The Cross-Sectional Association of Health Literacy With Healthy Lifestyle Behaviors in the Turkish Population: A Systematic Review and Meta-Analysis.

Abstract

To meta-analytically investigate the cross-sectional association between health literacy (HL) and healthy lifestyle behaviors (HLBs) in the Turkish population. Web of Science, PubMed, Scopus, EBSCO, DergiPark, TRDizin, and Türkiye Council of Higher Education Thesis Center. Not accessible in Turkish or English in full text; not on the Turkish population; addressed e-HL, digital HL, mobile HL or corporate HL; addressed HL in a specific context; did not seek any association between HL and HLBs. Cross-sectional studies that reported a correlation coefficient or any convertible equal statistical measure for the association between HL and HLBs. Two reviewers independently screened the articles, extracted the data from the included studies into a structured form and assessed their methodological quality. We conducted meta-analyses and reported the characteristics, outcomes, and quality assessment of studies. Of 3833 records accessed we included 52 that fulfilled the eligibility criteria. Our primary findings demonstrated positive low-to-moderate associations between HL and health-promoting behaviors (r = .32 [CI:.30-.35; I2 = .00]), HL and physical activity (r = .23 [CI:.18-.27; I2 = .12]), and HL and vaccination (r = .12 [CI:.07-.17; I2 = .00]). In contrast, HL was not significantly associated with non-smoking (r = .02 [CI:-.02-.36; I2 = .09]), healthy diet (r = .02 [CI:-.01-.06; I2 = .00]), and screening (r = .07 [CI:.04-.11; I2 = .07]). However, our sensitivity and meta-regression analysis results suggested that the association of HL with healthy diet seems to increase with age. On the other hand, we failed to find any convincing evidence of any of the included variables affecting the association between HL and all types of HLBs (r = .17, I2 = 95.81%). HL has the potential to improve the HLBs of Turkish individuals, however, there is a need for better understanding of the possible underlying determinants of the association between them.