Evaluation of General and Musculoskeletal Health Literacy Disparities in Pediatric Sports Injury Patient and Guardian Populations

Abstract

Background: Increased participation of adolescents in organized sports has led to an increase in pediatric sports injury. Limited health literacy puts patients at risk for worse outcomes through decreased compliance. We aim to evaluate the extent of health literacy disparities in pediatric sports medicine populations. Methods: Patients aged 10 to 17 years and their consenting guardians visiting clinic for treatment of a sports-related injury completed a unique questionnaire including self-reported health literacy measures and direct assessment of knowledge regarding care for musculoskeletal injuries. Statistical analysis based on socioeconomic factors and demographics was performed using t tests. Results: A total of 268 patient surveys (14.37±1.94 y) and 251 guardian surveys (43.62±9.08 y) were collected. In self-reported general health literacy scores for guardians, all categories except ethnicity played a statistically significant role, with higher health literacy scores associated with higher education, use of English as the primary language at home, private insurance, and female guardians (P<0.001, <0.001, <0.001, 0.011). In contrast, age was the only factor affecting scores in the patient population (P=0.015). Among self-reported musculoskeletal health literacy and directly measured musculoskeletal literacy scores, there were significant differences in groups by age, primary language, and level of education (P=0.020, 0.003). Conclusions: Significant disparities in general and musculoskeletal health literacy exist within pediatric sports medicine populations, most notably between guardian groups. Improving disparities in health literacy for these populations may best be aimed at guardians, using medical education through verbal/written instruction in multiple languages. Level of Evidence: Level IV.

Readability of Patient Educational Materials in Sports Medicine

“…This can be achieved with the use of field testing and calculating PEM readability using easily accessible software, such as the one used in this study. Finally, measures such as providing multilingual PEMs that address cultural and linguistic barriers, which can significantly affect the health literacy of sports medicine patients, 60 may also enhance patient health literacy. Of the 5 websites assessed in this study, only the AAOS website provided multilingual content.…”

Caregiver Literacy in a Pediatric Orthopedic Population: A Cross-Sectional Study

“…Su et al reported significant disparities in musculoskeletal health literacy in pediatric sports medicine patients and caregivers [33] . They reported Caucasian guardians with private insurance as well as Englishspeaking and highly educated guardians were associated with higher directly assessed musculoskeletal health literacy.…”

A Health Equity Primer: Understanding and Addressing Inequities in Pediatric Orthopaedics

“…One root of inequitable orthopaedic care lies in disparate levels of patient comprehension of orthopaedic terminology and care instructions, which are lower in families with lower education levels, incomes, and levels of English proficiency. 26,27 This disparity is exacerbated by the inaccessibility of the patient education resources available on major society websites, many of which are written in complex language that lies above the average patient's level of reading comprehension. 28,29…”

“…30,31 Utilizing non-certified interpreters contributes to LEP patients/families facing decreased access to telehealth appointments, lower comprehension of orthopaedic terminology and treatments, and lower interpersonal satisfaction with the care that they receive. 26,27,32,33 The adult literature further demonstrates resultant disparities in quality of care and postoperative outcomes among non-English speaking patients. 6…”