Health literacy in pediatric otolaryngology: A scoping review

Abstract

Objective

To review research on status and outcomes of health literacy in pediatric otolaryngology and identify opportunities for quality improvement.

Methods

We performed a scoping review, adhering to methodologic standards. A combination of MeSH terms and keywords related to health literacy in otolaryngology was used to conduct a search. Relevant studies were identified using PubMed, Ovid MEDLINE, and Google Scholar databases. Studies were selected for inclusion by two authors if they addressed the domains of pediatric otolaryngology as well as health literacy. Data were abstracted from each study on the number of participants, the setting, the study design, the outcome measure, the intervention used, and the overall theme. Authors identified prominent overarching themes and grouped studies accordingly. Results were then tabulated for further review and to discern implications for future practice and research.

Results

Of 1046 articles identified, 20 articles were included. Studies fell into three major themes: readability of patient materials, patient recall after informed consent, and optimal patient education. Prominent findings included the following: 1. Much of the printed and electronic educational material in otolaryngology is above the recommended reading level for public health information; 2. Parents do not easily recall information provided verbally or in written form; and 3. Adding visual and multimodal components improves the success of parental education.

Conclusion

Health literacy in pediatric otolaryngology may influence comprehension of educational materials and adequacy of informed consent. Future research may address whether patient health literacy affects clinical outcomes.

Introduction

According to the U.S. Department of Health and Human Services, health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” [1]. Health literacy has gained popularity as a discussion topic in recent years because of an increased focus on patient education. Paternalism in medicine is no longer the modus operandi, and patients increasingly want to participate in their own health care decisions. In order for them to participate in a meaningful way, they must be educated about their condition, the potential treatments, and the risks and benefits of these interventions. Health literacy becomes important because it provides an assessment of the sophistication level at which this information must be provided. The American Medical Association (AMA) [2] and the National Institutes of Health (NIH) [3] recommend that medical information be developed to read between the 6th and 8th grade reading levels. Physicians, who have spent a minimum of seven years in medical school and post-graduate training, have a different vocabulary than that of the general population. As a result, they may provide information to patients using jargon and a higher level of complexity than the patients can understand [4].

Adult patients with low health literacy have lower rates of knowledge about illness [5], higher rates of hospital admissions and emergency room visits [6], and lower use of preventive care services [7]. Because of higher rates of complications and preventable illnesses, health care costs are higher for patients with low health literacy [8]. According to the National Assessment of Adult Literacy, 14% of U.S. adults read below basic health literacy standards, and only 12% have proficient health literacy [9].

While the concept of health literacy is well understood, there is no commonly accepted way to assess health literacy among patients. There are multiple validated tools including the Short Assessment of Health Literacy (SAHL) [10], the Rapid Estimate of Adult Literacy in Medicine (REALM) [11], and the Newest Vital Sign [12]. However, not all studies use the same tool to assess health literacy, and these tools are rarely implemented into clinical practice.

Despite the critical importance of health literacy for enhancement of patient education and outcomes, little is known about it in otolaryngology. The surgical services and specifically otolaryngology, which bridges the disciplines of medicine and surgery, have made relatively small research contributions on the topic of health literacy. Furthermore, the majority of research performed has focused on adult patients rather than children and their parents. Health literacy is especially important in pediatrics, where parents act as proxy decision makers for children who are not yet competent to make their own decisions. We conducted a scoping review to map the pediatric otolaryngology literature on health literacy as it currently exists, identify the key concepts, and inform future practice.