M. Reilly1, C. Iroz4,5, M.E. Alagna1, E. Ho2, A.W. Hoel1, A. Vavra1, A. Lundberg3, J.K. Johnson4,5,6, K. Ho1 1Northwestern University, Vascular Surgery, Department Of Surgery, Chicago, IL, USA 2Northwestern University, Department Of Medical Social Sciences, Chicago, IL, USA 3Northwestern University, Department Of Emergency Medicine, Chicago, IL, USA 4Northwestern University, Department Of Surgery, Chicago, IL, USA 5Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES), Chicago, IL, USA 6University Of North Carolina At Chapel Hill, Department Of Surgery, Chapel Hill, NC, USA
Introduction:
Lower extremity peripheral artery disease (PAD) is a highly prevalent chronic condition that leads to increased risk of cardiovascular death, walking impairment, and amputation. However, patient knowledge of PAD is low when compared to other cardiovascular diseases. We aimed to examine disease awareness and comprehension in a cohort of patients with an established diagnosis of PAD.
Methods:
In this single-center, convergent parallel mixed methods study, participants with an established diagnosis of PAD were recruited from a vascular surgery practice. Participants completed an 87-item survey assessing PAD-specific knowledge, demographics, functional health literacy (FHL, as measured by the Short Test of Functional Health Literacy), and PAD diagnosis awareness. Semi-structured interviews were conducted to elucidate disease understanding. For the survey, bivariate analyses of associations of the PAD knowledge score with demographics, FHL, and diagnosis awareness were conducted. Multivariable linear regression was also used to identify factors associated with PAD knowledge scores. For qualitative information obtained from the interviews, inductive and deductive codes were created through iterative reconciliation of independent coding by four coders using the constant comparative approach to identify themes.
Results:
Of 91 participants (77.2% response rate, 49.5% female, 45.1% Non-White, mean age 68.6 ± 11.9 years), most (51.7%) had chronic limb-threatening ischemia, and 17.6% had undergone major leg amputation. While 24.4% were unaware of their diagnosis of PAD, the average PAD knowledge score was 79.1%. In bivariate analyses, non-White race, low income, non-ambulatory status, poor FHL, lack of PAD awareness, and being unsure of PAD chronicity were associated with low knowledge scores. In multivariable analysis, non-White race, poor FHL, and being unsure of the chronicity of PAD diagnosis were independently associated with low PAD knowledge scores. Qualitative analysis of 22 participants revealed difficulty understanding and remembering the term “PAD,” confusion of PAD symptoms and treatments with other comorbidities (e.g., diabetes), and incorrect beliefs about PAD, despite relatively high knowledge scores.
Conclusion:
Factors associated with low PAD knowledge include non-White race, poor FHL, and lack of awareness of the diagnosis of PAD. However, patients with high knowledge scores continue to have incorrect beliefs about PAD and difficulty with the term “PAD,” suggesting gaps in the knowledge assessment tool. Future work will optimize patient education methods, identify strategies to accurately measure patient understanding, and further clarify the relationship between health literacy and PAD knowledge.