Accuracy of Subjective Health Literacy Assessments in a Urogynecology Population

Objectives: Contemporary urogynecology practice involves a shared decision-making approach, which necessitates effective communication. This process relies on an accurate understanding of a patient's health literacy to convey relevant medical information appropriately. Inadequate health literacy perceptions can result in failure to explain complex urogynecology topics, adversely affecting the decision-making process. While formal assessments of health literacy exist, they are extensive and time-consuming. Healthcare providers often conduct informal assessments of health literacy instead and adjust their communication based on perceived, rather than formally assessed, health literacy. Our study was designed to assess the accuracy of healthcare providers in estimating patients' health literacy levels against a validated health literacy tool called New Vital Sign (NVS) in a urogynecology patient population.

Methods: This is a prospective study of female patients presenting to a single urogynecology office. The NVS was administered during the visit. A score of 0-1 indicates limited health literacy, 2-4 suggests possible limited literacy, and 5-6 specifies adequate health literacy. Providers subjectively assessed each participant’s health literacy using the same categories. These subjective assessments were compared to the NVS scores to evaluate the accuracy of providers’ perceptions. Demographic data was obtained via self-report from the participants, and Charlson-Comorbidity Index scores were calculated from data in the EMR. Data is reported as frequencies or medians with interquartile ranges as appropriate. Spearman's rank correlation coefficient was utilized to determine the inter-rater agreement between subjective and objective health literacy evaluations.

Results: 186 subjects were included, most of whom were White, Non-Hispanic, and college educated (Table 1). Providers correctly assessed the subjects’ health literacy levels 62.4% of the time. Analysis yielded a Spearman's rho of 0.268 (p < .001), suggesting that provider perceptions of health literacy were only weakly aligned with the objective measures of the NVS (Figure 1). There was a tendency for providers to overestimate patients' health literacy levels. Providers perceived 132 subjects to have adequate health literacy, whereas only 116 were identified as such by the NVS. Only 13 individuals were perceived by providers to have limited health literacy, whereas the NVS identified 29.

Conclusions: While providers were able to correctly gauge health literacy levels in the majority of cases, there remains a substantial margin for improvement. Providers have a propensity to view patients as having better health literacy skills than what is objectively measured by the NVS. Including the NVS as part of a new patient office visit would improve identification of patients with limited health literacy who may need additional resources.