Health Literacy Interventions and Outcomes: An Updated Systematic Review

Evidence report/technology assessment 03/2011; 199(199):1-941.
Source: PubMed


To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined.
We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010.
We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence.
We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites. The strength of evidence of numeracy studies was insufficient to low, limiting conclusions about the influence of numeracy on health care service use or health outcomes. Two studies suggested numeracy may mediate the effect of disparities on health outcomes. We found no evidence concerning oral health literacy and outcomes. Among intervention studies (27 randomized controlled trials [RCTs], 2 cluster RCTs, and 13 quasi-experimental designs), the strength of evidence for specific design features was low or insufficient. However, several specific features seemed to improve comprehension in one or a few studies. The strength of evidence was moderate for the effect of mixed interventions on health care service use; the effect of intensive self-management inventions on behavior; and the effect of disease-management interventions on disease prevalence/severity. The effects of other mixed interventions on other health outcomes, including knowledge, self-efficacy, adherence, and quality of life, and costs were mixed; thus, the strength of evidence was insufficient.
The field of health literacy has advanced since the 2004 report. Future research priorities include justifying appropriate cutoffs for health literacy levels prior to conducting studies; developing tools that measure additional related skills, particularly oral (spoken) health literacy; and examining mediators and moderators of the effect of health literacy. Priorities in advancing the design features of interventions include testing novel approaches to increase motivation, techniques for delivering information orally or numerically, "work around" interventions such as patient advocates; determining the effective components of already-tested interventions; determining the cost-effectiveness of programs; and determining the effect of policy and practice interventions.

    • "G. Moon et al. / Social Science & Medicine 143 (2015) 185e193 187 Berkman et al., 2011 "
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    ABSTRACT: The relative contributions of functional literacy and functional numeracy to health disparities remain poorly understood in developed world contexts. We seek to unpack their distinctive contributions and to examine how these contributions are framed by place-based deprivation and rurality. We present a multilevel logistic analysis of the 2011 Skills for Life Survey (SfLS), a representative governmental survey of adults aged 16-65 in England. Outcome measures were self-assessed health status and the presence of self-reported long-term health conditions. Exposure variables were functional literacy (FL) and functional numeracy (FN). Age, sex, individual socio-economic status, ethnicity, whether English was a first language, non-UK birthplaces, housing tenure and geography were included as potential confounders and mediators. Geography was measured as area-based deprivation and urban/rural status. FL and FN were both independently associated with self-assessed health status, though the association attenuated after taking account of confounders and mediators. For long-term conditions, the association with FN remained significant following inclusion of confounders and mediators whilst FL attenuated to non-significance. Rurality did not influence these associations. Area deprivation was a significant factor in attenuating the association between FL and self-assessed health status. Policy makers and health professionals will need to be aware of the distinctive impact of FN as well as FL when combating health inequalities, promoting health and managing long-term conditions.
    No preview · Article · Sep 2015 · Social Science [?] Medicine
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    • "However, there were still 31.9% of respondents who had low (problematic and inadequate) health literacy levels. This needs serious attention because of health literacy is a person's ability to access, understand and implement health information that is known or unknown health literacy is a basic skill needed someone to make decisions that will have an effect in improving the quality of health (Berkman et al ND., 2011). A health professional should have good health literacy so that the condition of the health literacy of the majority of students were still supposed to get attention and intervention, either through the curriculum, and non-curriculum, for example by making health information more accessible. "
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    ABSTRACT: Introduction: Health literacy is new term in Indonesia but it has become a health determinant in the world. Health education institutions, such as the Faculty of Health Sciences yields graduates who eventually became a health provider. Assessment of health literacy on students is very important because they come from different high schools, different regions, who have different social backgrounds, cultures and access to information and health services. Methods: This was cross sectional study, used online questionnaire. The study population was first semester 285 students at Faculty of Health Sciences of Dian Nuswantoro University, until the end of the study period, 69 students filled out the online questionnaire form. The questionnaire of health literacy consisted of HLS-EU-16 (Health Literacy Survey-Europe-16 Questions), eHEALS (eHealth Literacy Scale) and NVS (The Newest Vital Sign). Results: Low health literacy problems were happened on 31.9% of respondents. Factors associated with health literacy on student were age, frequency of access to health information through TV and radio, access to health information through the internet and mobile phones, eHEALS, functional health information / NVS. Respondents who had good health literacy tended to use health services actively and more likely to ask questions during a consultation with a doctor. Health literacy correlated with general health conditions.
    Full-text · Conference Paper · Apr 2015
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    • "Health literacy is an essential aspect of self-management and shared decision-making to improve health outcomes in patients with stroke. Numerous studies have highlighted the importance of an adequate level of health literacy to the disease management process [11] [12] [13] [14] and noted that inadequate health literacy is a potentially modifiable determinant of poor health outcomes in people with chronic disease [15] [16] [17] [18]. Thus, it is important to assess "
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    ABSTRACT: We aimed to validate a Mandarin version of the short-form Health Literacy Scale (SHEAL) in patients with stroke. Each patient with stroke was interviewed with the SHEAL. The Public Stroke Knowledge Quiz (PSKQ) was administered as a criterion for examining the convergent validity of the SHEAL. The discriminative validity of the SHEAL was determined with age and education level as independent grouping variables. A total of 87 patients with stroke volunteered to participate in this prospective study. The SHEAL demonstrated sufficient internal consistency reliability (alpha=0.82) and high correlation with the PSKQ (r=0.62). The SHEAL scores between different age groups and education level groups were significantly different. The SHEAL, however, showed a notable ceiling effect (24.1% of the participants), indicating that the SHEAL cannot differentiate level of health literacy between individuals with high health literacy. The internal consistency reliability, convergent validity, and discriminative validity of the SHEAL were adequate. However, the internal consistency reliability and ceiling effect of the SHEAL need to be improved. The SHEAL has shown its potential for assessing the health literacy of patients with stroke for research purposes. For clinical usage, however, the SHEAL should be used with caution. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Mar 2015 · Patient Education and Counseling
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