By Jonathan Springston, Editor, Relias Media

Patients who struggle to read, absorb, and follow healthcare instructions may be more likely to contract an infection after surgery, according to the results of new research.

Investigators from the University of Alabama at Birmingham (UAB) Hospital examined 270 patients who underwent colon or rectal operations. Using the Brief Health Literacy Screening Tool, researchers measured these patients’ literacy, placing them in three categories: 213 demonstrated adequate health literacy, 38 demonstrated marginal health literacy, and 19 demonstrated low health literacy. Patients with low literacy were 4.5 times more likely to contract an infection one month after surgery vs. those with adequate literacy.

“It’s important to understand that patients with limited health literacy might be at higher risk for an infection after surgery so we can start to understand why and design interventions and tools to better support those patients,” Lauren Theiss, MD, a third-year surgical resident at UAB School of Medicine and lead investigator, said in a statement.

In addition to 30-day complications, the authors studied length of stay, readmission rates, and mortality statistics. Additionally, they looked closely at what level patients complied with UAB Hospital’s enhanced recovery program (ERP), a specialized guide designed to help patients experience the best post-surgical outcomes. At least two problems with this work are apparent. First, the researchers could not determine if patients who contracted an infection did so while still in the hospital or later at home. Second, it seems unclear if UAB’s ERP is too complicated for patients to understand, if UAB did not provide instructions timely, if the patients received the information but ignored parts of it, or some combination.

Nevertheless, the investigators acknowledged that on top of demographics, socioeconomics, and other patient-level factors, overly intricate institutional instructions play into poor health literacy. “For many patients, the surgical journey can be very confusing,” Daniel Chu, MD, FACS, a colorectal surgeon at UAB Medicine and the study’s senior investigator, said in a statement.

Considering the results of this study, UAB surgeons have committed to improving the way they communicate information to patients. This may range from easier-to-understand language and more visual elements in collateral patients receive to surgeons taking their time when delivering instructions (e.g., slower speech patterns, drawing visuals on a piece of paper in front of patients).

“As providers, we should interact with patients assuming they have limited health literacy,” Theiss said. “It’s our responsibility to engage patients and make sure they understand what’s being communicated to them.”

Using plain language is one way researchers are trying to improve health literacy among study participants, as reported in the July issue of IRB Advisor. One expert suggested reviewing informed consent and subject recruitment materials to ensure the study information is clear and adheres to regulatory requirements. Also, investigators can give feedback to IRBs on the language used in information given to patients. The idea is to avoid locking into specific templates, instead continuously updating material to fit the audience.

Patients may take the initiative and try to supplement the information they receive from a facility with their own digital research. However, some patients may face barriers, such as a lack of access to digital solutions or a lack of skills it takes to navigate digital tools, as reported in the August issue of Hospital Case Management. Here, case managers can not only help patients navigate these digital tools but also improve overall health literacy by ensuring each patient understands and follows closely all instructions received.

For more on this subject, be sure to read future issues of Same-Day Surgery.