The association of health literacy domains with hospitalizations and mortality

Association between health literacy and mortality: a systematic review and meta-analysis

“…Four were carried out in the United Kingdom [ 27 , 31 , 34 , 38 ], one in Spain [ 17 ], and one in Turkey [ 36 ]. Of the 19 studies, seven were conducted in the elderly [ 24 , 27 , 29 , 30 , 34 , 38 , 39 ], six in patients with heart failure [ 16 , 17 , 26 , 33 , 37 , 40 ], one in chronic kidney disease patients [ 31 ], one in cardiovascular disease patients [ 28 ], one in chronic hemodialysis patients [ 25 ], one in kidney transplant candidates [ 32 ], one in palliative care patients [ 36 ], and one in male veterans [ 35 ]. The length of follow-up ranged from 3 months to 8 years (one study [ 31 ] did not provide data on follow-up period).…”

“…Nine different instruments were used to screen HL in the studies included in this systematic review: the S-TOFHLA [ 24 , 27 , 28 , 33 , 39 , 40 ], Rapid Estimate of Adult Literacy in Medicine (REALM) [ 25 , 27 , 30 ], Brief Health Literacy Screen (BHLS) [ 16 , 26 , 28 , 31 , 32 , 37 ], Newest Vital Sign [ 35 ], Short Assessment of Health Literacy for Spanish-speaking Adults [ 17 ], 3-item version of the Subjective Numeracy Scale [ 28 ], Health Literacy Survey-European Union-Questionnaire [ 36 ], a brief 4-item comprehension test based on instructions similar to those found on a packet of aspirin bought over the counter [ 38 ], general functional HL [ 27 ] and a 9-item instrument [ 29 ]. Two articles [ 27 , 28 ] used more than one tool to measure HL.…”

“…In contrast, three articles did not find an association between HL and mortality. One study was conducted only in male veterans [ 35 ], one was conducted in Spain in HF patients [ 17 ], and one was conducted in the UK in chronic kidney disease patients [ 31 ]. These may be the reasons for the different conclusions, reflecting two factors: different care delivery systems may be a factor in the outcome, underscoring the need for further studies to be conducted in different countries; and mortality has high statistical heterogeneity, which may be caused by the different populations in the studies.…”

“…Five of the studies [ 16 , 24 , 30 , 31 , 34 ] failed to provide a conceptual definition of HL; 12 of the studies [ 17 , 25 – 27 , 29 , 32 , 34 , 36 – 40 ] simply defined HL as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make basic health decisions”, failing to recognize the multifaceted nature of HL that goes beyond these abilities. The rest [ 28 , 35 ] recognized HL as a multidimensional process, incorporating systemic demands and complexities as well as individuals’ skills and abilities, and may encompass numerical and graphical literacy. The differences in the conceptual definitions provided are not surprising given that there is no universal consensus on the definition of HL.…”