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Health Equity/Community Health

Poster Session 2

(508) Association of health literacy on patient decision quality regarding mode of delivery after cesarean

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Daisy Leon-Martinez, MD (she/her/hers)

Assistant Professor
University of California, San Francisco (UCSF)
San Francisco, CA, United States

Coauthor(s)

CB

Cinthia Blat, MPH

Data Systems Supervisor
University of California, San Francisco (UCSF)
San Francisco, CA, United States
Anjali J. Kaimal, MD (she/her/hers)

Professor and Vice Chair of Clinical Operations, Department of OBGYN
University of South Florida Morsani College of Medicine
Tampa, FL, United States
William A. Grobman, MD, MBA

Professor
The Ohio State University
Columbus, Ohio, United States
Miriam Kuppermann, PhD

Professor
University of California, San Francisco (UCSF)
San Francisco, CA, United States

Objective: To assess the association of health literacy with patient decision quality regarding mode of delivery after cesarean.

Study Design: Secondary analysis of a multicenter randomized trial of pregnant people with one prior cesarean and no prior vaginal birth after cesarean conducted 2016-19. Participants were randomized before 25 weeks’ gestation to use a tablet-based decision support tool focused on the choice between trial of labor after cesarean (TOLAC) and elective repeat cesarean delivery (ERCD) or to having usual care (no tablet) before deciding on a mode of delivery. Health literacy was assessed at enrollment using the Newest Vital Sign (NVS) tool. Validated scales measuring decision quality (knowledge, decisional conflict, shared decision-making, decision self-efficacy, decision satisfaction) were administered by phone at 34-37 weeks’ gestation. To assess the association of limited health literacy (defined as NVS score < =4/6) with decision quality, we calculated mean scores for each scale by level of health literacy (limited vs adequate) and estimated adjusted mean differences (aMD) using linear regression. Model covariates were selected by backwards stepwise regression.

Results: Compared to participants with adequate health literacy (n=1059), those with limited health literacy (n=396) had significantly lower knowledge scores (3.9 vs 5.4; aMD -0.8, 95% CI [-1.0, -0.5], p< 0.001). Scores were similar for decisional conflict (17.7 vs 17.2; aMD 0.0, 95% CI [-1.9, 2.0], p=0.971), shared decision-making (76.9 vs 73.9; aMD 1.5, 95% CI [-0.8, 3.8], p=0.196), decision self-efficacy (91.1 vs 90.4; aMD 0.4, 95% CI [-1.4, 2.2], p=0.685) and decision satisfaction (4.7 vs 4.6; aMD 0.4, 95% CI [0.0, 0.1], p=0.328).

Conclusion: Individuals with limited health literacy reported similar levels of decision quality compared to those with adequate health literacy but had lower knowledge scores. Future efforts should be directed towards understanding how best to support informed and values concordant decision making for individuals with limited health literacy.