Elyette Lugo, BS
Andrea Fábregas, BS
Norman Ramírez, MD

Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, Maryland
School of Medicine, Universidad Central del Caribe, Bayamón, Puerto Rico
Pediatric Orthopedic Surgery Department, Mayagüez Medical Center, Mayagüez, Puerto Rico

Introduction

Health literacy (HL) significantly impacts outcomes in spine surgery, where informed decision making and understanding treatment options are essential. Underserved populations face barriers such as language and socioeconomic disparities. Despite its importance, existing tools used to assess HL often lack spine-specific content and fail to address multidimensional aspects such as print, numeracy, and visual comprehension. This review examines existing HL tools used in spine surgery, their effects on underserved populations, and identifies their advantages, limitations, and gaps.

Methods

A comprehensive search of PubMed, Embase, and Cochrane Library databases was conducted in August 2024. Studies published between 2014 and 2024, involving human participants and directly assessing HL in spine surgery were included. Data on study design, HL tools and dimensions, and associated sociodemographic factors were extracted and analyzed.

Results

Nine studies (2,958 patients) identified eight HL tools: three objective methods (LiMP, NVS, REALM-SF) and five subjective methods (BRIEF, verbal and visual comprehension tasks, surveys, and single-item screening questions). The studies covered various HL dimensions, including print literacy (n=3), print and numeracy literacy (n=1), combined print, oral, and numeracy literacy (n=1), oral and visual comprehension (n=2), and a mix of print and oral literacy (n=1). Limited HL was reported in 9%–50% of patients and was associated with factors such as older age, lower education levels, Hispanic population, and socioeconomic disparities. However, none of the tools specifically addressed the unique spine-related literacy needs or accounted for cultural and linguistic nuances.

Conclusion

Current HL tools in spine surgery primarily focus on general literacy skills, lacking spine-specific components and cultural sensitivity for underserved populations such as the Hispanic population. Developing a comprehensive, spine-focused HL tool that integrates multiple dimensions and addresses the unique challenges faced by each population is essential for enhancing patient understanding, promoting shared decision-making, and achieving equitable surgical outcomes.

Keywords

Health literacy (HL), Spine Surgery, Patient Outcomes, Underserved populations, Spine-specific health literacy