You Can Help Spine Patients With Limited Health Literacy

Low health literacy is common and associated with poorer outcomes in patients with spinal problems, but it can be addressed

What’s the Claim?

Even after controlling for relevant confounding variables (including age, gender, race/ethnicity, whether English was a first language, affluence, and overall reading ability), researchers studying more than 300 patients receiving care for a variety of spinal conditions determined that a low level of health literacy was associated with poorer baseline PROM scores and poorer self-reported general health. About one-third of patients had limited health literacy in this study, a finding that did not correspond neatly with overall reading ability, since about 82% of patients in this study read at a high-school (9th grade) level or greater. Although descriptive, this study points to a number of important steps that spine surgeons can take to help make life easier and safer for their patients.

How’s It Stack Up?

Before we get to those, though, it’s worth pointing out some things this study did not prove — there is no cause-effect relationship, despite the study authors’ use of cause-effect language in the paper (starting in the title, with the word “impact”). The exact percentage of patients with limited health literacy (and limited literacy overall) obviously will vary from study to study; the numbers here were generally in range of other studies on the topic that we’ve seen.

What’s Our Take?

There are several practical takeaways here. First, don’t assume that because a patient seems articulate that (s)he possesses an adequate level of health literacy, or that (s)he really understands the concepts you’re sharing. If you really want to know how your patients are doing, the health literacy screening tool the authors used in this paper is freely available in English and Spanish, and it’s easily administered by your office nurse or medical assistant (it’s six questions that ask for a patient’s comprehension about a nutrition label from a jar of ice cream). The key point is that overall literacy as well as other markers that clinicians commonly use — like a patient’s affluence, insurance type, and age — did not track with health literacy in this study, and that finding is almost certainly generalizable. And if the patient isn’t understanding what you’re saying, there’s a good chance (s)he will have trouble following your instructions after surgery. With that in mind, it’s worth making sure that patients can easily understand the informational materials you use to educate them. In case you missed it, CORRelations recently covered an article showing how ChatGPT can rewrite and simplify your patient education materials in ways that make them easier for readers with limited literacy to understand. It seems well worth doing!


Lans A, Bales JR, Borkhetaria P, et al. Impact of Health Literacy on Self-Reported Health Outcomes in Spine Patients. Spine (Phila Pa 1976). 2023;48:E87-E93.