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The Relationship between Health Literacy and Health Disparities: A Systematic Review
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OBJECTIVES: Health literacy is commonly associated with many of the antecedents of health disparities. Yet the precise nature of the relationship between health literacy and disparities remains unclear. A systematic review was conducted to better understand in how far the relationship between health literacy and health disparities has been systematically studied and which potential relationships and pathways have been identified. METHODS: Five databases, including PubMed/MEDLINE and CINAHL, were searched for peer-reviewed studies. Publications were included in the review when they (1) included a valid measure of health literacy, (2) explicitly conceived a health disparity as related to a social disparity, such as race/ethnicity or education and (3) when results were presented by comparing two or more groups afflicted by a social disparity investigating the effect of health literacy on health outcomes. Two reviewers evaluated each study for inclusion and abstracted relevant information. Findings were ordered according to the disparities identified and the role of health literacy in explaining them. RESULTS: 36 studies were included in the final synthesis. Most of the studies investigated racial/ethnic disparities, followed by some few studies that systematically investigated educational disparities. Some evidence was found on the mediating function of health literacy on self-rated health status across racial/ethnic and educational disparities, as well as on the potential effect of health literacy and numeracy on reducing racial/ethnic disparities in medication adherence and understanding of medication intake. CONCLUSION: Overall the evidence on the relationship between health literacy and disparities is still mixed and fairly limited. Studies largely varied with regard to health(-related) outcomes under investigation and the health literacy assessments used. Further, many studies lacked a specific description of the nature of the disparity that was explored and a clear account of possible pathways tested.
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“Language barriers are not the only issue that contributes to health inequities, and much has been written about these factors that are collectively known as social determinants of health [59-62]”
From Technology enabled clinical care (TECC): Protocol for a prospective longitudinal cohort study of smartphone-augmented mental health treatment (2021) · cites this paper as [61]
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Metadata
- Authors
- Mantwill, S., Monestel-Umaña, S., & Schulz, P. J.
- Affiliations
- Università della Svizzera italiana (CH)
- Corresponding author
- Mantwill, Sarah
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-12-23
- Volume
- 10
- Issue
- 12
- Pages
- e0145455
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4689381
- OpenAlex
- W2199607157
- Cited by
- 395
- References
- 73
- Citations by year
- 2026: 36 · 2025: 45 · 2024: 44 · 2023: 35 · 2022: 41 · 2021: 54 · 2020: 72 · 2019: 30 · 2018: 19 · 2017: 15 · 2016: 3
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Cultural Competency in Health Care
- Keywords
- health literacy, health disparities, racial and ethnic disparities, educational inequality, self-rated health, medication adherence, numeracy, social determinants of health, mediation pathways
- MeSH terms
- Ethnicity, Humans, Health Knowledge, Attitudes, Practice, Health Status Disparities, Health Literacy
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