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Original Research (Original Article) 


Adel Saeed Eid Alghamdi et al, 2019;3(8):676–680.

International Journal of Medicine in Developing Countries

Orthopedic foot and ankle patients’ knowledge: a cross-sectional study

Adel Saeed Eid Alghamdi1*, Abdullah Saad Al-Zahrani1, Seraj Mohammad Al-Zahrani1, Mohammed Mahdi Alghamdi1, Ahmed Saleh Minqash1, Hatem Tarig Alzahrani1

Correspondence to: Adel Saeed Eid Alghamdi

*King Fahad Hospital, Al-Baha, Saudi Arabia.

Email: dr.adelhannash [at] gmail.com

Full list of author information is available at the end of the article.

Received: 15 January 2019 | Accepted: 30 January 2019


ABSTRACT

Background:

People with limited health literacy may not effectively communicate with their doctors and may lack the skills needed to make accurate health decisions. That is why it is an essential that health care providers have insight into patients’ baseline medical knowledge, as this may help doctors customize their approach to the treatment plan for each patient. The current study aimed to assess orthopedic foot and ankle patients’ knowledge using “The Foot and Ankle Literacy Survey.”


Methodology:

An online survey was conducted (October and November 2018) was conducted for evaluating patient knowledge of foot and ankle terminology, anatomy, conditions, treatment, and perioperative considerations. The performance was assessed as a function of participants’ demographic factors.


Results:

A total of 250 participants participated in our study. A significant improvement in the performance correlated with higher levels of education (college, p = 0.008), patient type (preoperative visit, p = 0.003), and a current or previous health care employee (p = 0.001). Gender was significantly related with the performance improvement in the perioperative considerations (p = 0.001). Education was associated with markedly improved performances in the terminology (p = 0.02), conditions and treatment (p = 0.001), and perioperative considerations (p = 0.001) categories. Being a health care employee or professional was associated with significantly (p = 0.02) enhanced performances in the perioperative considerations category. Health care visit type was associated with significantly (p = 0.02) improved performances in the anatomy category.


Conclusion:

Education, health care experience, visit type, and prior visits to health care providers for foot and ankle complaints were significantly found to improve the questionnaire performance.


Keywords:

Health literacy (HL), FALS, foot, ankle.


Introduction

Health literacy (HL) can be seen as the property of literacy skills and the ability to perform knowledge-based literacy tasks that are required to make health-related decisions in a variety of different environments (home, community, and health clinic). HL has been defined and conceptualized in multiple ways [1,2] reacting the range of cognitive and social skills that enable people to obtain, understand, and use the information to enhance their health and well-being, and engage in health care decision-making [3,4]. The concept has also been developed in two distinctive settings in clinical care where HL is most often viewed as a risk factor for poor health and poor compliance with health care advice; and in public/community health where HL can be considered to be in a personal and population asset offering greater autonomy and control over health decision-making [5,6]. It is necessary for everyone to obtain and process the basic health information and services needed to make informed health decisions [7,8]. An estimated 33%–68% of Americans have inadequate HL, which is troubling, as limited HL impedes the effective dissemination and comprehension of relevant health information and also complicates communication, compromises care, and leads to critical outcomes [912].

The adverse issues associated with limited literacy included poor health, prolonged hospitalizations, worse control of chronic conditions, the infrequent use of preventive services, increased use of emergency services, and early death [8]. Conversely, patients with adequate HL experience are more effective with their physicians and are better to have appropriate treatment decisions [13,14]. It was found that patients with limited HL are susceptible to adverse outcomes. It is urgent to identify characteristics related to these poor traits, healthcare policy aimed at improving HL could be performed more efficiently. It was demonstrated that many patients were ignorant of musculoskeletal-specific HL, its terminology, anatomy, conditions and treatment, and perioperative considerations categories [1518]. Through the use of a questionnaire, this study investigated foot and ankle patients’ knowledge in the categories of foot and ankle-related terminology, anatomy, conditions, treatment, and perioperative considerations. It also evaluated the relationship between patients’ demographic factors and foot and ankle-specific knowledge. The current study aimed to assess orthopedic foot and ankle patients’ knowledge using the Foot and Ankle Literacy Survey (FALS).


