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JAMA Surg. 2018 Aug 1;153(8):738-745. doi: 10.1001/jamasurg.2018.0672.

Association Between Functional Health Literacy and Postoperative Recovery, Health Care Contacts, and Health-Related Quality of Life Among Patients Undergoing Day Surgery: Secondary Analysis of a Randomized Clinical Trial.

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School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.



Day surgery puts demands on the patients to manage their own recovery at home according to given instructions. Low health literacy levels are shown to be associated with poorer health outcomes.


To describe functional health literacy levels among patients in Sweden undergoing day surgery and to describe the association between functional health literacy (FHL) and health care contacts, quality of recovery (SwQoR), and health-related quality of life.

Design, Setting, and Participants:

This observational study was part of a secondary analysis of a randomized clinical trial of patients undergoing day surgery and was performed in multiple centers from October 2015 to July 2016 and included 704 patients.

Main Outcomes and Measures:

The primary end point was SwQoR in the FHL groups 14 days after surgery. Secondary end points were health care contacts, EuroQol-visual analog scales, and the Short Form (36) Health Survey in the FHL groups.


Of 704 patients (418 [59.4%] women; mean [SD] age with inadequate or problematic FHL levels, 47 [16] years and 49 [15.1], respectively), 427 (60.7%) reported sufficient FHL, 223 (31.7%) problematic FHL, and 54 (7.7%) inadequate FHL. The global score of SwQoR indicated poor recovery in both inadequate (37.4) and problematic (22.9) FHL. There was a statistically significant difference in the global score of SwQoR (SD) between inadequate (37.4 [34.7]) and sufficient FHL (17.7 [21.0]) (P < .001). The patients with inadequate or problematic FHL had a lower health-related quality of life than the patients with sufficient FHL in terms of EuroQol-visual analog scale scores (mean [SD], 73 [19.1], 73 [19.1], and 78 [17.4], respectively; P = .008), physical function (mean [SD], 72 [22.7], 75 [23.8], and 81 [21.9], respectively; P < .001), bodily pain (mean [SD], 51 [28.7], 53 [27.4], and 61 [27.0], respectively; P = .001), vitality (mean [SD], 50 [26.7], 56 [23.5], and 62 [25.4], respectively; P < .001), social functioning (mean [SD], 73 [28.2], 81 [21.8], and 84 [23.3], respectively; P = .004), mental health (mean [SD], 65 [25.4], 73 [21.2], and 77 [21.2], respectively; P < .001), and physical component summary (mean [SD], 41 [11.2], 42 [11.3], and 45 [10.1], respectively; P = .004). There were no differences between the FHL groups regarding health care contacts.

Conclusions and Relevance:

Inadequate FHL in patients undergoing day surgery was associated with poorer postoperative recovery and a lower health-related quality of life. Health literacy is a relevant factor to consider for optimizing the postoperative recovery in patients undergoing day surgery.

Trial Registration: Identifier: NCT02492191.

[Indexed for MEDLINE]
Free PMC Article

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