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Cited by 292Health Literacy and Information AccessibilityPatient-Provider Communication in HealthcareHealth Policy Implementation Science

Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review

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Walters, Ronie, Leslie, Stephen J., Polson, Rob, Cusack, Tara, Gorely, Trish·2020·BMC Public Health
DOI 10.1186/s12889-020-08991-0PMC PMC7329558
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Abstract

Background: The primary aim of this review was to establish whether health literacy interventions, in adults, are effective for improving health literacy. Two secondary aims assessed the impact of health literacy interventions on health behaviours and whether health literacy interventions have been conducted in cardiovascular patients. Methods: A systematic review (Prospero registration: CRD42018110772) with no start date running through until April 2020. Eligible studies were conducted in adults and included a pre/post measure of health literacy. Medline, Embase, Eric, PsychINFO, CINAHL, Psychology and Behavioural Science, HMIC, Web of Science, Scopus, Social Care Online, NHS Scotland Journals, Social Policy and Practice, and Global Health were searched. Two thousand one hundred twenty-seven papers were assessed, and 57 full text papers screened to give 22 unique datasets from 23 papers. Risk of bias was assessed regarding randomisation, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting and other biases. Intervention reporting quality was assessed using the TIDieR checklist. Results: Twenty-two studies were included reporting on 10,997 participants in nine countries. The majority of studies (14/22) were published in 2018 or later. Eight studies (n = 1268 participants) also reported on behavioural outcomes. Health literacy interventions resulted in improvements in at least some aspect of health literacy in 15/22 studies (n = 10,180 participants) and improved behavioural outcomes in 7/8 studies (n = 1209 participants). Only two studies were conducted with cardiovascular patients. All studies were at risk of bias with 18 judged as high risk. In addition, there was poor reporting of intervention content with little explication of the theoretical basis for the interventions. Conclusions: Health literacy interventions can improve health literacy and can also lead to changes in health behaviours. Health literacy interventions offer a way to improve outcomes for populations most at risk of health inequalities. Health literacy is a developing field with very few interventions using clear theoretical frameworks. Closer links between health literacy and behaviour change theories and frameworks could result in higher quality and more effective interventions. Prospero registration: Prospero registration: CRD42018110772

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  • Animation, text or social media promotion, or apps help patients acquire health information more effectively.

    “For example, animation [357,358], text or social media promotion [359,360,361], or apps [362,363] help patients acquire health information more effectively [364].”

    From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [364]

    The Results sections on intervention characteristics and intervention effects report that animation and text or social-media interventions improved health literacy compared with controls. But the app study found no significant improvement, and the review measured health literacy rather than directly measuring how effectively patients acquired health information. (LLM, conf=0.88)

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Authors
Walters, R., Leslie, S. J., Polson, R., Cusack, T., & Gorely, T.
Affiliations
  • University of the Highlands and Islands (GB)
  • Raigmore Hospital (GB)
  • University College Dublin (IE)
Corresponding author
Walters, Ronie
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2020-06-30
Volume
20
Issue
1
Pages
1040-1040
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-020-08991-0
PMC
PMC7329558
OpenAlex
W3039781545
Cited by
292
References
85
Citations by year
2026: 57 · 2025: 57 · 2024: 68 · 2023: 41 · 2022: 38 · 2021: 25 · 2020: 5 · 2012: 1
FWCI
5.17
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (submittedVersion)
Funders
Interreg
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
health literacy interventions, health literacy, health behavior, cardiovascular patients, intervention effectiveness, behaviour change theory, intervention reporting quality, risk of bias, health disparities
MeSH terms
Health Promotion, Humans, Scotland, Program Evaluation, Health Behavior, Randomized Controlled Trials as Topic, Health Literacy

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