Subjects and Methods

A total of 250 patients from Al-Baha completed the FALS questionnaire from June to October 2018. It was composed of two parts. The first was a demographic section consisting of questions regarding age, gender, level of education, employment status, visit type (new patient preoperative evaluation, postoperative visit, and non-operative follow-up), symptomatic anatomic region (ankle, hindfoot, midfoot, and forefoot), and whether the patient had been seen previously by a health care provider for foot and ankle complaints. The second part of the FALS consisted of 14 questions assessing patients’ foot and ankle knowledge. Questions were based on the following four categories, though were presented in mixed order: terminology, anatomy, conditions and treatment, and perioperative considerations. This approach to questionnaire design was derived from a prior study describing the development and validation of a musculoskeletal-specific HL assessment tool. Participants’ overall and categorical performance (e.g., terminology, anatomy, conditions and treatment, and perioperative considerations) on the FALS was determined. The total and categorical scores were then evaluated as a function of patients’ demographic traits. Significant differences between FALS performance and demographic characteristics were assessed by Wilcoxon rank sum and Kruskal-Wallis testing, depending on the number of variables within each demographic category. The study was done under the supervision of King Fahad Hospital, Al-Baha, Saudi Arabia.


Results

Table 1 showed that among the total 250 participants in the present study, more than one-half (56%) of participants were between 41 and 60 years old, 20% were between 21 and 40 years in age, 20% were older than 60 years old, while only 4% of them were lower than 21 years old. Two-thirds (68%) of participants were female, while only 32% were male. The majority of the respondents had a college degree or more (70%) and were not health care employee (72%). The majority of respondents (80%) have prior health care visit for foot and ankle complaint, more specifically, 40% of them have visited an orthopedic surgeon and 20% of them had visited orthopedic surgeon and podiatrist.

Table 1. Participants’ demographics.

Variables N = 250 (%)
Age (year) (Mean ± SD)
≤21
21–40
41–60
>60
45 ± 12.4
10 (4%)
50 (20%)
140 (56%)
50 (20%)
Gender
Male
Female
80 (32%)
170 (68%)
Education
College degree or more
A degree less than college
175 (70%)
75 (30%)
A health care employee/professional (currently or previously)
Yes
No
70 (28%)
180 (72%)
Prior health care visit for foot and ankle complaint
Yes
Orthopedic surgeon
Podiatrist
Orthopedic surgeon and podiatrist
Other No
200 (80%)
100 (40%)
25 (10%)
50 (20%)
25 (10%)
50 (20%)
Anatomic region
Ankle
Hindfoot
Midfoot
Forefoot
Not identified
20 (8%)
40 (16%)
10 (4%)
150 (60%)
30 (20%)

Table 2 demonstrated the relationship between participants’ demographic characteristics and overall FALS performance. Significantly better performance correlated with higher levels of education (college, p = 0.008), patient type (preoperative visit, p = 0.003), and a current or previous health care employee (p = 0.001).

Table 3 showed the correlation between respondent’s demographics and categorical performance. Age and anatomic region did not have significant associations with performance in any of the categories. Gender was significantly related to improved performances in the perioperative considerations (p = 0.001). Education was markedly associated with enhanced performances in the terminology (p = 0.02), conditions and treatment (p = 0.001), and perioperative considerations (p = 0.001) categories. Being a health care employee or professional was significantly (p = 0.02) associated with enhanced performances in the perioperative considerations category. Health care visit type was significantly (p = 0.02) associated with improved performances in the anatomy category.

Table 2. FALSE performance among study participants as a function of demographic characteristics.

Variables Mean + SD FALS p-value
Age (year) (Mean ± SD)
≤21
21–40
41–60
>60
9 + 1.2
10.2 + 1.9
9.9 + 2.4
9.7 + 2.6
0.1
Gender
Male
Female
10.4 + 2.2
9.6 + 1.4
0.9
Education
College degree or more
A degree less than college
10.5 + 1.8
9.1 + 2.9
0.0008
A health care employee/professional
(currently or previously)
Yes
No
10.4 + 1.6
9.2 + 2.4
0.001
Visit type
New
Pre-operative evaluation
Post-operative follow-up
Non-operative follow-up
Ambulatory care center
10.1 + 2.1
11 + 2
10.3 + 2.2
10.1 + 2.8
8 + 1.1
0.003
Prior health care visit for foot and ankle complaint
Yes
Orthopedic surgeon
Podiatrist
Orthopedic surgeon and podiatrist
Other
No
10.4 + 2.6
10.1 + 2.7
9.4 + 2.5
10.5 + 2.3
8.8 + 1.7
9.4 + 2.9
0.7
Anatomic region
Ankle
Hindfoot
Midfoot
Forefoot
10.3 + 2.7
10.4 + 2.1
9.3 + 3
10.4 + 2.2
0.4

