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Health Literacy, Racial/ Ethnicity, and Knowledge of Labor Neuraxial Analgesia
Abstract Number: SAT-47
Abstract Type: Original Research
Background: Neuraxial analgesia is the most effective method of relieving labor pain; however, a racial/ethnic disparity exists in labor neuraxial analgesia use. The decision to use neuraxial labor analgesia is multifactorial, and incorporates both prior experiences and preconceived opinions of the procedure. Health literacy is the degree to which patients can understand basic health information. We hypothesized that patients with low health literacy will have less knowledge of neuraxial analgesia than patients with high health literacy.
Methods: A survey was developed and tested for content validity. In-person interviews were conducted upon admission to the labor and delivery ward, prior to a pre-anesthetic consultation at both Northwestern University and the University of Illinois at Chicago. Data collected included demographic data, analgesic plans, source of information on labor analgesia, knowledge of neuraxial analgesia, and health literacy evaluated by s-TOFLA. Inadequate health literacy was defined as an s-TOFLA score < 23. Data were analyzed using χ2 statistic. P <0.05 was significant.
Results: Two hundred patients were interviewed with 194 completing the survey. White patients were more likely to be married, college educated, have private insurance and higher incomes than minority patients (P<0.01 for all). Six patients had inadequate health literacy, and there were no differences in health literacy among the racial/ethnic groups (P=0.09). Patients with inadequate health literacy scored below the median on the neuraxial knowledge assessment (P=0.005). Patients with low neuraxial knowledge assessment scores were also less likely to use neuraxial analgesia compared to those with high scores (81% vs. 95%, P=0.02). Hispanics were least likely to plan and receive neuraxial analgesia for labor (P< 0.05 for both).
Conclusions: Although most patients had adequate health literacy, all patients with inadequate health literacy scored below the median on the neuraxial anesthesia knowledge assessment. Knowledge of neuraxial analgesia was associated with neuraxial analgesia use. Future studies should evaluate whether low-literacy prenatal educational interventions alter knowledge and use of neuraxial labor analgesia.