Identifying modifiable patient characteristics associated with low educational attainment in older cardiac surgery patients

Abstract

Background: Limited health literacy has consistently been demonstrated to have far-reaching consequences. It is associated with an increased number of hospitalizations, rehospitalizations, mortality and morbidity. Less educated adults were found to demonstrate lower health literacy skills. The “PREvention Decline in Older Cardiac Surgery patients” (PREDOCS) consult is developed for older cardiac surgery patients to reduce postoperative complications. This intervention seems to be less successful in less educated patients. The PREDOCS consult should thus be optimized. For this optimization, it is necessary to identify the patient characteristics that are responsible for not obtaining, understanding and/or applying health information. Aim: To determine if the patient problem solving, self-efficacy, motivation and patient participation is influenced by low educational attainment in older (≥ 65 years) elective cardiac surgery patients. Method: A cross-sectional design was used. This study focuses on the patient characteristics: self-efficacy, problem solving, motivation and patient participation. Three validated surveys, namely the Dutch General Self-Efficacy Scale (GSES), the Patient Activation Measure (PAM) and Self-Management Screening (SeMaS) are used to measure the modifiable patient characteristics. Conclusion is drawn based on multiple analysis. Results: In total, 41 patients consented to participate. Of these patients, 22 (53.7%) were less educated patients and 19 (46.3%) normally educated. The total score of GSES significantly differs between less educated and normally educated patients (P=0,043). However, when the data are corrected for age and gender, there is no significant association between education level and the PAM, SeMaS and GSES. Conclusion and recommendations: No significant associations were found between low educational attainment and modifiable patient characteristics in older (≥ 65 years) elective cardiac surgery patients. Further research focus on additional personal characteristics of less educated patients affecting health outcomes.