Which providers can bridge the health literacy gap in lifestyle risk factor modification education: a systematic review and narrative synthesis

Sarah Dennis,Anthony Newall,Elizabeth Denney-Wilson,Tim Shortus,Anna Williams,Jane Taggart,Nicholas Zwar,Mark F Harris

doi:10.1186/1471-2296-13-44

Abstract

BackgroundPeople with low health literacy may not have the capacity to self-manage their health and prevent the development of chronic disease through lifestyle risk factor modification. The aim of this narrative synthesis is to determine the effectiveness of primary healthcare providers in developing health literacy of patients to make SNAPW (smoking, nutrition, alcohol, physical activity and weight) lifestyle changes.MethodsStudies were identified by searching Medline, Embase, Cochrane Library, CINAHL, Joanna Briggs Institute, Psychinfo, Web of Science, Scopus, APAIS, Australian Medical Index, Community of Science and Google Scholar from 1 January 1985 to 30 April 2009. Health literacy and related concepts are poorly indexed in the databases so a list of text words were developed and tested for use. Hand searches were also conducted of four key journals. Studies published in English and included males and females aged 18 years and over with at least one SNAPW risk factor for the development of a chronic disease. The interventions had to be implemented within primary health care, with an aim to influence the health literacy of patients to make SNAPW lifestyle changes. The studies had to report an outcome measure associated with health literacy (knowledge, skills, attitudes, self efficacy, stages of change, motivation and patient activation) and SNAPW risk factor.The definition of health literacy in terms of functional, communicative and critical health literacy provided the guiding framework for the review.Results52 papers were included that described interventions to address health literacy and lifestyle risk factor modification provided by different health professionals. Most of the studies (71%, 37/52) demonstrated an improvement in health literacy, in particular interventions of a moderate to high intensity.Non medical health care providers were effective in improving health literacy. However this was confounded by intensity of intervention. Provider barriers impacted on their relationship with patients.ConclusionCapacity to provide interventions of sufficient intensity is an important condition for effective health literacy support for lifestyle change. This has implications for workforce development and the organisation of primary health care.

Highlights

People with low health literacy may not have the capacity to self-manage their health and prevent the development of chronic disease through lifestyle risk factor modification
We could not identify established tools for measuring interactive and critical health literacy so we looked to the self management literature for instruments that measure the concepts of self-efficacy, patient motivation, confidence and broader social support such as the Diabetes Self Efficacy Scale, the Social Support Survey and measures of Prochaska and DiClemente’s Stages of Change Model [26]
Health literacy and SNAPW risk factor were both improved for 61% (14/23) of interventions to address nutrition, 54% (15/28) for physical activity, 43% (3/7) for weight and 40% (6/15) for smoking

Summary

Introduction

People with low health literacy may not have the capacity to self-manage their health and prevent the development of chronic disease through lifestyle risk factor modification The aim of this narrative synthesis is to determine the effectiveness of primary healthcare providers in developing health literacy of patients to make SNAPW (smoking, nutrition, alcohol, physical activity and weight) lifestyle changes. The Australian National Primary Health Care Strategy [1] and Council of Australian Governments (COAG) Australian Better Health Initiative (ABHI) include key priority areas that focus on improved chronic disease prevention and screening of those with at least one risk factor for chronic disease [1] Integral to achieving this is to increase health literacy in relation to modifying the behavioural risk factors of smoking, nutrition, alcohol, physical activity and weight (SNAPW). High levels of health literacy are associated with specific health promoting behaviours such as eating five portions of fruit and vegetables per day or being a non-smoker independently of age, education, gender, ethnicity or income [13,14]

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Discussion

Conclusion