Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review (Preprint)

Abstract

BACKGROUND Health literacy is the ability to make informed decisions using health information. As health data and information availability increases due to online clinic notes and patient portals, it is important to understand how health literacy relates to social determinants of health and the place of informatics in mitigating disparities. OBJECTIVE This systematic literature review aims to examine the role of health literacy in interactions with social determinants of health and to identify feasible health literacy-based interventions that address low patient understanding of health information to improve clinic note sharing efficacy. METHODS The review examined two databases, Scopus and PubMed, for English language articles relating to health literacy and social determinants of health. We conducted a quantitative analysis of study characteristics and qualitative synthesis to determine roles of health literacy and interventions. RESULTS The results (n=43) were analyzed quantitatively and qualitatively for study characteristics, role of health literacy, and interventions. A majority (n=30) identified a correlate role for health literacy in relation to social determinants of health, but others noted that health literacy could also be a mediator (n=5), a result of social determinants of health (n=5), or considered a modifiable social determinant of health (n=2). CONCLUSIONS The multivariable nature of health literacy indicates that it could form the basis for many interventions to combat low patient understandability, including interventions using informatics-based solutions. Health literacy is a crucial, multidimensional skill in supporting patient understanding of health materials. Designing interventions aimed at improving health literacy or addressing poor health literacy in patients can help increase comprehension of health information, including the information contained in clinic notes that are shared with patients.