Limited health literacy in shoulder and elbow patients

Background: The aim of this study was to evaluate health literacy in orthopedic shoulder and elbow patients. Methods: This retrospective cross-sectional study included all new English-speaking adult patients presenting to two fellowship-trained shoulder and elbow surgeons from October 2020–July 2021. Patients who did not complete the Brief Health Literacy Screen Tool (BRIEF) were excluded, leaving 594 patients. Patient demographics and patient-reported outcome scores were also collected. Results: Average BRIEF score was 18.7 (range, 4–20), with limited health literacy (BRIEF <17) in 84 patients (14.1%). Patients with limited health literacy were significantly older (58 ± 18 vs. 54 ± 15 years, p = 0.03), less likely to be employed (34 [40%] vs. 332 [65%], p < 0.001), and less likely to have private insurance (35 [42%] vs. 330 [65%], p < 0.001). Average area deprivation index percentile was significantly higher (more deprivation) with limited (38 ± 20) compared to adequate health literacy (32 ± 21; p = 0.027). PROMIS physical (40.5 ± 8.5 vs. 45.5 ± 7.6, p = 0.001) and mental health scores (46.9 ± 10.5 vs. 51.0 ± 8.6, p = 0.015) and pain visual analog scale scores (5.3 ± 2.9 vs. 4.6 ± 2.7, p = 0.017) were significantly worse with limited health literacy. Discussion: Limited health literacy is present in shoulder and elbow patients and may affect patient-reported outcomes. Surgeons must recognize this in order to provide high-level equitable care. Level of evidence: Level III, retrospective cohort.