Harsono Alfonsus Adrian Hadikusumo, Kim Gina, English Nathan C, Naik Gurudatta A, Velagala Dinakar Sai, Wong Kristen, Stahl Richard D, Grams Jayleen M, Chu Daniel I, Mustian Margaux N
Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1808 7Th Ave S, BDB 564, Birmingham, AL, 35294-0016, USA.
Department of Surgery, University of Cape Town, Cape Town, South Africa.
Surg Endosc. 2025 Jul 8. doi: 10.1007/s00464-025-11916-w.
Bariatric surgery utilization is low in the Deep South despite the high prevalence of obesity in the region. The impact of health literacy (HL) on access to bariatric surgery is unclear. We aim to assess the relationship between HL and patients' perspectives on healthcare, including bariatric surgical care in the Deep South.
A multi-institutional study was conducted in surgery clinics at three institutions in Alabama. Participants were recruited to complete a survey based on the NIH PhenX tool kit, assessing socioeconomic determinants of health, as well as perception of safety, efficacy, and accessibility of bariatric surgery. HL was measured based on BRIEF Health Literacy Screening tool and classified as high (score ≥ 17) or low (< 17). Bivariate analyses were performed.
A total of 127 participants were recruited, with 26.8% (n = 34) having low HL. Low HL patients reported lower household incomes and lower rates of post-secondary education (11.7% vs. 45.2%, p < 0.01). Participants with low HL also reported less understanding of prescribed medications (90.6% vs. 98.8%), awareness of available treatment options (71.9% vs. 90.0%), and trust in their doctors (91.2% vs. 98.9%; all p < 0.01). Moreover, low HL patients were more likely to have challenges in making an appointment (23.5% vs. 8.6%) and miss appointments due to transportation issues (44.1% vs. 17.2%, both p < 0.01). Although there were no differences in obesity rates, low HL patients were less likely to consider bariatric surgery if indicated (61.8% vs. 81.7%) and recommend bariatric surgery to others (52.9% vs. 72.0%; both p < 0.01).
Low HL patients in the Deep South reported less familiarity with healthcare treatment options, trust in their doctors, and likelihood to consider bariatric surgery when indicated. Community outreach and education programs addressing the unique needs of low HL patients are necessary to increase their awareness and improve their access to bariatric surgery.
尽管美国最南部地区肥胖症患病率很高，但该地区减肥手术的利用率却很低。健康素养（HL）对获得减肥手术的影响尚不清楚。我们旨在评估健康素养与患者对医疗保健的看法之间的关系，包括美国最南部地区的减肥手术治疗。
在阿拉巴马州三所机构的外科诊所进行了一项多机构研究。招募参与者完成一项基于美国国立卫生研究院（NIH）PhenX工具包的调查，评估健康的社会经济决定因素，以及对减肥手术的安全性、有效性和可及性的认知。基于简短健康素养筛查工具测量健康素养，并将其分为高（得分≥17）或低（<17）。进行了双变量分析。
共招募了127名参与者，其中26.8%（n = 34）健康素养低。健康素养低的患者家庭收入较低，高等教育率也较低（11.7%对45.2%，p < 0.01）。健康素养低的参与者对处方药的理解也较少（90.6%对98.8%），对可用治疗选择的认知较少（71.9%对90.0%），对医生的信任也较少（91.2%对98.9%；所有p < 0.01）。此外，健康素养低的患者在预约方面更有可能遇到困难（23.5%对8.6%），并且由于交通问题错过预约的可能性更大（44.1%对17.2%，两者p < 0.01）。尽管肥胖率没有差异，但健康素养低的患者如果有指征，考虑进行减肥手术的可能性较小（61.8%对81.7%），向他人推荐减肥手术的可能性也较小（52.9%对72.0%；两者p < 0.01）。
美国最南部地区健康素养低的患者对医疗保健治疗选择的熟悉程度较低，对医生缺乏信任，并且在有指征时考虑进行减肥手术的可能性较小。有必要开展针对健康素养低的患者独特需求的社区宣传和教育项目，以提高他们的认识并改善他们获得减肥手术的机会。