Discussion

The present study has insight into the respondent’s knowledge of foot and ankle-related topics and to enhance our understanding of the relationship between demographics and performance. Age and anatomic region did not have significant associations with FALS performance in any of the categories. In the present study, two-thirds (68%) of participants were female, while only 32% were male. Gender was significantly related with improved performances in the perioperative considerations (p = 0.001) in FALS survey. The majority of our respondents (70%) had a college degree or more. Higher levels of education significantly (college, p = 0.008) correlated with better performance. Education was markedly associated with improved performances in all FALS categories; the terminology (p = 0.02), conditions and treatment (p = 0.001), and perioperative considerations (p = 0.001). HL can be improved through education and can be regarded as a measurable outcome for health education in the same way which measures of literacy are used as one way of assessing the success of school education. Improvements in HL can be measured through changes to the knowledge and skills that support greater autonomy in health decision-making. This knowledge and related skills can be developed through formal health education or patient education that is designed to meet individual needs and circumstances. As with all forms of education, marked differences in educational methods, media, and content will result in different learning outcomes and associated health outcomes [19]. Our results found that the majority of respondents (80%) have prior health care visit for foot and ankle complaint, more specifically, 40% of them have visited an orthopedic surgeon, and 20% of them had visited orthopedic surgeon and podiatrist. Health care visit type was significantly (p = 0.02) associated with improved FALS performances in the anatomy category. Patients presenting for perioperative follow-up (p = 0.003) had better performance on the FALSE. The patients presenting for their preoperative evaluations had been using other resources to learn about foot and ankle conditions, their specific diagnosis, and planned interventions, which could have contributed to their higher FALS scores. It was hypothesized that an improved service organization could enhance the quality of communication between patients and health care providers. The restricted time available in clinical consultations will often limit contact with factual information on health risks and the way to use medications and health care services. Patient education of this type will usually be directed toward better outcomes—such as achieving compliance with the use of prescribed medicines. Patient education in the clinic can also contribute to the development of a broader range of knowledge and skills necessary for successful self-management of chronic disease [5]. One’s ability to make informed health-related decisions relies on HL, the ability to comprehend necessary health information, and an underlying foundation of knowledge [7]. Our results showed that, significantly better performance correlated current or previous health care employee (p = 0.001). Being a health care employee or professional was significantly (p = 0.02) associated with enhanced performances in the perioperative considerations category. Previous studies are consistent with our findings, as they have identified poor postoperative comprehension in patients following orthopedic surgery [20]. It was suggested that patients had low awareness and recalled immediately following a discussion of the consent form and that it further deteriorated by the first postoperative visit [21]. It was also found limited postoperative comprehension among orthopedic trauma patients, who demonstrated a limited understanding of their injuries, surgeries, and postoperative instructions [21].

Table 3. Participants’ categorical performance on the FALS as a function of demographic characteristics.

Variable Terminology
(p value)
Anatomy
(p value)
Conditions and treatment
(p value)
Perioperative considerations
(p value)
Age 0.1 0.8 0.2 0.08
Gender 0.9 0.3 0.3 0.01
Education 0.02 0.8 0.001 0.001
Health care (employee/Professional) 0.7 0.4 0.02
Visit type 0.4 0.02 0.06 0.06
Prior health care visit for foot and ankle complaint 0.03 0.9 0.1 0.2
Anatomic region 0.6 0.09 0.07 0.4

Conclusion

This work demonstrated the use of a questionnaire to enhance our understanding of what foot and ankle patients do and do not know. The current study suggests that patients may lack essential foot and ankle-specific knowledge, and that demographic variable may correlate with performance.


