A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors

Abstract

BackgroundTo evaluate the effectiveness of interventions used in primary care to improve health literacy for change in smoking, nutrition, alcohol, physical activity and weight (SNAPW).MethodsA systematic review of intervention studies that included outcomes for health literacy and SNAPW behavioral risk behaviors implemented in primary care settings.We searched the Cochrane Library, Johanna Briggs Institute, Medline, Embase, CINAHL, Psychinfo, Web of Science, Scopus, APAIS, Australasian Medical Index, Google Scholar, Community of Science and four targeted journals (Patient Education and Counseling, Health Education and Behaviour, American Journal of Preventive Medicine and Preventive Medicine).Study inclusion criteria: Adults over 18 years; undertaken in a primary care setting within an Organisation for Economic Co-operation and Development (OECD) country; interventions with at least one measure of health literacy and promoting positive change in smoking, nutrition, alcohol, physical activity and/or weight; measure at least one outcome associated with health literacy and report a SNAPW outcome; and experimental and quasi-experimental studies, cohort, observational and controlled and non-controlled before and after studies.Papers were assessed and screened by two researchers (JT, AW) and uncertain or excluded studies were reviewed by a third researcher (MH). Data were extracted from the included studies by two researchers (JT, AW). Effectiveness studies were quality assessed. A typology of interventions was thematically derived from the studies by grouping the SNAPW interventions into six broad categories: individual motivational interviewing and counseling; group education; multiple interventions (combination of interventions); written materials; telephone coaching or counseling; and computer or web based interventions. Interventions were classified by intensity of contact with the subjects (High ≥ 8 points of contact/hours; Moderate >3 and <8; Low ≤ 3 points of contact hours) and setting (primary health, community or other).Studies were analyzed by intervention category and whether significant positive changes in SNAPW and health literacy outcomes were reported.Results52 studies were included. Many different intervention types and settings were associated with change in health literacy (73% of all studies) and change in SNAPW (75% of studies). More low intensity interventions reported significant positive outcomes for SNAPW (43% of studies) compared with high intensity interventions (33% of studies). More interventions in primary health care than the community were effective in supporting smoking cessation whereas the reverse was true for diet and physical activity interventions.ConclusionGroup and individual interventions of varying intensity in primary health care and community settings are useful in supporting sustained change in health literacy for change in behavioral risk factors. Certain aspects of risk behavior may be better handled in clinical settings while others more effectively in the community. Our...

The Influence of Community and Individual Health Literacy on Self-Reported Health Status

“…A systematic review of 52 primary care health literacy interventions found that 73 % were associated with health literacy improvements. 28 Clinics might also provide community health education events, like health fairs, to reach people beyond the traditional patient encounter. Innovative examples exist for improving community social determinants in the context of primary care.…”

Gesundheitskompetenz von Erwachsenen in Deutschland

“…Bevölkerungs-gruppen mit besonders geringer GK sind häufig durch einen niedrigen Bildungsstand, geringes Einkommen, einen Migrationshintergrund, einen schlechten Gesundheitszustand und ein hohes Lebensalter gekennzeichnet [2,10,[14][15][16]. Daher werden zunehmend Interventionen zur Verbesserung der GK entwickelt, besonders für Patientinnen und Patienten in der Gesundheitsversorgung [17,18], aber auch für Bevölkerungsgruppen mit spezifischen Risiken oder Erkrankungen [13,[19][20][21]. Folglich nimmt auch der Bedarf an der Erhebung und Ermittlung der individuellen GK und insbesondere der Verteilung der GK in der Bevölkerung zu.…”

Caregivers’ Health Literacy and Their Young Children’s Oral-health–related Expenditures

“…Although health literacy may not be easily and sustainably modifiable, literacy-level-appropriate interventions may be effective. Possible strategies could include healthliteracy-modulating approaches such as motivational interviewing, group counseling, peer support, outreach workers, and improved print and visual materials (Kaakko et al, 2002;Taggart et al, 2012). To mention one possible interventional avenue, the WIC program (9.2 million participants in the USA in fiscal year 2010) has always had a strong interest in oral health, and it offers both the logistical capacity and caregiver access for staging a health-literacy-appropriate intervention.…”