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Allen C, Ghoora L, Murki R, Byworth C, Beale S, Mojadady A, Nagri J, Parmar C. Accuracy of Healthcare Professionals' Estimations of Health Literacy and Numeracy of Patients Visiting Metabolic Bariatric Surgery Clinic. Obes Surg 2024; 34:2799-2805. [PMID: 38965186 PMCID: PMC11289253 DOI: 10.1007/s11695-024-07379-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION To effectively support patients through their weight loss journey, it is vital that healthcare professionals (HCPs) understand the health literacy skills of their patients and communicate in a way that meets these needs. This is the first study looking at the accuracy of HCPs' estimations of their patients' health literacy and numeracy attending a metabolic bariatric surgery (MBS) clinic. METHOD A cross-sectional study was completed at a tertiary-level MBS clinic in London. Patients completed a demographic questionnaire and a validated measure of health literacy and numeracy, the Medical Term Recognition Test (METER) and General Health Numeracy Test-Short Form (GHNT-6), respectively. HCPs provided estimations of their patient's health literacy and numeracy based on each questionnaire's scoring categories. RESULTS Data was collected for 31 patients. A 80.6% of patients had functional health literacy based on METER. HCPs estimated patients' health literacy correctly 61.1% of the time; inter-rater agreement was poor (ICC = 0.14; 95% CI = - 0.19, 0.443; p = 0.202). A total of 22.6% of patients scored 0 out of 6 on GHNT-6. HCPs estimated health numeracy correctly 13.9% of the time and were more likely to overestimate than underestimate health numeracy. Inter-rater agreement for health numeracy was poor (ICC = - 0.2; 95% CI = - 0.49, 0.14; p = 0.878). CONCLUSION There is poor agreement between HCPs' perception of their patients' health literacy and numeracy and their assessed ability. HCPs' understanding of their patient's health literacy and numeracy skills is vital in ensuring HCPs can support patients through the challenging bariatric surgical pathway, consenting process and post-operative course.
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Affiliation(s)
- Calisha Allen
- Institute of Health Informatics, University College London, London, NW1 2DA, UK.
- The Royal Free London NHS Foundation Trust, London, NW3 2QG, UK.
| | - Lubnaa Ghoora
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK
| | - Rajashree Murki
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK
| | - Chad Byworth
- The Royal Free London NHS Foundation Trust, London, NW3 2QG, UK
| | - Sarah Beale
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Akifah Mojadady
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK
| | - Jameela Nagri
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK
- Apollo Hospitals Educational and Research Foundation, New Delhi, India
- Department of Targeted Intervention, University College London, London, UK
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Del Risco A, Cherches A, Polcaro L, Washabaugh C, Hales R, Jiang R, Allori A, Raynor E. Improving Health Literacy of Elective Procedures in Pediatric Otolaryngology. Otolaryngol Head Neck Surg 2024; 171:546-553. [PMID: 38520236 DOI: 10.1002/ohn.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/02/2024] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To identify if the addition of supplementary material, such as video or written resources, to the consent process, can improve a patient's or guardian's health literacy in pediatric otolaryngology. STUDY DESIGN Prospective randomized crossover design. SETTING Tertiary Academic Center. METHODS From April 18, 2022 to August 29, 2023, 151 children scheduled to undergo 1 of 6 procedures by the same provider were queried and completed a 6-question baseline test based on the information. They each watched a 2-minute video and read a written summary about the procedure; the order of resources was randomized. They answered the same 6-questions after viewing each resource. All tests were scored based on accuracy using an ordinal scale of 1 to 6. Resource preference was collected. Wilcoxon signed-rank tests were run to analyze differences in scores after the addition of supplementary resources and logistic regression modeling was run to analyze demographic effects on postresource score differences. RESULTS Of 151 participants, 74.2% were guardians, with 78.8% having completed a high school or greater education. The Wilcoxon signed-rank test indicated that postresource scores were statistically significantly higher (P < .001) than pretest scores. Logistic regression modeling showed that participants were less likely to show score improved if they were younger than 18 and were of white race. A majority (87.4%) preferred the addition of a video to the consent process. CONCLUSION The addition of video or written resources significantly improves understanding of elective procedures. The development of procedure-specific resources can supplement the consent process and ensure decision-makers have adequate health literacy for informed decision-making.
