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Table 3 HL and LBP health outcome measures used and their relationship

From: Health literacy and health outcomes in patients with low back pain: a scoping review

HL measure

Health outcome (HO)

HO measure

Relationship between HO and HL

Briggs et al. [10]

 Short-form Test of Functional Health Literacy in Adults (S-TOFHLA)

Pain severity

Numeric pain-rating scale

Unspecified

Pain impact

LBP episodes (last 1 year), workdays missed, sought health professional advice, medication use, intrusion on regular daily and recreational activities

Unspecified

LBP related disability

Oswestry Disability Index (ODI)

Unspecified

Fear avoidance

Fear Avoidance Beliefs Questionnaire (FABQ)

No significant relationship

Beliefs about LBP

Back Pain Beliefs Questionnaire (BBQ)

No significant relationship

Catastrophising

Coping Skills Questionnaire (CSQ)

No significant relationship

Beliefs on “cause and course of low back pain”, and “seeking, understanding and utilising low back pain information”

Telephone interviews

Unspecified correlation to HL. However, participants reported obstacles in seeking, comprehending and using LBP information, which were not reflected in S-TOFHLA scores

Briggs et al. [41]

 Health Literacy Measurement Scale (HeLMS)

Same as Briggs 2010

Same as Briggs 2010

Chronic LBP associated with lower scores in HeLMS domain 1: ‘Patient attitudes towards their health’ and greater difficulty in managing personal health

Devraj et al. [12]

 Newest Vital Sign (NVS)

Pain awareness and medication knowledge

12-question survey based on chronic pain guidelines, patient education resources, and previous studies

Limited HL associated with lower ability to find healthcare providers to manage chronic pain, less likely to know alternative methods to treat pain besides medications alone, and less likely to know over-the-counter medications to take for pain control

Pain severity

100 mm Visual Analogue Scale (VAS)—(pain severity over the past week)

No significant relationship

Farin et al. [11]

 HELP questionnaire (health education literacy of patients with chronic musculoskeletal diseases)

General health status

One-item measure (How would you rate your health?)

Poor self-rated health status was the greatest risk factor for low HL. Study considered this is a causal path in the opposite direction: low HL patients are at a disadvantage and thus experience a less positive disease course

Camerini and Schulz [51]

 Low Back Pain Knowledge Questionnaire

Patient empowerment

Psychological Empowerment Scale

No significant relationship

Patient involvement

Modified Patients’ Perceived Involvement in Care Scale (M-PICS)

Low HL group more inclined to ask healthcare provider for information regarding treatment plan

Medication non-adherence

Pain Medication Questionnaire

No significant relationship

Health outcomes

6 questions from the Chronic Pain Grading Scale on intensity and functionality

No significant relationship

Burke et al. [53]

 “Never heard of it/Do not know much about it” questions from the NHIS (National Health Interview Survey)

Lack of need

“Do not need it” from the NHIS (National Health Interview Survey)

No significant relationship

Health status

Self-reported health status, functional limitation, hospitalization and emergency department attendance (last 12 months)

No significant relationship

Health behaviours

Activity level, smoking status, alcohol consumption level, body mass index, flu immunisation (last 12 months), use of pneumonia vaccine

Low HL associated lower activity level

Healthcare access

Healthcare provider visits (last 12 months), health insurance coverage, delayed healthcare due to cost concerns, delayed healthcare due to non-cost concerns, ability to afford common supplementary healthcare

Low HL associated with greater inability to afford ancillary care

Al-Eisa et al. [48]

 Newest Vital Sign (NVS)

Disability level for LBP

Oswestry Disability Index

Disability was negatively correlated with HL

Avoidance behaviour due to pain

Fear Avoidance Beliefs' Questionnaire (FABQ)

Negative correlation between FAB (in terms of Physical Activity) and HL

No significant relationship between FAB (in terms of work) and HL

MacLeod et al. [54]

 “How confident are you filling out medical forms by yourself?” screening question

Patient dissatisfaction

Modified Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. 10-point scales measuring dissatisfaction with general healthcare, specialists, physicians, and AARP Medicare Supplement Insurance plans

Inadequate HL associated with greater dissatisfaction with healthcare system and general healthcare (e.g. physicians, specialists, insurers, and general experiences)

Preventive services or quality of care

Administrative medical claims databases

Inadequate HL associated with reduced compliance towards preventive healthcare services and less uptake of flu immunisations

Healthcare utilization and expenditures

Administrative medical claims databases

Inadequate HL associated with higher emergency department attendance, inpatient admission and yearly healthcare expenditure

Köppen et al. [20]

 3 screening questions from Brief Questions to Identify Patients with Inadequate Health Literacy: “how often do you have someone help you read hospital materials”, “how confident are you filling out medical forms by yourself” and “how often do you have problems learning about your medical condition because of difficulty understanding written information?”

Pain intensity

Visual Analogue Scale (VAS)

Higher HL associated with lower pain intensity

Pain perception

Short-form McGill Pain Questionnaire (SF-MPQ)

No significant relationship

Pain duration

Listed in months

No significant relationship

Glassman et al. [47]

Newest Vital Sign (NVS)

LBP related disability

Oswestry Disability Index

No significant relationship

Health Literacy Assessment (HLA)

Pain

Numeric Rating Scales for Back and Leg Pain

Lower HL associated with higher back pain scores

Generic health status

Euro-QOL5D (EQ-5D)

No significant relationship

 

Utilisation of lumbar spine treatment (last 6 months), physiotherapy attendance, immunisation history, medication use, employment, days of work missed

Adequate HL group used more medications and consulted a specialist more frequently than limited HL group

Limited HL group reported more individual visits to chiropractor and had lower use of NSAIDs