Exploring surgical patients' health literacy following the use of a patient safety checklist - A qualitative study.

Abstract

Low health literacy is common among surgical patients, with few interventions addressing this problem. A patient safety checklist (PASC) was developed to involve elective surgical patients in optimising health and safety before and after surgery. This study explores how PASC influences patients' health literacy. An explorative qualitative research design was utilised, including focus groups, dyadic, and individual interviews. The study is part of a multicentred, stepped wedge cluster randomized trial investigating various effects of PASC. A strategic sample of elective surgical patients (n = 20) who had utilised PASC were recruited from eight surgical wards from three hospitals in Norway. The interviews were analysed using content analysis at a thematic level. Two themes were identified. The first theme facilitating active self-management encompassed how PASC supported patients in understanding and managing their health by providing clear instructions and promoting awareness of critical information. It also helped patients organise health-related details and take proactive steps in their surgical care. The second theme impacting patients' communication and interactions demonstrated that PASC enhanced active dialogue with healthcare providers and encouraged patients to seek relevant information. Additionally, PASC supported patients in comparing and evaluating information to improve their understanding. Non-adherence to PASC was associated with several identified challenges and barriers. Findings suggest that PASC promote patients' health literacy and engagement by helping them manage complex health information throughout the surgical pathway. PASC has the potential to enhance patients' health literacy by providing clear and consistent information, as well as by strengthening organizational health literacy. Standardising health information through PASC may increase patients' awareness on safety issues and potentially contribute to the reduction of patient harm. The active involvement of healthcare professionals and their responsiveness to patients using PASC are essential to support these improvements. This study is associated with the trial entitled: "Development and Implementation of Patient Safety Checklists Before, During and After In-hospital-Surgery" a Stepped Wedge Cluster Randomized Controlled Trial. Registration date in the ClinicalTrials.gov, 20 March 2017, ID: NCT03105713.