Abstract
BackgroundLow health literacy is a common problem among older adults. It is often suggested to be associated with poor adherence. This suggested association implies a need for effective adherence interventions in low health literate people. However, previous reviews show mixed results on the association between low health literacy and poor adherence. A systematic meta-review of systematic reviews was conducted to study the association between health literacy and adherence in adults above the age of 50. Evidence for the effectiveness of adherence interventions among adults in this age group with low health literacy was also explored.MethodsEight electronic databases (MEDLINE, ERIC, EMBASE, PsycINFO, CINAHL, DARE, the Cochrane Library, and Web of Knowledge) were searched using a variety of keywords regarding health literacy and adherence. Additionally, references of identified articles were checked. Systematic reviews were included if they assessed the association between health literacy and adherence or evaluated the effectiveness of interventions to improve adherence in older adults with low health literacy. The AMSTAR tool was used to assess the quality of the included reviews. The selection procedure, data-extraction, and quality assessment were performed by two independent reviewers. Seventeen reviews were selected for inclusion.ResultsReviews varied widely in quality. Both reviews of high and low quality found only weak or mixed associations between health literacy and adherence among older adults. Reviews report on seven studies that assess the effectiveness of adherence interventions among low health literate older adults. The results suggest that some adherence interventions are effective for this group. The interventions described in the reviews focused mainly on education and on lowering the health literacy demands of adherence instructions. No conclusions could be drawn about which type of intervention could be most beneficial for this population.ConclusionsEvidence on the association between health literacy and adherence in older adults is relatively weak. Adherence interventions are potentially effective for the vulnerable population of older adults with low levels of health literacy, but the evidence on this topic is limited. Further research is needed on the association between health literacy and general health behavior, and on the effectiveness of interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2251-y) contains supplementary material, which is available to authorized users.
Highlights
Low health literacy is a common problem among older adults
It has been suggested that difficulty in adhering to medical advice may partly explain why low health literacy leads to poor health outcomes [11,12,13]
Reference lists of included systematic reviews were manually searched for further reviews that could add to our metareview
Summary
Low health literacy is a common problem among older adults. It is often suggested to be associated with poor adherence. Evidence for the effectiveness of adherence interventions among adults in this age group with low health literacy was explored. It has been suggested that difficulty in adhering to medical advice may partly explain why low health literacy leads to poor health outcomes [11,12,13]. Adherence can be defined as the extent to which a person’s behavior such as following a diet, taking medication, and/ or executing lifestyle changes, are in agreement with recommendations from a health professional [14]. This includes any behavior to prevent, cure, or care for health problems. Adherence may be an important factor through which health literacy impacts health outcomes
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