Evidence on the effectiveness of health literacy interventions in the EU: a systematic review

Boudewijn B Visscher,Monique Heijmans,Iris van der Heide,Bas Steunenberg,Walter Devillé,Jany Rademakers,Jolien M Hofstede

doi:10.1186/s12889-018-6331-7

Abstract

BackgroundIn the last decade, the attention for health literacy has increased in the European Union. This is due to three main reasons. First, reviews have shown that inadequate health literacy is associated with worse health outcomes, higher health care use and expenditure. Second, in all European countries the population is aging and the number of chronically ill people is rising. Improving health literacy in this group can offer greater opportunities to take an active part in society, be independent and improve quality of life. Third, since most research on health literacy has been conducted outside Europe and relatively little is known about the development of health literacy interventions and its effects on outcome measures in European countries. The aim of this systematic review was to assess the evidence on the effectiveness of health literacy interventions in the European Union published between 1995 and 2018.MethodsSearches have been performed in Medline, PubMed, EMBASE, CINAHL, Cochrane library, PsychINFO, ERIC, Web of Science and SCOPUS for publications on health literacy intervention studies in European Union countries. Studies were included if the research was conducted in one or more Member States of the European Union, the publication described an intervention study, the intervention was aimed at health literacy, the publication described an outcome measure related to health literacy and the publication was written in English, French or German.ResultsA total of 23 studies were included. Three types of interventions were identified; aimed at improving health literacy, tailored to different health literacy levels and aimed at improving health outcomes in general that differentiated in effects for people with different health literacy levels. Most interventions identified in the review focus on the functional level of health literacy or numeracy. The strength of evidence from the European health literacy intervention studies was low and there was a huge heterogeneity in study design, measurement tools and outcomes measured.ConclusionsPromising interventions were tailored to the needs of patients, addressing functional, interactive and critical skills and use not difficult animated spoken text. Future research should focus on the development and assessment of such interventions and use stronger designs.

Highlights

In the last decade, the attention for health literacy has increased in the European Union
Health literacy is ‘linked to literacy and encompasses 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.’. This is the definition of health literacy as it was developed in the European Health Literacy Project (HLS-European Union (EU)) [1, 2]
Our literature search yielded 6206 publications between 1995 and mid-2018. Of these publications 6042 (97%) were excluded based on title and abstract because they did not fulfil one or more of the inclusion criteria: 3950 (65%) were excluded because not describing an intervention, 1037 (17%) did not meet the first criterion, 1024 (17%) of the European interventions were excluded because they were not focusing on health literacy and 26 (1%) of the studies were excluded because there was no health literacy outcome measure

Summary

Introduction

The attention for health literacy has increased in the European Union. Health literacy is ‘linked to literacy and encompasses 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.’. This is the definition of health literacy as it was developed in the European Health Literacy Project (HLS-EU) [1, 2]. Interactive health literacy refers to ‘more advanced cognitive and literacy skills which, together with social skills, can be used to actively participate in everyday situations, extract information and derive meaning from different forms of communication, and apply this to changing circumstances.’ [3] Critical health literacy refers to ‘more advanced cognitive skills which, together with social skills, can be applied to critically analyse information and use this to exert greater control over life events and situations’. [3] Most of existing research on health literacy focusses on functional health literacy

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