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Spine J. 2018 Nov 2. pii: S1529-9430(18)31169-0. doi: 10.1016/j.spinee.2018.10.012. [Epub ahead of print]

The Impact of Health Literacy on Health Status and Resource Utilization in Lumbar Degenerative Disease.

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Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202.
Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202. Electronic address:
University of Louisville School of Medicine 323 E Chestnut St, Louisville, KY 40202.
Center for Health Services Research, University of Kentucky, 740 South Limestone, Lexington, KY 40536, USA.



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.


To determine the impact of health literacy in the evaluation and management of patients with chronic low back pain.


Cross sectional PATIENT SAMPLE: Patients seen at a multi-surgeon spine specialty clinic OUTCOME MEASURES: Oswestry Disability Index, EQ-5D and Numeric Rating Scales (0 to 10) for back and leg pain METHODS: The Newest Vital Sign (NVS) and Health Literacy Survey (HealthLitt) ODI, 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.


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 HealthLitt Scores. Patients with limited literacy had worse back and leg pain scores compared to patients with possibly limited literacy and adequate literacy.Patients with adequate health literacy were more likely to use medications (80% vs 53%, p=0.017) and were more likely to see a specialist (34% vs. 17%) compared to those with limited literacy. Patients with limited health literacy were not more likely to see a chiropractor (7% vs. 7%), but reported more average visits (19 vs 8).


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 under-utilize some resources and over-utilize other resources. Further study is needed to clarify these patterns, and to examine their impact on health status and clinical outcomes.


Health literacy; health related quality of life; low back pain; patient reported outcomes; resource utilization

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