# The association between quality of life, intensity of counseling and health literacy amongst patients with nephrolithiasis

## TL;DR

This study explores how counseling and health literacy affect quality of life in patients with kidney stones.

## Contribution

It identifies comprehensive counseling as a key predictor of improved health literacy in kidney stone patients.

## Key findings

- Patients who received comprehensive counseling had higher health literacy scores.
- Knowledge about oxalates was significantly better in those with comprehensive counseling.
- Correct response rates to prevention-related questions were generally poor.

## Abstract

The American Urological Association (AUA) provides guidance on primary prevention for nephrolithiasis; however, patient compliance is often poor. The role of healthy literacy in the primary prevention of nephrolithiasis is not well understood. Understanding kidney stone formers’ perceptions and knowledge of primary prevention is critical to evaluating their health literacy. This study aimed to assess these perceptions and explore how they relate to counseling intensity and quality of life among patients with nephrolithiasis.

A cross-sectional web-based survey was administered to a random sample of adult volunteers. Disease specific information was queried for stone formers and all participants were asked a series of questions based on the AUA Metabolic Stone Management Guidelines (2016) regarding primary prevention. Receipt of dietary counseling was categorized by comprehensiveness. Patient quality of life was assessed using the Wisconsin Stone Quality of Life questionnaire (WisQOL). Multivariable linear regression was used to identify predictors of stone-specific health literacy.

Of the 2482 participants, 429 (17%) reported prior stone history. Overall accuracy rates ranged from 10% to 98%. Stone patients with comprehensive counseling had the highest scores, driven by significantly better knowledge on oxalate-specific questions (p < 0.001). Multivariable linear regression showed receipt of comprehensive counseling (p = 0.032) was an independent predictor of higher primary prevention-specific health literacy.

Overall, correct response rates were poor, especially surrounding dietary oxalates. However, kidney stone formers who received more comprehensive counseling demonstrated. greater disease-specific knowledge, serving as a proxy for improved health literacy.

The online version contains supplementary material available at 10.1007/s00345-026-06336-x.