Introduction
Methods
Protocol registration and eligibility criteria
Search strategy
Data extraction, synthesis and quality appraisal
Results
Study | Year | Design | CKD stage (or population) | N | Age (years) Median, IQR [mean, SD] | Male:female | Health literacy measure |
---|---|---|---|---|---|---|---|
Dahl et al. [44] | 2020 | Cross-sectional | KTR | 159 | 58, 20–81 | 109:50 | HLQ |
Stømer et al. [18] | 2020 | Cross-sectional | CKD stages 3–5 | 187 | [67, 13] | 122:65 | HLQ |
Demian et al. [17] | 2016 | Cross- sectional | KTR | 96 | [53, 13] | 54:42 | HLQ |
Gardiner [19] | 2019 | Cross-sectional | ESKD incl. KTR or waitlist | 30 | [48, 13] | 16:14 | HLQ |
Murali et al. [40] | 2020 | Cross-sectional | HD and non-dialysis CKD | 223 | 70, 63–74 | 136:87 | HLQ |
Dawson et al. [39] | 2020 | Cross-sectional | CKD 5 (PD, HD, conservative) | 102 | [73, 12] | 69:33 | HLQ |
Dodson et al. [42] | 2016 | Cross-sectional | Dialysis (PD, HD) | 100 | 68, 26–93 | 57:43 | HLQ |
Griva et al. [29] | 2020 | Prospective cohort | HD (+ diabetes) | 221 | [59, 10] | 134:87 | HLQ |
Skoumalova et al. [20] | 2019 | Cross-sectional | HD | 452 | [64, 14] | 329:123 | HLQ – Slovak version |
Zavacka et al. [49] | 2020 | Cross-sectional | HD | 542 | [64, 14] | 329:213 | HLQ – Slovak version |
Lim et al. [22] | 2019 | Cross-sectional | HD | 84 | Not stated | Not stated | HLQ – European version |
Cavanaugh et al. [30] | 2010 | Cohort | Incident HD | 480 | 62, 51–72 | 269:211 | REALM |
Tohme et al. [26] | 2017 | Cohort | HD | 286 | 64, 56–73 | 160:126 | REALM |
Wright Nunes et al. [23] | 2015 | Cross-sectional | CKD 1–5 | 155 | [57, 15] | 84:71 | REALM |
Jain et al. [33] | 2015 | Cross-sectional | PD | 32 | 48 [13] | 17:15 | REALM |
Patzer et al. [13] | 2016 | Cohort | KTR | 99 | 53 [13.2] | 66:33 | REALM |
Green et al. [41] | 2011 | Cross-sectional | HD | 260 | 64, 56–73 | 163:97 | REALM |
Green et al. [28] | 2013 | Cohort | HD | 260 | 62, 55–73 | 150:110 | REALM |
Wright et al. [11] | 2011 | Cross-sectional | CKD 1–5 | 401 | 58, 46–68 | 213:188 | REALM |
Cavanaugh et al. [48] | 2010 | Cross-sectional | HD | 50 | [51, 15] | 24:26 | REALM |
Nelson et al. [16] | 2015 | Cross-sectional | CKD 3–5 | 208 | [72] | 116:92 | REALM |
Singla et al. [36] | 2016 | Cohort | CKD 3–4 | 74 | [58, 13] | 32:42 | REALM |
Schrauben et al. [10] | 2020 | Cross-sectional | CKD 1–5 | 401 | [57, 16] | 213:188 | REALM |
Balhara et al. [34] | 2020 | Cross-sectional with control | HD | 49 | Cases—[54, 13] Controls—[55, 11] | 27:22 | REALM-short form |
Kazley et al. [43] | 2014 | Cross-sectional | Advanced CKD incl. KTR or dialysis | 127 | 53 [17] | 61:66 | REALM—transplant Newest Vital Sign |
Kazley et al. [46] | 2015 | Cross-sectional | Advanced CKD incl. KTR or dialysis | 92 | [54, 16] | 47:45 | REALM—transplant Newest Vital Sign |
Gordon and Wolf [37] | 2009 | Cross-sectional | KTR | 124 | [47, 12] | 70:54 | REALM S-TOFHLA |
Weng et al. [15] | 2013 | Cross-sectional | KTR | 252 | 55, 45–63 | 151:101 | S-TOFHLA |
Ricardo et al. [24] | 2014 | Cross-sectional | CKD 2–4 | 2340 | Limited HL [66, 9] Adequate HL [62, 11] | Limited HL 221:160 Adequate HL 1041:918 | S-TOFHLA |
Adeseun et al. [25] | 2012 | Cross-sectional | HD or PD | 72 | [51.6] | 48:23 | S-TOFHLA |
Grubbs et al. [45] | 2009 | Cohort | HD | 62 | [52.4, 12.2] | 41:21 | S-TOFHLA |
Foster et al. [59] | 2011 | Cross-sectional | HD or PD | 311 | [58, 15] | 167:144 | S-TOFHLA |
Blandon et al. [38] | 2011 | Cross-sectional | CKD 2–4 | 225 | 49 | 110:115 | S-TOFHLA |
Dageford et al. [60] | 2015 | Cross-sectional | Scheduled for transplant evaluation | 104 | [52, 12] | 63:41 | Brief Health Literacy Screen |
Warsame et al. [32] | 2018 | Cohort | Kidney transplant candidates | 1578 | [55, 13] | 964:614 | Brief Health Literacy Screen |