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Affiliation(s)
- Amanda Del Risco
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexander Cherches
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lauren Polcaro
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Claire Washabaugh
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robin Hales
- Department of Child Life, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rong Jiang
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexander Allori
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Eileen Raynor
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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Srinivasan N, Samaan JS, Rajeev ND, Kanu MU, Yeo YH, Samakar K. Large language models and bariatric surgery patient education: a comparative readability analysis of GPT-3.5, GPT-4, Bard, and online institutional resources. Surg Endosc 2024; 38:2522-2532. [PMID: 38472531 PMCID: PMC11078810 DOI: 10.1007/s00464-024-10720-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/28/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The readability of online bariatric surgery patient education materials (PEMs) often surpasses the recommended 6th grade level. Large language models (LLMs), like ChatGPT and Bard, have the potential to revolutionize PEM delivery. We aimed to evaluate the readability of PEMs produced by U.S. medical institutions compared to LLMs, as well as the ability of LLMs to simplify their responses. METHODS Responses to frequently asked questions (FAQs) related to bariatric surgery were gathered from top-ranked health institutions. FAQ responses were also generated from GPT-3.5, GPT-4, and Bard. LLMs were then prompted to improve the readability of their initial responses. The readability of institutional responses, initial LLM responses, and simplified LLM responses were graded using validated readability formulas. Accuracy and comprehensiveness of initial and simplified LLM responses were also compared. RESULTS Responses to 66 FAQs were included. All institutional and initial LLM responses had poor readability, with average reading levels ranging from 9th grade to college graduate. Simplified responses from LLMs had significantly improved readability, with reading levels ranging from 6th grade to college freshman. When comparing simplified LLM responses, GPT-4 responses demonstrated the highest readability, with reading levels ranging from 6th to 9th grade. Accuracy was similar between initial and simplified responses from all LLMs. Comprehensiveness was similar between initial and simplified responses from GPT-3.5 and GPT-4. However, 34.8% of Bard's simplified responses were graded as less comprehensive compared to initial. CONCLUSION Our study highlights the efficacy of LLMs in enhancing the readability of bariatric surgery PEMs. GPT-4 outperformed other models, generating simplified PEMs from 6th to 9th grade reading levels. Unlike GPT-3.5 and GPT-4, Bard's simplified responses were graded as less comprehensive. We advocate for future studies examining the potential role of LLMs as dynamic and personalized sources of PEMs for diverse patient populations of all literacy levels.
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Affiliation(s)
- Nitin Srinivasan
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA
| | - Jamil S Samaan
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nithya D Rajeev
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA
| | - Mmerobasi U Kanu
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA
| | - Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA.
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Samaan JS, Yeo YH, Rajeev N, Hawley L, Abel S, Ng WH, Srinivasan N, Park J, Burch M, Watson R, Liran O, Samakar K. Assessing the Accuracy of Responses by the Language Model ChatGPT to Questions Regarding Bariatric Surgery. Obes Surg 2023; 33:1790-1796. [PMID: 37106269 PMCID: PMC10234918 DOI: 10.1007/s11695-023-06603-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 91.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE ChatGPT is a large language model trained on a large dataset covering a broad range of topics, including the medical literature. We aim to examine its accuracy and reproducibility in answering patient questions regarding bariatric surgery. MATERIALS AND METHODS Questions were gathered from nationally regarded professional societies and health institutions as well as Facebook support groups. Board-certified bariatric surgeons graded the accuracy and reproducibility of responses. The grading scale included the following: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Reproducibility was determined by asking the model each question twice and examining difference in grading category between the two responses. RESULTS In total, 151 questions related to bariatric surgery were included. The model provided "comprehensive" responses to 131/151 (86.8%) of questions. When examined by category, the model provided "comprehensive" responses to 93.8% of questions related to "efficacy, eligibility and procedure options"; 93.3% related to "preoperative preparation"; 85.3% related to "recovery, risks, and complications"; 88.2% related to "lifestyle changes"; and 66.7% related to "other". The model provided reproducible answers to 137 (90.7%) of questions. CONCLUSION The large language model ChatGPT often provided accurate and reproducible responses to common questions related to bariatric surgery. ChatGPT may serve as a helpful adjunct information resource for patients regarding bariatric surgery in addition to standard of care provided by licensed healthcare professionals. We encourage future studies to examine how to leverage this disruptive technology to improve patient outcomes and quality of life.
