DISP-06. Health Literacy and Neurosurgical Outcomes: A Systematic Review and Framework for Action

Limited health literacy (HL) is associated with worse clinical outcomes across medical specialties, but its association with neurosurgical outcomes remains largely unknown. Through a systematic review of the literature, we synthesize existing evidence of the association between limited caregiver and/or patient HL and worse neurosurgical outcomes. We also provide a framework for improving health literacy in the context of neurosurgical care. A systematic search was conducted in PubMed, Embase, CINAHL, and JBI EBP from inception to February 12, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study design, sample size, population of interest, neurosurgical diagnosis/procedure, health literacy assessment, pertinent findings, and related demographic factors were summarized. Our search yielded 698 titles and abstracts, 37 of which underwent full-text review, and 6 of which met inclusion criteria for this systematic review. These 6 studies encompassed 695 neurosurgical patients and/or caregivers and utilized various methods to assess HL. Sample sizes ranged from 27 to 300, and included pediatric, adult, and mixed (pediatric and adult) patient populations as well as caregivers of pediatric and adult patients. All six studies were conducted outside the United States. Limited HL was found to be associated with (1) delays in neurosurgical care, (2) increased rates of discharge against medical advice, (3) decreased patient independence, and (4) worse psychological well-being. Our results highlight that limited HL is associated with worse neurosurgical outcomes, and that there is a paucity of studies on patient outcomes among limited HL patients and/or caregivers. Standardized definitions and assessments of HL should be used in future research. Addressing limited HL should employ strategies such as using plain language, visual aids, and teach-back methods. Together, these concrete steps can help address critical health inequities in neurosurgical care.