Health Literacy Assessment Tools in Spine Surgery

Objective: To summarize and provide existing health literacy (HL) assessment tools used in spine surgery and identify their advantages, limitations, and gaps in measuring spine-specific health literacy. Summary of Background Data: Health literacy plays a crucial role in patient-reported outcomes (PROs), particularly in spine surgery, where complex decisions and comprehension are required. However, the current tools used to assess HL often lack spine-specific content and fail to address the multidimensional nature of HL, such as numeracy, print, and visual comprehension. Methods: A comprehensive search was conducted across PubMed, Embase, and Cochrane Library databases in August 2024. Studies published between 2014 and 2024, involving human participants and directly assessing HL in patients with spinal conditions, were included. Data on study design, HL tools, HL dimensions, and associated sociodemographic factors were extracted and analyzed descriptively. Results: Nine studies, encompassing 2958 spine patients, met the inclusion criteria. Eight HL tools were identified, including 3 objective (LiMP, NVS, and REALM-SF) and 5 subjective methods (BRIEF, verbal and visual comprehension tasks, surveys, and single-item screening questions). The studies covered various HL dimensions, including print literacy (n = 3), print and numeracy literacy (n = 1), combined print, oral, and numeracy literacy (n = 1), oral and visual comprehension (n = 2), and a mix of print and oral literacy (n = 1). Limited HL was reported in 9%–50% of patients and was associated with older age, lower education levels, non-native English speakers, and socioeconomic disparities. None of the tools specifically addressed spine-related literacy needs. Conclusion: Current HL tools used in spine surgery focus primarily on general literacy skills and lack spine-specific components. Developing a comprehensive, spine-focused HL tool that incorporates multiple dimensions is crucial to improving patient understanding and shared decision-making.