Bridging the Gap: Digital and Disease-Specific Literacy in Vascular Surgery Patients at an Urban Safety-Net Hospital.

Abstract

Patients undergoing vascular surgery have disproportionately high rates of limited health literacy, yet vascular disease-specific knowledge and digital health literacy remain poorly characterized in this population, particularly in a safety-net setting. We assessed both domains among vascular surgery patients at an urban safety-net hospital and examined their relationship. We conducted a prospective, cross-sectional study of adult vascular surgery patients across three outpatient clinic sites within a single urban safety-net institution over an eight-week period. Participants completed the Vascular Surgery Literacy Assessment Tool (VSLAT), a 24-item assessment, and the eHealth Literacy Scale (eHEALS), an 8-item measure of perceived digital health proficiency. Demographic and clinical data were collected. Bivariate analyses and multivariable linear regression were used to identify factors associated with each literacy domain and to characterize the relationship between them. Among 84 patients (mean age 64 years; 57.1% female; 48.8% white, 35.7% Black), the mean VSLAT score was 11.3 of 24 (47.1%), with 62.9% scoring at or below 50%. The mean eHEALS score was 24.7 of 40, with fewer than half of patients (43.5%) expressing confidence in using online health information. Black patients scored significantly lower on both vascular literacy (8.8 vs 13.4, p<0.001) and eHEALS (18.0 vs 28.6, p<0.001) compared to their white counterparts. Low household income was independently associated with lower eHEALS scores (β = -7.9, p<0.001). Vascular and digital literacy were moderately correlated (r = 0.541, p<0.001). After adjusting for eHEALS in the regression model, Black race was no longer associated with a lower vascular literacy score (β = -0.4, p = 0.71), suggesting that digital health literacy influences the observed racial disparity in vascular knowledge. Vascular surgery patients at a safety-net hospital demonstrated significant deficits in both disease-specific knowledge and digital health literacy, with disparities linked to race and socioeconomic status. Digital literacy impacted the relationship between race and vascular disease knowledge, highlighting the compounding effect of the digital divide on health inequity. These findings highlight the need for multimodal, literacy-adapted educational interventions tailored to address these barriers in vulnerable patient populations.