2006. Health Literacy among Preoperative Patients in a VA Medical Center
LD Chew, University of Washington and HSR&D Center of Excellence, Puget Sound Health Care System, KA Bradley, University of Washington and Center of Excellence, Puget Sound Health Care System, PB Cornia, University of Washington, TD Koepsell, University of Washington

Objectives: Little is known about the health literacy of VA patients. We evaluated the prevalence of low health literacy, patient characteristics associated with low health literacy, and whether low health literacy was associated with non-adherence to preoperative instructions among VA patients.

Methods: We administered a validated health literacy instrument (the Short Test of Functional Health Literacy in Adults - STOFHLA), assessed cognitive function, and asked questions regarding socio-demographic characteristics to patients attending a preoperative clinic at the VA Puget Sound Health Care System. Patients who met the STOFHLA criteria for inadequate or marginal health literacy were considered to have “low health literacy.” When patients returned for their scheduled procedures, adherence to preoperative instructions was assessed by patient self-report.

Results: Of 332 participants, the mean age was 58.2 years, 7% had < 8th grade education, and 12% had low health literacy.  Older adults (age > 65 years) were more likely to have low health literacy (25% vs. 5%, p < 0.001), as were patients with cognitive impairment, and those reporting < 8th grade education, unemployment, and annual incomes < $20,000 (p-values <0.01 for all). After controlling for education, employment, and cognitive impairment, the adjusted odds ratio for low health literacy for patients > 65 years was 4.0 (95%CI: 1.9-8.6).  Impaired cognitive function was also independently associated with increased odds of low health literacy (4.0; 95%CI: 1.6-9.9). A higher proportion of patients with low health literacy compared to those with adequate health literacy were non-adherent to preoperative medication instructions (37% vs. 21%, p=0.07). After controlling for age, marital status, number of medications, and cognitive function, low health literacy was associated with a trend toward increased non-adherence to preoperative medication instructions (adjusted OR 1.9; 95%CI: 0.8-4.8).

Conclusions: Low health literacy was especially common among older VA patients and may be associated with lower adherence to preoperative medication instructions.

Impact: This study suggests that many VA patients may not have the literacy skills to participate fully in their care.  Larger studies are needed to evaluate health literacy in other VA populations and determine its effects on health outcomes.