Cited by 395Health Literacy and Information AccessibilityHealth disparities and outcomesCultural Competency in Health Care

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The Relationship between Health Literacy and Health Disparities: A Systematic Review

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Mantwill, Sarah, Monestel-Umaña, Silvia, Schulz, Peter J.·2015·PLOS ONE

DOI 10.1371/journal.pone.0145455PMC PMC4689381

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Abstract

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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Fig 1 Overview of search strategy. 1For demonstration purposes only the last search terms include Boolean operators.CC BY · PubMed Central

Fig 2 Flowchart of screening process (adapted from: Moher, D., Liberati, A., Tetzlaff, J., & Altman, 2009).CC BY · PubMed Central

Fig 3 Possible pathways on how health literacy explains disparities in health outcomes.CC BY · PubMed Central

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Authors: Mantwill, S., Monestel-Umaña, S., & Schulz, P. J.
Affiliations: Università della Svizzera italiana (CH)
Corresponding author: Mantwill, Sarah
ORCID: Mantwill, Sarah
Schulz, Peter J.
Venue: PLOS ONE
Publisher: Public Library of Science (PLoS)
Published: 2015-12-23
Volume: 10
Issue: 12
Pages: e0145455
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0145455
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: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
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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The Relationship between Health Literacy and Health Disparities: A Systematic Review

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