At the Mass General Research Institute, our community of 9,500+ investigators work diligently to publish peer-reviewed work and scientific findings to better understand disease and develop solutions to medicine’s most pressing challenges.

Footnotes in Science is a space where investigators bring you the behind-the-scenes details of their recently published work.

In this Q&A, we pick the brain of Amanda Lans, MD, MS, regarding her team’s latest research article published in Sage Journals, Health Literacy in Orthopedic Surgery: A Systematic Review.

Dr. Lans is a Spine Research Fellow in the Department of Orthopaedics at Massachusetts General Hospital.

In this study she and her team sought to review the literature for studies investigating the level of health literacy in patients undergoing orthopedic surgery and also to assess how those studies report factors affecting health equity.

What motivated you and your team to publish this study?

First and foremost, we recognized that health literacy plays a crucial role in improving health outcomes and reducing healthcare disparities, and we wanted to highlight the importance of this issue in the context of orthopaedic surgery.

We also noticed that there was a lack of research specifically focused on health literacy in orthopaedics, despite the fact that orthopaedic surgery often involves complex procedures and post-operative care.

As a result, we saw an opportunity to contribute to the existing literature by synthesizing current research on health literacy in orthopaedics, identifying gaps in knowledge and suggesting areas for future research.

We also wanted to raise awareness among healthcare providers and patients alike about the importance of health literacy in orthopedics.

By publishing our review paper, we hoped to bring attention to this issue and encourage healthcare providers to take steps to improve health literacy among their patients, such as providing written materials in plain language, using visual aids to enhance understanding, and engaging in effective patient-provider communication.

What is Health Literacy? 

Health literacy refers to the ability of individuals to obtain, understand and use information related to healthcare and health services to make informed decisions about their health.

It includes a range of skills, such as reading, writing, listening and critical thinking that enable people to navigate the healthcare system, understand medical terms and interpret health-related information.

Health literacy is important because it allows individuals to actively participate in their own healthcare, make informed decisions about their health and improve their health outcomes.

What are the biggest takeaways from this study?

Health literacy is a dynamic, multifaceted skill set that has serious implications for overall health and safety, managing expectations, measuring treatment outcomes, and containing healthcare costs in patients who require orthopaedic care.

Orthopaedic surgeons should be aware of the large proportion of patients who have inadequate health literacy and great difficulty understanding health-related information, particularly with respect to their diagnosis, treatment and prognosis.

It is crucial to identify patients at risk of poor health literacy and use appropriate assessment tools to measure their true understanding of their diagnosis and supplement their education when necessary.

Identifying the best ways to achieve this goal will requires thoughtful, high-quality trials across diverse demographics and geographies.

An improved body of literature—based on the findings from these trials—can help physicians target specific aspects of health-related education throughout the entire care cycle, maximizing patient/physician collaboration while providing high-quality and resource-respecting care. 

Are there any statistics that reflect that increased health literacy leads to better outcomes?

Yes, there is evidence to suggest that increased health literacy leads to better outcomes in orthopaedic surgery.

A study published in the Journal of Bone and Joint Surgery found that patients with lower health literacy had worse functional outcomes following total knee arthroplasty compared to those with higher health literacy levels.

Another study published in the Journal of Arthroplasty found that patients with higher health literacy were more likely to be satisfied with their surgical outcomes and were better able to manage their pain and rehabilitation after total hip arthroplasty.

In addition, a review of multiple studies published in the Journal of Bone and Joint Surgery found that low health literacy was associated with increased rates of surgical complications, longer hospital stays and higher healthcare costs.

These studies suggest that improving health literacy in patients undergoing orthopaedic surgery can lead to better outcomes and reduced healthcare costs.

Healthcare providers can play a crucial role in promoting health literacy by providing clear and concise information, using plain language, and providing visual aids to help patients understand their diagnosis, treatment and recovery.

Is there a recommended level of English speaking that clinicians should consider when talking with patients about their diagnosis and prognosis?

While there is no specific recommended level of English proficiency for clinicians to consider when talking with patients, it is important for clinicians to communicate in a manner that is easily understandable.

This requires the clinician to assess the patient’s level of health literacy—including their ability to understand medical terminology and concepts—and to adjust their communication accordingly.

To communicate effectively with patients with limited English proficiency, clinicians can use plain language, avoid medical jargon, and use visual aids to help illustrate complex concepts. Clinicians may also need to use professional interpreters or translators to ensure accurate communication.

What are the next steps?

Develop and Implement Health Literacy Interventions:

Researchers can develop and test interventions aimed at improving health literacy among orthopaedic surgery patients. This can include initiatives to improve patient-provider communication, providing patients with written materials in plain language or using visual aids to help patients better understand their condition and treatment options.

Study the Impact of Health Literacy on Patient Outcomes:

Further research can be conducted to better understand the relationship between health literacy and patient outcomes in the context of orthopaedic surgery. For example, studies could explore whether patients with lower health literacy are at increased risk for complications or longer hospital stays.

Assess Health Literacy in Clinical Practice:

Researchers can investigate how health literacy is currently being assessed in clinical practice and identify barriers to assessing and addressing health literacy. This could involve conducting surveys or focus groups with healthcare providers and patients to better understand their experiences.

Address Health Literacy Disparities:

Health literacy disparities may exist among certain populations, such as those with limited English proficiency, low income, or low education.

Researchers can investigate these disparities and develop interventions to address them, such as providing materials in multiple languages or using culturally appropriate communication strategies.

Overall, there is much that can be done to improve health literacy in the context of orthopaedic surgery, and continued research is needed to better understand the impact of health literacy on patient outcomes and to identify effective interventions.

Is there a community or patient population that is at a disadvantage in health literacy?

Yes, certain community or patient populations may be at a disadvantage when it comes to health literacy. These populations may include:

Individuals with limited education:

People who have lower levels of education may have more difficulty understanding complex health information and medical terminology.

Older adults:

As people age, their health needs tend to become more complex, which can make it more challenging for them to understand and navigate the healthcare system. Age-related declines in cognitive function can also impact health literacy.

Non-native English speakers:

People who are not fluent in English may struggle to understand health information that is presented in English, which can lead to lower health literacy.

Low-income populations:

People who have limited financial resources may face barriers to accessing healthcare services, which can impact their ability to understand and manage their health.

Individuals with chronic conditions:

People who have chronic conditions such as diabetes, heart disease, or arthritis may require ongoing management of their health, which can be challenging if they have limited health literacy.

It is important to note that these populations may also face other barriers to accessing healthcare services, such as lack of transportation or insurance coverage, which can further compound health literacy challenges.

By understanding these disparities and developing targeted interventions to address them, healthcare providers can help improve health outcomes for all patients, regardless of their health literacy level.