effort when indicated to help clarify home care instructions or find alternatives such as communicating with a caretaker, which can help mitigate post-operative complications.

References
1. Shahid R, Shoker M, Chu LM, Frehlick R, Ward H, Pahwa P. Impact of low health literacy on patients' health outcomes: a multicenter cohort study. BMC Health Serv Res. 2022;22(1):1148.
2. What is health literacy? 2023. Accessed August 18, 2024.
3. Test of functional health literacy in adults (TOFHLA). In: Affairs OoIaR, ed.
Figure 1: Short Test of Functional Health LiteracyFigure 1: Short Test of Functional Health LiteracyFigure 2: Study sample and groups