Does Patient Health Literacy Affect Patient Reported Outcome Measure Completion Method in Orthopaedic Patients?

Introduction: PROMIS® Computer Adaptive Testing (CAT) is a testing tool for tracking patient-reported outcome measures (PROM) with a goal to improve individual and population outcomes. Patients' health literacy (HL) may affect how they are able to complete PROM. We hypothesized that patients with low HL were less likely both to complete surveys and to do so via online patient portal (OPP).

Methods: A retrospective cohort study of 3926 orthopaedic patients in a rural state was performed. Completion rate and completion method both were subjected to log-binomial regressions with patient demographics and HL as predictor variables.

Results: PROM surveys were completed by 2166 (55.2%) of patients, including 512 completed via OPP and 1654 completed via in-clinic tablet (ICT). Compared to high HL patients, low HL patients had a 23% higher non-completion rate, and low HL completers were 63% less likely to use OPP. Age and gender had significant (P < 0.05) associations with completion method, but not completion rate, whereas Area Deprivation Index (ADI) had significant associations with both. Compared to White patients, Black patients had a 25% higher non-completion rate, and Black completers were 49% less likely to use OPP.

Discussion: Our analysis shows that health literacy, demographics, and socioeconomic status affect both whether and how patients fill out PROM surveys. Patients with low HL were less likely to complete PROM surveys, and less likely to use the OPP when they did.

Conclusion: Our results demonstrate that patients' health literacy, demographics, and socioeconomic status affect both whether they complete their PROMIS® CAT and what method they complete it with. Additional efforts should be made to understand these factors, accommodate patients, and facilitate accurate and complete PROM responses, especially in hospitals that serve diverse and socioeconomically disadvantaged patients.