Effectiveness of cardiometabolic health education interventions in populations with lower educational attainment: A systematic review and meta-analysis.

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Health education is integral to cardiometabolic disease (CMD) management. Certain populations, such as people with lower educational attainment have higher risk of CMD and worse outcomes. They are also known to have differing preferences for health education formats and delivery compared with the general population. This study assessed the efficacy of CMD educational interventions in populations with lower educational attainment. Four databases (Medline, Proquest, CINAHL, and Google Scholar) were systematically searched to identify studies using an educational intervention, targeting CMD-related outcomes, in a population with low educational attainment, in a community or primary care setting. A random-effects meta-analysis was conducted to calculate pooled mean differences. Educational interventions were associated with statistically significant improvements at approximately 3 months, compared with baseline, in terms of BMI (mean difference [95 % confidence interval] = -0.27 [-0.42, -0.12] kg/m2; p < 0.001), weight (-0.20 [-0.35, -0.06] kg; p = 0.007), % fat in diet (-2.45 [-3.08, -1.81]; p < 0.001), systolic blood pressure (-0.51 [-0.98, -0.05] mmHg; p = 0.031), total cholesterol (-0.54 [-0.70, -0.38] mg/dL; p < 0.001), HbA1c (-0.46 [-0.74, -0.17] %; p = 0.002), physical activity (1.04 [0.43, 1.66] hours/week; p < 0.001), and CES depression score (-0.72 [-1.16, -0.27]; 0.002). However, where 12 or 24 month follow-up data were available, there were no statistically significant differences compared with baseline. CMD education interventions can improve multiple outcomes in the short term in people with lower educational attainment. Further work is needed around how such benefits may be maintained.