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 |