Health Literacy, Treatment Choice, and Outcomes in Adult Spine Patients: A Systematic Review

Health literacy (HL) is a multidimensional construct influencing patients' ability to access, understand, and use health information. In certain clinical contexts, higher HL has been linked to improved treatment decision making and outcomes. Its role in patients with spinal complaints remains underexplored. We aim to systematically review existing literature examining the association between HL and treatment selection and outcomes in adult patients presenting with spinal complaints. Comprehensive literature search of PubMed, Embase, CINAHL, Web of Science, and Google Scholar (January 2005-June 2025) was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Inclusion required use of validated HL assessment and reporting of treatment selection or outcome data. Risk of bias assessed with the Joanna Briggs Institute checklist. Certainty of evidence evaluated using GRADE. Three cross-sectional studies met inclusion criteria. Higher HL was associated with reduced surgical acceptance and increased second opinion seeking. Adequate HL was linked to greater medication adherence and follow-up in one study. No significant association was found between HL and postoperative drug-related problems. Educational attainment correlated with HL but did not fully account for differences. Racial and ethnic data were not reported. Higher HL may influence treatment selection in spinal care by reducing surgical acceptance and promoting active decision making. Evidence for HL's impact on treatment adherence and outcomes is limited and mixed. The small number of studies, cross-sectional designs, and lack of diverse samples limit generalizability. Future longitudinal and interventional studies should clarify HL's role in spinal treatment pathways and inform the development of HL-sensitive interventions.