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Abstract
BackgroundThe primary aim of this review was to establish whether health literacy interventions, in adults, are effective for improving health literacy. Two secondary aims assessed the impact of health literacy interventions on health behaviours and whether health literacy interventions have been conducted in cardiovascular patients.MethodsA systematic review (Prospero registration: CRD42018110772) with no start date running through until April 2020. Eligible studies were conducted in adults and included a pre/post measure of health literacy. Medline, Embase, Eric, PsychINFO, CINAHL, Psychology and Behavioural Science, HMIC, Web of Science, Scopus, Social Care Online, NHS Scotland Journals, Social Policy and Practice, and Global Health were searched. Two thousand one hundred twenty-seven papers were assessed, and 57 full text papers screened to give 22 unique datasets from 23 papers. Risk of bias was assessed regarding randomisation, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting and other biases. Intervention reporting quality was assessed using the TIDieR checklist.ResultsTwenty-two studies were included reporting on 10,997 participants in nine countries. The majority of studies (14/22) were published in 2018 or later. Eight studies (n = 1268 participants) also reported on behavioural outcomes. Health literacy interventions resulted in improvements in at least some aspect of health literacy in 15/22 studies (n = 10,180 participants) and improved behavioural outcomes in 7/8 studies (n = 1209 participants). Only two studies were conducted with cardiovascular patients. All studies were at risk of bias with 18 judged as high risk. In addition, there was poor reporting of intervention content with little explication of the theoretical basis for the interventions.ConclusionsHealth literacy interventions can improve health literacy and can also lead to changes in health behaviours. Health literacy interventions offer a way to improve outcomes for populations most at risk of health inequalities. Health literacy is a developing field with very few interventions using clear theoretical frameworks. Closer links between health literacy and behaviour change theories and frameworks could result in higher quality and more effective interventions.Prospero registrationProspero registration: CRD42018110772
Highlights
The primary aim of this review was to establish whether health literacy interventions, in adults, are effective for improving health literacy
The evidence in this review suggests that health literacy interventions are effective at influencing behaviour, though as no study conducted mediation analysis, we are unable to confirm the direction of this influence
Even allowing for the strict inclusion criteria applied, 22 studies were found with health literacy interventions
Summary
The primary aim of this review was to establish whether health literacy interventions, in adults, are effective for improving health literacy. In 2012 the European Health Literacy Consortium [6] conducted a major review of the literature and developed a new definition of health literacy - “Health literacy is linked to literacy and entails people’s knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course.” (Pg.). In 2012 the European Health Literacy Consortium [6] conducted a major review of the literature and developed a new definition of health literacy - “Health literacy is linked to literacy and entails people’s knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course.” (Pg.3) Applying this definition suggests that health literacy pervades patient’s encounters with healthcare services at every level. More recently there has been a recognition of the responsibility that healthcare services have to ensure they are providing information in a way that patients can understand [9]
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