List of Abbreviations

FALS Foot and Ankle Literacy Survey
HL Health literacy

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

A verbal approval was sought from King Fahad Hospital to conduct this study.


Author details

Adel Saeed Eid Alghamdi1, Abdullah Saad Al-Zahrani1, Seraj Mohammad Al-Zahrani1, Mohammed Mahdi Alghamdi1, Ahmed Saleh Minqash1, Hatem Tarig Alzahrani1

  1. King Fahad hospital, Al-Baha, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alghamdi ASE, Al-Zahrani AS, Al-Zahrani SM, Alghamdi MM, Minqash AS, Alzahrani HT. Orthopedic foot and ankle patient knowledge: a cross-sectional study.. IJMDC. 2019; 3(8): 676-680. doi:10.24911/IJMDC.51-1547590647


Web Style

Alghamdi ASE, Al-Zahrani AS, Al-Zahrani SM, Alghamdi MM, Minqash AS, Alzahrani HT. Orthopedic foot and ankle patient knowledge: a cross-sectional study.. http://www.ijmdc.com/?mno=26400 [Access: July 23, 2019]. doi:10.24911/IJMDC.51-1547590647


AMA (American Medical Association) Style

Alghamdi ASE, Al-Zahrani AS, Al-Zahrani SM, Alghamdi MM, Minqash AS, Alzahrani HT. Orthopedic foot and ankle patient knowledge: a cross-sectional study.. IJMDC. 2019; 3(8): 676-680. doi:10.24911/IJMDC.51-1547590647



Vancouver/ICMJE Style

Alghamdi ASE, Al-Zahrani AS, Al-Zahrani SM, Alghamdi MM, Minqash AS, Alzahrani HT. Orthopedic foot and ankle patient knowledge: a cross-sectional study.. IJMDC. (2019), [cited July 23, 2019]; 3(8): 676-680. doi:10.24911/IJMDC.51-1547590647



Harvard Style

Alghamdi, A. S. E., Al-Zahrani, . A. S., Al-Zahrani, . S. M., Alghamdi, . M. M., Minqash, . A. S. & Alzahrani, . H. T. (2019) Orthopedic foot and ankle patient knowledge: a cross-sectional study.. IJMDC, 3 (8), 676-680. doi:10.24911/IJMDC.51-1547590647



Turabian Style

Alghamdi, Adel Saeed Eid, Abdullah Saad Al-Zahrani, Seraj Mohammad Al-Zahrani, Mohammed Mahdi Alghamdi, Ahmed Saleh Minqash, and Hatem Tarig Alzahrani. 2019. Orthopedic foot and ankle patient knowledge: a cross-sectional study.. International Journal of Medicine in Developing Countries, 3 (8), 676-680. doi:10.24911/IJMDC.51-1547590647



Chicago Style

Alghamdi, Adel Saeed Eid, Abdullah Saad Al-Zahrani, Seraj Mohammad Al-Zahrani, Mohammed Mahdi Alghamdi, Ahmed Saleh Minqash, and Hatem Tarig Alzahrani. "Orthopedic foot and ankle patient knowledge: a cross-sectional study.." International Journal of Medicine in Developing Countries 3 (2019), 676-680. doi:10.24911/IJMDC.51-1547590647



MLA (The Modern Language Association) Style

Alghamdi, Adel Saeed Eid, Abdullah Saad Al-Zahrani, Seraj Mohammad Al-Zahrani, Mohammed Mahdi Alghamdi, Ahmed Saleh Minqash, and Hatem Tarig Alzahrani. "Orthopedic foot and ankle patient knowledge: a cross-sectional study.." International Journal of Medicine in Developing Countries 3.8 (2019), 676-680. Print. doi:10.24911/IJMDC.51-1547590647



APA (American Psychological Association) Style

Alghamdi, A. S. E., Al-Zahrani, . A. S., Al-Zahrani, . S. M., Alghamdi, . M. M., Minqash, . A. S. & Alzahrani, . H. T. (2019) Orthopedic foot and ankle patient knowledge: a cross-sectional study.. International Journal of Medicine in Developing Countries, 3 (8), 676-680. doi:10.24911/IJMDC.51-1547590647