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Affiliation(s)
- Jamil S Samaan
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
| | - Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Nithya Rajeev
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
| | - Lauren Hawley
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
| | - Stuart Abel
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
| | - Wee Han Ng
- Bristol Medical School, University of Bristol, 5 Tyndall Ave, Bristol, BS8 1UD, UK
| | - Nitin Srinivasan
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
| | - Justin Park
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
| | - Miguel Burch
- Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Rabindra Watson
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Omer Liran
- Department of Psychiatry and Behavioral Sciences, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Department of Surgery, Health Care Consultation Center, Keck School of Medicine of USC, 1510 San Pablo St. #514, Los Angeles, CA, 90033, USA
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Psychometric Evaluation of a Measure of Health Numeracy Among Individuals Seeking Bariatric Surgery. Obes Surg 2023; 33:682-684. [PMID: 36562961 DOI: 10.1007/s11695-022-06427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
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Numeracy levels influence shared decision-making and surgical outcomes: A scoping review of the literature. Am J Surg 2023; 225:967-974. [PMID: 36623965 DOI: 10.1016/j.amjsurg.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/18/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Health literacy has been widely studied with regard to medical decision-making and health care access, however research regarding numeracy - the ability to comprehend and attach meaning to numbers - is more limited. METHODS A scoping review following PRISMA guidelines was conducted. We screened 132 abstracts and 12 studies were included in the analysis. RESULTS Surgical population numeracy ranged from 47 to 86.1%. We found heterogeneity in the scales used to measure numeracy and the cutoff values used to define adequate numeracy. Low numeracy was shown to influence the accuracy of patients' responses to quality of life measures used to determine surgical outcomes and was associated with patient overestimation of pre-operative risk. Adequate numeracy was correlated with improved outcomes 2-4 years after bariatric surgery. CONCLUSIONS Patient numeracy is generally poor and has important implications for pre-operative risk understanding, accuracy of health measurement tools and long-term surgical outcomes.
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Marchese SH, Pandit AU. Psychosocial Aspects of Metabolic and Bariatric Surgeries and Endoscopic Therapies. Gastroenterol Clin North Am 2022; 51:785-798. [PMID: 36375996 DOI: 10.1016/j.gtc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Obesity is a prevalent progressive and relapsing disease for which there are several levels of intervention, including metabolic and bariatric surgery (MBS) and now endoscopic bariatric and metabolic therapies (EBMTs). Preoperative psychological assessment focused on cognitive status, psychiatric symptoms, eating disorders, social support, and substance use is useful in optimizing patient outcomes and minimizing risks in MBS. Very little is known about the psychosocial needs of patients seeking EBMTs, though these investigations will be forthcoming if these therapies become more widespread. As MBS and EBMT inherently alter the gastrointestinal (GI) tract, considerations for the longer-term GI functioning of the patient are relevant and should be considered and monitored.
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Affiliation(s)
- Sara H Marchese
- Department of Psychiatry & Behavioral Sciences, Section of Bariatric & Outpatient Psychotherapy, Rush University Medical Center, 1645 W. Jackson Boulevard, Suite 400, Chicago, IL 60618, USA
| | - Anjali U Pandit
- Division of Gastroenterology and Hepatology & Psychiatry, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, 14th Floor, Chicago, IL 60611, USA.
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Exploring gender, psychiatric symptoms, and eating behaviors as predictors of attrition to bariatric surgery. Am J Surg 2022; 224:999-1003. [DOI: 10.1016/j.amjsurg.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 11/21/2022]
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Varlı Ü, Naz İ, Yılmaz H. Investigation of Body Awareness and Affecting Factors in Patients with Bariatric Surgery. Obes Surg 2022; 32:829-836. [PMID: 34988896 DOI: 10.1007/s11695-021-05864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Major weight loss after bariatric surgery (BS) makes the body sensitive to the environment. The factors associated with body awareness are unknown in patients with BS. In this study, we aimed to investigate the body awareness and the affecting factors in patients with BS. METHODS Our study included 81 patients who had BS at least 6 months ago and 40 people of the same age and gender who had not. Participants' body awareness was evaluated with the Body Awareness Questionnaire, body compositions with bioelectric impedance device, joint position sensation (JPS) with photography method, physical activity level with International Physical Activity Questionnaire, quality of life with the Short Form-36, depression status with the Beck Depression Inventory, and cognition with the Montreal Cognitive Assessment Scale. Mann-Whitney U and Chi-square tests were used for the comparison of the groups, and Spearman correlation analysis was used for in-group correlation analysis. RESULTS Body awareness was found to be higher in patients with BS compared to the control group (p = 0.002). Body awareness had a positive correlation with cognition (r = 0.277, p = 0.012), quality of life sub-scales (r = 0.245-0.374, p < 0.05), the amount of change in total body weight (r = 0.241, p = 0.027), and body mass index (BMI) (r = 0.269, p = 0.032); negative correlation with depression (r = - 0.409, p = 0.016) and deviation in the JPS (r = - 0.223, p = 0.046). CONCLUSION Body awareness of patients with BS was found to be high after surgery. Body awareness in patients with BS is associated with the amount of weight loss and BMI, depression, cognition, JPS, and health-related quality of life.
