Adherence to Medical Appointments Among Patients Undergoing Bariatric Surgery: Do Health Literacy, Health Numeracy, and Cognitive Functioning Play a Role?

Excerpt

All patients included in this study (N = 210) underwent a laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy from 2016 to 2018 and completed a pre-surgical psychosocial evaluation. As part of this retrospective chart review study, demographic information, health literacy (ability to use health information for decision-making), health numeracy (ability to use health-related numerical information), cognitive functioning, and adherence to medical appointments were extracted from patients’ electronic medical records. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine and Rapid Estimate of Adult Literacy in Medicine-Short Form, with a reading level below 9^th grade indicative of limited health literacy [1]. The Brief Medical Numbers Test was used as a measure of health numeracy, using a cutoff of < 4/4 items correct to indicate limited health numeracy [2]. Lastly, the Montreal Cognitive Assessment was used to assess cognitive functioning, with a cutoff score < 26 to denote lower levels of cognitive functioning [3]. All health care appointments in the 2 years prior to a patient’s bariatric surgery were tallied, including the number of canceled, “no-showed,” and missed appointments (i.e., a sum of no-showed and canceled appointments). Post-surgery, the number of canceled, no-showed, and missed bariatric-only health care appointments were tallied within 1 year of patients’ surgery date. Percentages were calculated for the total number of missed and completed appointments both pre- and post-surgery. Approval was obtained by the institutional review board, and informed consent was waived because the study is retrospective. …