# Patient health literacy and cognitive impairment surveys highlight barriers to patient-provider communication

## TL;DR

This study shows that providers often fail to recognize patients' health literacy and cognitive issues, which can hinder communication in urogynecology clinics.

## Contribution

The study introduces a novel approach to assess communication barriers by comparing patient health literacy and cognitive screening results with provider perceptions.

## Key findings

- Providers identified only 2 of 59 patients with mild cognitive impairment.
- 12% of patients could not correctly define all ten medical terms.
- Patients with lower health literacy had significantly lower cognitive screening scores.

## Abstract

Providers may underestimate patient health literacy, and patients may not understand commonly used medical terms. Undiagnosed cognitive impairment among Urogynecology and Reconstructive Pelvic Surgery (URPS) patients may further hinder communication. We assessed communication barriers between URPS clinic patients and their providers.

Following IRB approval, women aged 18–80 years attending outpatient visits were invited to participate. Non-English speakers and those with diagnosed cognitive impairment were excluded. Participants completed a health literacy measure (REALM-SF), a validated cognitive impairment screen (STMS questionnaire), and an 8th-grade level URPS Lexicon of ten medical terms. Providers, blinded to questionnaire results, then answered questions about their perception of the patient's health literacy and cognitive status.

From June to December 2024, 157 patients were invited to participate (9 declined). Of the 59 who scored in at least the mild impairment range (29–33) on the STMS, only 2 were noted by the provider as cognitively impaired. All words were correctly identified by 100 patients (68%), and at least 8 words by 82%. “Vagina” was the most commonly misdefined, followed by “bowel,” “pelvis,” and “urethra.” Providers identified 7 patients as having low health literacy, 4 of whom answered 6 or fewer words correctly, while 3 answered all 10 words correctly. Patients with lower health literacy had significantly lower STMS scores as compared to the patients with high-school level health literacy (p = 0.036).

Discrepancies between provider assessments and screening results highlight the need for improved recognition of cognitive impairment and health literacy to enhance communication and patient care.