K. E. Hudak1, M. F. Gleason1, S. J. Baker1, L. N. Wood2, J. A. Cannon2, M. S. Morris2, G. D. Kennedy2, D. I. Chu2 1University Of Alabama at Birmingham,Birmingham, Alabama, USA 2University Of Alabama at Birmingham,Department Of Gastrointestinal Surgery,Birmingham, Alabama, USA
Introduction: Patient engagement applications provide an electronic platform to guide patients recovering from surgery. From self-monitoring to quality of life surveys, these applications promote patient engagement through the surgical journey. It is unclear, however, whether patients with low health literacy have similar levels of engagement compared to those with adequate health literacy. Our objective was to characterize the utilization of a patient engagement application with patients with low health literacy. We hypothesized that differences in utilization measures would exist based on differences in health literacy.
Methods: Patients undergoing elective colorectal surgery at our institution from January to June 2018 were sequentially enrolled in a patient engagement application. A pre-operative survey was given which included a validated 3-question self-reported health literacy instrument. Patients were stratified by health literacy scores to four levels (high, intermediate high, intermediate, and low). Patients underwent surgery and were followed 30-days post-operatively. The primary outcomes were utilization measures which were defined as the number of days using the application, response rate to five individual surveys, and days to completion of each survey. Comparisons were made using ANOVA and chi-squared tests.
Results: A total of 78 patients enrolled in a patient engagement platform and underwent elective colorectal surgery with 30-day follow-up. The mean age was 59 years (IQR 15-83), 43.6% were female (n=34), and 17.9% were African American (n=14) with the remainder being white (82.1%, n=64). On assessment of health literacy level, 43.6% (n=34) of patients had high health literacy, 23.1% (n=18) had intermediate high, 19.2% (n=15) had intermediate, and 14.1% (n=11) had low health literacy. Of low health literacy patients, 18.2% were female (n=2), compared to 53.3% (n=8) of intermediate, 44.4% (n=8) of intermediate high, and 47.1% (n=16) high health literacy (p=0.02). There were no statistical differences in age or race by health literacy. The average number of days spent using the application was 8.5 days with a range of 7.9 to 9.2 days. The average response rate to the first five individual surveys was 100% for survey 1, 57.7% for survey 2, 52.6% for survey 3, 33.3% for survey 4, and 47.4% for survey 5. The average days to survey completion was 29.8 days with a range of 3.1 to 59.4 days. On comparison by health literacy levels, there was no significant difference in utilization rates by number of days using the application, survey response rate, or days to completion of survey (p>0.05).
Conclusion: Patients with all levels of health literacy, including those with low health literacy, had similar engagement with a patient engagement platform after major surgery. These results suggest a potential role for such technology in caring for postoperative patients of all health literacy levels.