EP301 - Bridging Literacy and Language Gaps in Hemorrhoid Care: Developing and Implementing a Patient-Centered Educational Tool

Purpose/Background: Hemorrhoids are among the most common reasons for referral to colorectal surgery. Effective treatment relies heavily on patient education regarding diet and behavioral modifications, yet counseling may be challenging in populations with low health literacy and limited English proficiency. These barriers to education may prolong symptoms, increase clinic utilization, and lead to reliance on invasive treatments due to perceived failure of conservative management. To address this gap, we developed and implemented a patient-centered hemorrhoid teaching tool (HTT) in an urban safety-net colorectal surgery clinic serving a predominantly Spanish- and English-speaking population.

Methods/Interventions: We conducted 20 semi-structured patient interviews exploring treatment expectations, symptom perception, understanding of hemorrhoids, perceived causes, and treatment options. Interviews were thematically coded by two investigators, and findings directly informed development of the HTT. The tool was designed in English, forward-back translated into Spanish, and assessed for readability, understandability, and actionability using the Patient Education and Materials Assessment Tool (PEMAT). The HTT is currently in pilot testing with patients in both English and Spanish, with serial feedback and revision. Implementation will occur through three 2-month Plan-Do-Study-Act (PDSA) cycles. Effectiveness will be assessed using process and outcome goals focusing on reach (delivery of the HTT to >80% of eligible patients), comprehension (>80% patient recall of ≥2 self-management strategies and correctly describing the role of surgery), and impact (>50% demonstrating symptom improvement at 2-3-month follow-up, measured by the Short Health Scale for Hemorrhoidal Disease). Results will be plotted on run charts, with significant improvement identified using specific-cause variation.

Results/Outcomes: Thematic analysis of patient interviews revealed 3 major domains: (1) disease perception and expectations - many expected surgeons to "remove" or "fix" hemorrhoids while others sought reassurance against cancer; (2) knowledge of hemorrhoids and causes - although most recognized constipation, few associated hemorrhoids with diet or toileting behaviors; and (3) understanding of treatment - awareness was limited to symptomatic relief with creams or baths, with minimal mention of fiber or lifestyle modification. Surgical management was also poorly understood. Findings guided the HTT's development by a multidisciplinary team to address expectations, clarify causes, and provide actionable recommendations (Table 1). The HTT showed high PEMAT scores for understandability (88%, 87.5%) and actionability (87.5%, 100%). Pilot testing and implementation are ongoing; patient feedback, recall, and preliminary symptom impact will be available at presentation.

Conclusion/Discussion: Effective hemorrhoid treatment depends on patient education, yet health literacy and language barriers impede quality care in safety-net settings. Interviews identified substantial gaps in baseline knowledge and expectations, highlighting the need for structured education. Patient input guided HTT development to address the specific needs of the target population. Ongoing implementation will assess the HTT's effectiveness in improving patient knowledge, self-management behaviors, and symptom burden. This work underscores the value of patient-informed interventions in mitigating disparities and advancing equitable care.

Table 1. Key Qualitative Domains Informing Development of the Hemorrhoid Teaching Tool.
HTT, hemorrhoid teaching tool