(19) Health Literacy Among Orthognathic Surgery Patients

Abstract: The orthognathic surgery process requires a significant amount of information transfer between the orthognathic surgeon and the patient including information navigating the surgeon-orthodontist collaboration, understanding the planned surgical procedures, and the perioperative process. The information transfer typically occurs over a 24 month treatment window through multiple appointments with face to face discussion and through patient education materials. Efficient and accurate transfer of information from the surgeon to the patient and their family allows for the patient to optimally navigate the process, participate in shared decision making and consent, and helps optimize patient outcomes.1,2 The purpose of this study is to quantify the health literacy of orthognathic surgery patients.
A retrospective cohort study was designed and implemented for patients who presented for orthognathic surgery evaluation at the University of Alabama at Birmingham Department of Oral and Maxillofacial Surgery between September 2021 and May 2022. Patients without complete data were excluded. Health literacy levels were assessed and recorded using the Brief Health Literacy Screening Tool (BRIEF, score range 4-20).
Eighty-six patients met inclusion criteria. The mean age was 25.1 + 12.5 years and 52% were female. The racial composition was 77% White, 14% Black, 6% Hispanic, 2% Asian patients. Ninety-three percent of the cohort reported English as their first language, 3.5% reported Spanish as their first language and 3.5% reported a first language that was neither English or Spanish. Sixty-eight patients were evaluated for a developmental dentofacial deformity (DFD), 12 patients for a cleft jaw deformity, and 6 patients for obstructive sleep apnea diagnosis.
The mean (SD) brief score was 18.7 + 2.8. Eighty-one percent of the participants demonstrated adequate health literacy scores, 14% with marginal scores, and 5% with limited scores. For patients presenting for orthognathic surgery evaluation, 19% had a marginal or limited health literacy score and may have difficulty understanding or participating in the perioperative discussion. For health literacy levels, age and facial deformity type (i.e. DFD, cleft-jaw, OSA) were statistically significant.
Approximately 1 in 5 patients presenting for orthognathic surgery evaluation were with marginal or limited health literacy scores. As lower health literacy levels have been associated with increase in post-operative complications, the surgical team should identify at risk patients and assure discussion as well as patient education materials are at an appropriate health literacy level.



References:
1. Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 27:1361-1367, 2012.

2. Chang ME, Baker SJ, Dos Santos Marques IC, et al: Health Literacy in Surgery. Health Lit Res Pract. 4: e46–e65. 2020.