What health literacy interventions are effective in the primary healthcare settings in weight loss management—A systematic review

Abstract

To assess the effectiveness of health literacy interventions in achieving weight loss in adults with overweight or obesity. Studies were obtained from searches of 17 electronic bibliographic databases, hand searching, relevant websites, and personal communication. Intervention studies using experimental or quasi-experimental methods conducted in primary healthcare (PHC) or by a PHC professional outside the PHC setting with a minimum 6 months followup, published in the English language between 1989 and June 2013 in one of the OECD member countries. Studies where patients had any chronic disease were excluded. Three authors extracted data and one independently assessed trial quality. Nineteen studies were included with 3747 participants (71% females). Of these, 15 were patient-focussed, one provider-focussed and three studies addressed both. Three studies included elements of functional, 15 of interactive and one of critical health literacy. All targeted lifestyle (diet and physical activity). Fourteen studies were randomised trials with nine showing significant between-group weight loss differences over a period of 6—12 month follow up. All five nonrandomised trials showed significant weight losses over a period of 6—18 month follow up. Five studies included patients from a disadvantaged background. Participants in 11 studies were at a high risk of developing diabetes. Duration of studies was 9 months (8). The intervention was delivered individually (4), group sessions (9), mixed group and individual (3), internet only (1), mixed telephone and internet (1), and mixed telephone and individual (1). The intervention was delivered by diabetes educators, dieticians, health promotion and internet counsellors, lay leaders, medical practitioners, nurses, physiotherapists, physical activity specialists, psychologists, traditional wellness coordinators, and the Internet. The results of this review show the effectiveness of a variety of health literacy-focussed lifestyle modification programs, incorporating physical activity and dietary changes, in achieving weight loss.