Impact of YouTube videos and health literacy on postoperative healthcare utilization following pediatric urologic surgery
Julie W. Cheng, MD, MAE1, Dimitri Christakis, MD, MPH1, Brett Niessen, MPH1, Nicolas Fernandez, MD, PhD1, Paul A. Merguerian, MD, MS1, Kathleen Kieran, MD, Msc, MME1, Edward K. Chang, MD2, Margarett Shnorhavorian, MD, MPH1.
1Seattle Children's Hospital, Seattle, WA, USA, 2University of Washington, Seattle, WA, USA.
BACKGROUND: Limited caregiver health literacy has been associated with poorer health outcomes in pediatric patients and may limit caregiver understanding of printed education resources. Postoperative healthcare utilization can be related to confusion about instructions or concerns for postoperative complications. The purposes of this study were to correlate health literacy of caregivers of patients undergoing ambulatory urologic surgeries with postoperative healthcare utilization and to evaluate the effect of instructional video supplementation on postoperative healthcare utilization.
METHODS: From July through December 2021, a prospective, randomized, double-blinded trial assessed differences in postoperative healthcare utilization by caregiver health literacy and access to supplemental education videos. Educational videos were created and uploaded to YouTube regarding general postoperative care and care after penile, groin or testicular, and hypospadias surgeries. The study included caregivers of patients undergoing outpatient urologic surgeries. Health literacy was measured by the validated Brief Health Literacy Screener. Caregivers were randomized 1:1 by surgery type to receive access to supplemental YouTube videos (intervention) or standardized printed postoperative instructions (control). The urology team was blinded to health literacy and group assignments and caregivers were blinded to intervention and outcomes. Medical record abstraction was completed 30 days following surgery to identify postoperative healthcare utilization and complications defined by the Clavien-Dindo scoring system. Primary outcome was postoperative healthcare utilization in the form of calls, MyChart messages, add-on clinic visits, or presentation for urgent or emergent care up to 30 days following surgery.
RESULTS: Target enrollment was achieved with 400 patient-caregiver dyads enrolled with 204 in the intervention group and 196 in the control group. There was a 32.5% overall rate of caregivers contacting the clinic or seeking medical evaluation. Of caregivers that called or sought medical attention, those in the intervention group initiated contact one time with a single issue (median 1 time with IQR 1, 2.3) compared to those in the control group who initiated contact multiple times (median 2 times with IQR 1,3) and had more than one issue that needed to be addressed (p<0.001). Adjusting for health literacy score, patient age, hypospadias surgery, and caregiver education, there was a 64% reduction (OR=0.36, 95 CI 0.16, 0.80) of initiating contact more than once amongst caregivers that received intervention compared to those in the control group (p=0.012). Health literacy was associated with caregiver education level (p<0.001). Sub-analysis of the control group demonstrated that total number of times that caregivers initiated contact increased with limited health literacy (p=0.005). For caregivers with limited health literacy, the effect of video intervention was more pronounced as there was a reduction in median calls from 2 to 0 calls with video intervention (p=0.0159).
CONCLUSIONS: Educational videos that supplement basic print postoperative instructions were associated with reduced early postoperative healthcare utilization after ambulatory pediatric urologic surgery. This effect is more pronounced in caregivers with limited health literacy.
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