Abstracts

Rationale: Health literacy (HL) entails the processes by which individuals “obtain, process, understand, and communicate about health-related information needed to make informed health decisions.” An estimated 30-50% of people with epilepsy (PWE) have low HL, which holds implications for epilepsy management and surgical decision-making. Little is known about the neuropsychological correlates of HL in epilepsy despite the clear cognitive demands of understanding, evaluating, and applying complex health information. The current investigation explored the relationships among HL, epilepsy clinical variables, and neuropsychological factors in PWE presenting to a Level 4 epilepsy center in consideration of or following surgical treatment.

Methods: This cross-sectional, correlational study included a consecutive series of 103 PWE presenting for pre- or post-surgical neuropsychological evaluation who completed the Newest Vital Sign and Brief Health Literacy Screener and 25 demographically comparable healthy adults. The participants with epilepsy also completed a comprehensive neuropsychological battery. Analyses included product-moment correlations, ANOVA, and linear multiple regressions to predict HL. A standard critical alpha of .05 was used for all analyses. Given the number of analyses conducted in each domain, Benjamini-Hochberg False Discovery Rate adjustments was used for the pairwise analyses.

Results: PWE had significantly lower HL as compared to healthy adults at a medium-to-large effect size. In a series of multiple regression models covarying for education and oral word reading literacy in the epilepsy sample, lower HL was independently associated with bilateral or generalized seizure onsets, greater antiseizure medication burden, and poorer performance on measures of language and information processing speed.

Conclusions: PWE are at risk for low HL, particularly in the context of longer epilepsy duration, higher ASM burden, and more widely distributed seizure networks. This may reflect shared underlying pathophysiology. Expressive language skills were unique predictors of HL and may impact surgical decision-making given the need to comprehend complex information, generate appropriate questions, and integrate competing factors to establish a personalized risk-benefit calculation. Assessment of health literacy may be considered as part of the surgical counseling process to promote best outcomes.



Funding: None