Does health literacy mediate the relationship between socioeconomic status and health disparities? Integrative review

Abstract

While socioeconomic disparities are among the most fundamental causes of health disparities, socioeconomic status (SES) does not impact health directly. One of the potential mediating factors that link SES and health is health literacy (HL). Yet although HL can be considered a modifiable risk factor of socioeconomic disparities in health, the relationship between SES, HL and health disparities is not well understood. This study reviewed the evidence regarding the mediating role of HL in the relationship between socioeconomic and health disparities. Medline, Cinahl, Embase, PsychInfo, Eric, Web of Science, Google, Google Scholar, Mednar, Doaj and Worldcat were used to retrieve studies that specifically addressed socioeconomic and socio-demographic factors related to low HL levels, as well as the mediating role of HL in the relationship between SES and disparities in health outcomes. Selected studies were assessed for methodological quality. Sixteen published studies were retained for inclusion and content analyzed using the constant comparison method. The review indicates that disadvantaged social and socioeconomic conditions contribute to low HL levels, whereby low SES, and particularly educational attainment, is the most important determinant of HL, and that HL mediates the relationship between SES and health status, quality of life, specific health-related outcomes, health behaviors and use of preventive services. HL can be considered as a modifiable risk factor of socioeconomic disparities in health. Enhancing the level of HL in the population or making health services more accessible to people with low HL may be a means to reach a greater equity in health.

The relationship between health literacy and health outcomes among male young adults: exploring confounding effects using decomposition analysis

“…With respect to the social determinants of health literature (Mackenbach 2006;Marmot et al 1991) and health literacy literature (Paasche-Orlow and Wolf 2007;Manganello 2008;Clancy 2009;Abel 2008), we understand health literacy not just as a ''risk factor'' of socioeconomic vulnerable people, but more generally as an intermediary (multidimensional) factor within the rather complex mechanisms effecting health. Hence, ''modifying'' health literacy (Stormacq et al 2018) may not be easy, due to the many structural constraints people experience in daily life. Health literacy might rather be an intermediary ''operator,'' which explains the mechanisms and functionings of social determinants of health (WHO 2010).…”

Health Literacy is Associated with Health Behaviors in Students from Vocational Education and Training Schools: A Danish Population-Based Survey

“…However, the evidence in young adults is scarce. A recent review indicates that health literacy may act as a modifier between SES and health outcomes [12], placing health literacy as an important dynamic and changeable intermediary determinant of health equity. The review includes only one study in younger adults examining the role of health literacy in relation to asthma outcomes in ethnic minority groups [13].…”

Autocuidado, Alfabetización en Salud Y Control Glicémico en Personas Con Diabetes Mellitus Tipo 2

“…Reportó un alfa de Cronbach de 0,92 en su versión original (21) y en la versión adaptada para Chile tuvo un buen resultado en el coeficiente de K-Richarson (KR20 = 0,9255) (22) . Aunque la literatura (23) advierte que pudiera existir relación entre alguna de las variables presentadas que pudiera originar sesgos que se deben considerar al momento de analizar los resultados, por ejemplo, el nivel educacional y la AS, esto no fue observado en la presente investigación.…”