Examining Health Literacy and Surgical Decision Making in Urogynecology

Objectives: While current literature suggests that most women seeking Urogynecology care are health literate, these studies have insufficiently looked at the populations who carry the largest disease burden: Hispanic women. Spanish-speaking women have been found to have lower levels of health literacy and inadequate understanding of medical care. Our study aims to qualitatively explore the impact that health literacy has on medical decision making in Urogynecology in our Hispanic minority-majority population. By establishing what factors influence patient’s decision making, we hope to identify areas to improve health literacy and strengthen patient’s ability to play an active role in shared decision-making.

Methods: In this IRB-approved study, English and Spanish speaking patients who were offered Urogynecologic surgery at our tertiary care center are recruited. Participants completed the Short Assessment of Health Literacy (SAHL) to obtain an objective health literacy score, followed by a basic demographic questionnaire, and then a semi-structured, recorded interview. Once recruitment is finished, qualitative analysis of the interview transcripts will be done using grounded theory and affinity diagramming. Continuous and categorical variables were analyzed using a t-test and chi-square test, respectively. A p-value < 0.05 was considered statistically significant.

Results: 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) and non-surgical intervention (16.63). Regarding race, 40% of Black patients chose to undergo surgery, while 71% of White patients chose surgery (p = 0.21). 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). 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).

Conclusions: Based on our interim results, new patients, patients with stress urinary incontinence and patients born outside of the US trended towards higher rates of 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, data collection is ongoing. Further data collection and analysis of qualitative data is needed to identify specific factors that influence medical decision-making.