Development of a Novel Health Literacy Tool for a Free Student- Run Orthopaedic Clinic for Underserved Patients

Hackett N¹, Hatcher L¹, Ross D¹, Guo L¹, Willacy R²* and Richardson JA¹

Keywords: Health Literacy; Orthopaedic Clinic; Patients

Introduction

Health literacy is important as it pertains to patient care in underserved populations. It can directly impact individuals’ ability to navigate the healthcare system and make informed decisions regarding their care. Effective communication and education by practitioners is essential for improving patient outcomes and reducing health disparities. With the Free Orthopaedic Clinic, established in April 2023 at Howard University Hospital in Washington, DC, our goal is to enhance health literacy to ensure equitable access to care. Research shows that 33% of patients in an urban outpatient spine center exhibited limited health literacy, particularly amongst those who were socioeconomically disadvantaged [1]. Likewise, a study of 200 hand surgery patients revealed that 43% had limited health literacy, with a higher prevalence amongst the underprivileged, highlighting the need for improved strategies to adequately assist vulnerable communities [2]. By simplifying health information and implementing targeted initiatives, such as creating a Health Literacy tool, we aim to address these challenges better support health management amongst patients.

Methods

For this study, health literacy is defined as the ability to find, understand, and use information and services for health- related decisions and actions [3]. Medically underserved communities face barriers and limited access to primary care “services” [4]. A scoping review of NIH’s PubMed database was queried for a broad range of study designs and literature published between 2015 to 2024. Search terms included Free Orthopaedic Clinic Health Literacy Questionnaire “health literacy,” “underserved populations,” “low-income” and “Medicaid-eligible.” The literature search yielded 695 results. Inclusion criteria for this study were manuscripts written in the English language that presented information on health literacy as defined by the U.S. Centers for Disease Control & Prevention, and medically-underserved population defined by the U.S. Department of Health & Human Services. Exclusion criteria for this study were manuscripts that were written in a language other than English and were written before January 2015.

Results

Our literature search yielded the following health literacy tools including Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA), and Newest Vital Sign (NVS). These tools are used in the literature to assess a patient’s health literacy (Table 2). The tool Literacy in Musculoskeletal Problems (LiMP) is also tailored to evaluate patients’ literacy in musculoskeletal conditions [5]. We plan to utilize these tools and tailor them to the specific needs of our patient population in the clinic to determine the literacy of patients and utilize the results to tailor education materials dispersed to meet their literacy needs [6, 7]. Our proposed plan is to create a brief and simple questionnaire with 8 questions assessing a patient’s general knowledge, application of knowledge and ability to critically think in regards to musculoskeletal topics (Table 1). Patients would be asked to answer a mix of true and false, multiple choice, and open ended questions. The scores would be graded on accuracy and completeness.

Questions Points

1. What is the role of an Orthopaedic Surgeon? a. A doctor that takes care of the lungs b. A doctor that takes care of the eyes c. A doctor that takes care of the heart d. A doctor that takes care of the bones

2. What is NOT part of the musculoskeletal system? a. Muscles b. Bones c. Kidneys d. Tendons

0 1

0 1

3. The femur is the longest bone in the human body. a. True b. False

4. Cartilage is harder than bone a. True b. False 0 1

5. A patient has osteoporosis. What can they do to make their bones stronger? 0 1 2

For each multiple choice and true and false question, a score would be assigned based on the accuracy of the response for a total of one point. For each open ended question a patient can score up to 2 points if the patient fully answers the question and gives a complete response. If the patient gives a partially correct answer but lacks a complete understanding they would receive 1 point. If the patient gives an incorrect answer or does not know the answer they would receive 0 points. Patients would be graded and fall under the categories of either proficient literacy (10-12), Moderate literacy (6-9 points), and low literacy (<6 points) (Table 2).

Proficient literacy refers to patients with a good understanding of complex musculoskeletal conditions. Moderate literacy refers to patients with a general understanding of musculoskeletal conditions but may benefit from education on more complex conditions and treatments. Low literacy refers to patients who will benefit from additional tools that further explain musculoskeletal conditions in a simplified educational manner. Utilizing the score, we can best determine what additional education support a patient requires.

Discussion/Conclusion

Health literacy plays a critical role in ensuring effective care in underserved populations which directly impacts patients’ understanding of their diagnoses, treatment options, and post-operative care. Oftentimes, navigating the US healthcare system goes beyond the health literacy abilities of many patients [8]. In orthopaedic surgery, where complex medical jargon and procedures are common, patients with limited health literacy may struggle to grasp the nuances of their conditions. This may, in turn, lead to low compliance and poor outcomes due to lack of effective communication [7]. A key challenge for providers is to bridge the gap between medical jargon and patient comprehension by ensuring that clear, simplified communication is utilized. This fosters better patient engagement and empowers individuals to take an active role in their treatment and recovery plan [9]. For the Free Orthopaedic Clinic, improved health literacy tools can significantly enhance the quality of care by enabling more effective communication, creating collaborative relationships, and improving patient satisfaction. In the future, studies should explore the impact of these tools in the prediction of long-term patient outcomes and complications, particularly in post-operative settings, in order to optimize patient care and serve the community more effectively [10].

Specifically, the development of health literacy assessment tools specifically tailored towards musculoskeletal conditions, such as LiMP, could be pivotal in identifying patients at risk of poor outcomes [5]. For example, incorporating interactive educational methods like visual aids, videos, and simplified take-home materials could further enhance comprehension amongst patients with limited literacy [2]. Additionally, studies could investigate the role of community-based interventions, including partnerships with local organizations, to deliver culturally sensitive education and address systemic barriers faced by underserved populations.3 Research is also needed to evaluate the integration of new means of technology, such as telemedicine and mobile apps, to deliver personalized education and support for post-operative care in these populations [10]. These measures would have the potential to translate into decreased readmissions and reduced healthcare costs, thereby ensuring equitable and effective care for vulnerable communities [7].