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Affiliation(s)
- Ümit Varlı
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, İzmir Katip Çelebi University, 35620, Çiğli İzmir, Turkey. .,Physiotherapy and Rehabilitation Clinic, EMOT Hospital, İzmir, Turkey.
| | - İlknur Naz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İzmir Katip Çelebi University, İzmir, Turkey
| | - Hüsnü Yılmaz
- Department of Endocrinology and Metabolic Diseases, Private Can Hospital, İzmir, Turkey
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Carter J, Chang J, Birriel TJ, Moustarah F, Sogg S, Goodpaster K, Benson-Davies S, Chapmon K, Eisenberg D. ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery. Surg Obes Relat Dis 2021; 17:1956-1976. [PMID: 34629296 DOI: 10.1016/j.soard.2021.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jonathan Carter
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California.
| | - Julietta Chang
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - T Javier Birriel
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Fady Moustarah
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Stephanie Sogg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Kasey Goodpaster
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Sue Benson-Davies
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Katie Chapmon
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Dan Eisenberg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
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Davaris MT, Bunzli S, Dowsey MM, Choong PF. Gamifying health literacy: how can digital technology optimize patient outcomes in surgery? ANZ J Surg 2021; 91:2008-2013. [PMID: 33825300 DOI: 10.1111/ans.16753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 01/22/2023]
Abstract
The digital age is entrenched in our society, with constant innovation driving change in the way clinicians and patients manage their health concerns. Health literacy is emerging as an important modifiable factor that can affect clinical and patient outcomes, yet traditional forms of patient education have shown mixed results. Digital media and technologies, the concept of gamification as a means to improve patient health literacy, and its potential for misuse will be explored in this review, in the context of a digital, gamified tool that could support patients along their surgical journey.
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Affiliation(s)
- Myles T Davaris
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Peter F Choong
- Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia
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12
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Miller-Matero LR, Hecht L, Patel S, Martens KM, Hamann A, Carlin AM. The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery. Surg Obes Relat Dis 2020; 17:384-389. [PMID: 33082073 DOI: 10.1016/j.soard.2020.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss. SETTING Single bariatric center. METHODS Patients (N = 567) who underwent bariatric surgery from 2014-2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener. RESULTS Among participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2-4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL. DISCUSSION Although health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
| | - Leah Hecht
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Shivali Patel
- Behavioral Health, Henry Ford Health System, Detroit, Michigan
| | - Kellie M Martens
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
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Hayter RR, Hess AS. Health Numeracy and Relative Risk Comprehension in Perioperative Patients and Physicians. Anesth Analg 2020; 131:579-585. [PMID: 32304457 DOI: 10.1213/ane.0000000000004816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Helping patients to understand relative risks is challenging. In discussions with patients, physicians often use numbers to describe hazards, make comparisons, and establish relevance. Patients with a poor understanding of numbers-poor "health numeracy"-also have difficulty making decisions and coping with chronic conditions. Although the importance of "health literacy" in perioperative populations is recognized, health numeracy has not been well studied. Our aim was to compare understanding of numbers, risk, and risk modification between a patient population awaiting surgery under general anesthesia and attending physicians at the same center. METHODS We performed a single-center cross-sectional survey study to compare patients' and physicians' health numeracy. The study instrument was based on the Schwartz-Lipkus survey and included 3 simple health numeracy questions and 2 risk reduction questions in the anesthesiology domain. The survey was mailed to patients over the age of 18 scheduled for elective surgery under general anesthesia between June and September 2019, as well as attending physicians at the study center. RESULTS Two hundred thirteen of 502 (42%) patient surveys sent and 268 of 506 (53%) physician surveys sent were returned. Median patient score was 4 of 5, but 32% had a score of ≤3. Patients significantly overestimated their total scores by an average of 0.5 points (estimated [mean ± standard deviation (SD)] = 4.3 ± 1.2 vs actual 3.8 ± 1.3; P < .001). Health numeracy was significantly associated with higher educational level (gamma = 0.351; P < .001) and higher-income level (gamma = 0.397; P < .001). Physicians' health numeracy was significantly higher than the patients' (median [interquartile range {IQR}] = 5 [4-5] vs 4 [3-5]; P < .001). There was no significant difference between physicians' self-estimated and actual total numeracy score (mean ± SD = 4.8 ± 0.6 vs 4.7 ± 0.6; P = .372). Simple health numeracy (questions 1-3) was predictive of correct risk reduction responses (questions 4, 5) for both patients (gamma = 0.586; P < .001) and physicians (gamma = 0.558; P = .006). CONCLUSIONS Patients had poor health numeracy compared to physicians and tended to overrate their abilities. A small proportion of physicians also had poor numeracy. Poor health numeracy was associated with incomprehension of risk modification, suggesting that some patients may not understand treatment efficacy. These disparities suggest a need for further inquiry into how to improve patient comprehension of risk modification.
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Affiliation(s)
| | - Aaron S Hess
- From the Departments of Anesthesiology.,Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin
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