Spanish-speaking patients may have difficulty understanding their orthopedic injury, care
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Key takeaways:
- Patients who spoke Spanish as their primary language may have difficulty understanding their orthopedic injuries and treatment.
- These patients showed limited health literacy compared with other groups studied.
Patients who speak Spanish as their primary language and undergo orthopedic trauma surgery may show limited health literacy and have difficulty understanding their injury and treatment plans vs. patients who primarily speak English.
“It is essential that patients have a clear understanding of all aspects of their care and recovery to improve outcomes,” the researchers wrote in the study.
Researchers administered a cross-sectional questionnaire to 103 adults who underwent open reduction and internal fixation or intramedullary fracture fixation at a single orthopedic trauma clinic.
According to the study, researchers used the newest vital sign health literacy assessment, as well as knowledge scores to assess patients’ overall health literacy and comprehension of their injuries and treatment plans. They defined limited health literacy as a newest vital sign health literacy score of less than four.
Overall, 68% of patients (n = 70) spoke English as their primary language; 30% of patients (n = 31) spoke Spanish as their primary language; 1% of patients (n = 1) spoke Armenian as their primary language and 1% of patients (n = 1) spoke Korean as their primary language. Researchers noted 63% of patients were Hispanic, 33% of patients did not have a high school diploma and 50% of patients received disability from surgery.
Researchers determined 75% of patients had limited health literacy. They found patients who primarily spoke Spanish were 8.77 times more likely to have limited health literacy vs. patients who primarily spoke English, Korean or Armenian.
Researchers also noted patients who were older than 30 years of age were 4.17 times more likely to have low health literacy. In addition, patients with low health literacy were 3.52 times more likely to answer incorrectly regarding which bone was fractured and 4.14 times more likely to answer incorrectly regarding which narcotic medication was prescribed.
“Orthopedic providers should consider employing standardized assessments of health literacy, prioritize improving communication with patients to enhance their understanding of surgical procedures and discharge instructions and pay particular attention to patients who are primarily Spanish-speaking,” the researchers concluded.
Perspective
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The authors are to be commended for further identifying the health literacy gap in the U.S. health care system and furthering the presence of these factors in the orthopedic literature. Indeed, while prior work has also established the prevalence of poor health literacy of certain vulnerable populations, the authors also include native Spanish-speaking patients (often excluded from this type of research) and identified even greater gaps in health literacy.
This area of work has similarly motivated a deeper analysis of which populations are included in orthopedic clinical research, factors that can affect outcomes in clinical trials and its implications on clinical care delivery. For example, a prior study on American Academy of Orthopaedic Surgeons clinical practice guidelines for distal radius fractures found that linguistic, racial and ethnicity data were often lacking from the original research used to motivate the guidelines.
While this line of investigation is a necessary first step, we encourage the authors to continue highlighting potential disparities in care based on socioeconomic status, including language/literacy. Moreover, this line of work benefits from studying approaches to address these gaps in care equity. As clinicians actively treating patients and helping them navigate our complex health care system, we are best positioned to investigate methods to ensure equitable, patient-centered care to all patients, regardless of their socioeconomic status, race/ethnicity or primary language. I thank the authors for this important contribution.
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