The impact of health literacy on health status and resource utilization in lumbar degenerative disease

Steven D. Glassman, Leah Y. Carreon, Morgan E. Brown, Jeffrey S. Jones, Jean Edward, Jing Li, Mark V. Williams

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


BACKGROUND CONTEXT: Health literacy, defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,” has been demonstrated to affect access to care and appropriate healthcare utilization. PURPOSE: To determine the impact of health literacy in the evaluation and management of patients with chronic low back pain. STUDY DESIGN: Cross sectional. PATIENT SAMPLE: Patients seen at a multisurgeon spine specialty clinic. OUTCOME MEASURES: Oswestry Disability Index, EQ-5D, and Numeric Rating Scales (0–10) for back and leg pain. METHODS: The Newest Vital Sign (NVS) and Health Literacy Survey, Oswestry Disability Index, EQ-5D and pain scales were administered to patients undergoing evaluation and treatment for lumbar degenerative disease in the outpatient setting. Patients were surveyed regarding their use of medication, therapy, and pain management modalities. RESULTS: Of 201 patients approached for participation, 186 completed the health literacy surveys. Thirty (17%) were assessed as having limited literacy, 52 (28%) as possibly having limited literacy and 104 (56%) having adequate literacy based on their NVS scores. The cohort with low NVS scores also had low Health Literacy Survey Scores. Patients with limited literacy had worse back and leg pain scores compared with patients with possibly limited literacy and adequate literacy. Patients with adequate health literacy were more likely to use medications (80% vs. 53%, p =.017) and were more likely to see a specialist (34% vs. 17%) compared with those with limited literacy. Patients with limited health literacy were not more likely to see a chiropractor (7% vs. 7%), but reported more visits (19 vs. 8). CONCLUSIONS: Patients with lower health literacy reported worse back and leg pain scores, indicating either more severe disease or a fundamental difference in their responses to standard health-related quality of life measures. This study also suggests that patients with limited health literacy may underutilize some resources and overutilize other resources. Further study is needed to clarify these patterns, and to examine their impact on health status and clinical outcomes.

Original languageEnglish
Pages (from-to)711-716
Number of pages6
JournalSpine Journal
Issue number4
StatePublished - Apr 2019

Bibliographical note

Funding Information:
Author disclosures: SDG: Royalties: Medtronic (H); Consulting: Medtronic (F), K2M (E); Other Office: American Academy of Orthopaedic Surgeons (Nonfinancial, Registry Oversight Committee); Research Support - Staff and/or Materials: Norton Healthcare (A, Paid directly to institution/employer). LYC: Device or Biologic Distributorship (Physician-Owned Distributorship): Pfizer (C, Support for Phase 2b FDA IDE Staphylococcus aureus 4-antigen vaccine, Paid directly to institution/employer), IntelliRod (B, Paid directly to institution/employer); Trips/Travel: Center for Spine Surgery and Research, Region of Southern Denmark (Financial, Travel and accommodations for Study Planning Meetings 05/2017, 08/2017, 12/2017; 5,500.00); Scientific Advisory Board: University of Louisville Institutional Review Board (Nonfinancial), Scoliosis Research Society Research Committee (Nonfinancial), The Spine Journal (Nonfinancial, Editorial Advisory Board), Spine (Nonfinancial, Editorial Advisory Board), Spine Deformity (Nonfinancial, Editorial Advisory Board); Other Office: Norton Healthcare (Financial, Clinical Research Director - Salary), Center for Spine Surgery and Research, Lillebaelt Hospital, University of Southern Denmark (Both, Professor); Research Support - Staff and/or Materials: Texas Scottish Rite Hospital / Scoliosis Research Society (B, Research grant Scoliosis-Specific Exercises for At-Risk Mild AIS Curves, Paid directly to institution/employer). MEB: Research Support - Staff and/or Materials: Pfizer (C, Paid directly to institution/employer), TSRH (B, Paid directly to institution/employer), Intellirod (B, Paid directly to institution/employer). JSJ: Nothing to disclose; JE: Nothing to disclose; JL: Nothing to disclose; MVW: Nothing to disclose.

Publisher Copyright:
© 2018 Elsevier Inc.


  • Health literacy
  • Health-related quality of life
  • Low back pain
  • Patient reported outcomes
  • Resource utilization

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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