Cavanaugh et al. [31] | 2015 | Cohort | HD | 11,476 | Not stated | Not stated | Brief Health Literacy Screen |
Devraj et al. [9] | 2015 | Cross-sectional | CKD 1–4 | 150 | Not stated Range 21–90 | 70:80 | Newest Vital Sign |
Devraj et al. [61] | 2018 | Cross-sectional | CKD 1–4 | 150 | Not stated (range 21–90) | 70:80 | Newest Vital Sign |
Mazarova et al. [47] | 2017 | Cross-sectional | HD | 56 | [63, 16] | 35:21 | Newest Vital Sign |
Levine R et al. [35] | 2018 | Retrospective cohort | CKD 2–5 incl. KTR and dialysis | 142 | [21, 6] | 89:53 | Newest Vital Sign |
Lai et al. [8] | 2013 | Cross-sectional | HD | 63 | [57, 10] | 38:25 | FCCHL |
Indino et al. [21] | 2019 | Cross-sectional | HD | 42 | [54, 14] | 25:17 | FCCHL |
Photharos et al. [12] | 2018 | Cross-sectional | CKD 2–3 | 275 | Not stated > 70% were aged 51–65 years | 165:110 | Health Literacy Scale 14 |
Chen et al. [7] | 2018 | Cross-sectional | CKD 1–5 | 410 | [70, 13] | 259:151 | S-MHLS |
Yu et al. [62] | 2021 | Cross-sectional | CKD 1–5 | 208 | [63.2, 12.8] | 123:85 | MMHLQ |
Taylor et al. [27] | 2019 | Prospective cohort | Incident HD | 2274 | Limited HL 58, 47–66 Adequate HL 58, 47–67 | Limited HL 231:128 Adequate HL 1243:672 | Single Item Literacy Screener |
Wong et al. [14] | 2018 | Cross-sectional | CKD 3–5 | 137 | [55, 12] | 66:71 | Validated 3 item scale |
Kita et al. [63] | 2021 | Cross-sectional | CKD 3–5 | 200 | 73 (61–80) | 128:72 | HLSEU-Q47 |
Health literacy measures
Health literacy measure | Number of studies using the measure (%) | Total number of participants using the measure | Brief description of the measure | Type of health literacy measured | Health literacy categorisation |
---|---|---|---|---|---|
Health Literacy Questionnaire (HLQ) | 11 (23) | 2196 | A multidimensional tool containing 44 items across nine independent scales that provides information about different dimensions of health literacy The nine domains of health literacy defined are: 1. Feeling understood and supported by healthcare providers 2. Having sufficient information to manage my health 3. Actively managing my health 4. Social support for health 5. Appraisal of health information 6. Ability to actively engage with healthcare providers 7. Navigating the healthcare system 8. Ability to find good health information 9. Understand health information well enough to know what to do | Functional Communicative Critical | The HLQ has no total summative score and no cut‐off for inadequate health literacy, however, higher scores indicate better health literacy in each domain |
Rapid estimate of adult health literacy in medicine (REALM) | 13 (27) | 2570 | 125 health-related words (66 in more commonly used form) tested for pronunciation accuracy | Functional | 0–44: inadequate 45–60: marginal 61–66: adequate (limited = inadequate + marginal) |
REALM-SF | 1 (2) | 49 | Short Form of REALM. Seven health-related words tested for pronunciation accuracy | Functional | 0–3: inadequate 4–6: marginal 7: adequate |
REALM-T | 2 (4) | 219 | Transplant-specific version of REALM. 69 kidney transplant-related terms tested for pronunciation accuracy | Functional | 0–44: inadequate 45–59: marginal 60–69: adequate |
Newest Vital Sign (NVS) | 6 (13) | 440 | Six-item assessment of reading comprehension from an ice-cream nutrition label | Functional | 0–1: high likelihood marginal/inadequate 2–3: possible marginal/inadequate 4–6: adequate |
Short test of functional health literacy in adults (STOFHLA) | 7 (15) | 3313 | 36 reading comprehension items—select from four choices to replace missing words in text (modified Cloze procedure) | Functional | 0–16: inadequate 17–22: marginal 23–36: adequate |
Brief Health Literacy Screen (BHLS) | 3 (6) | 13,158 | A three-question subjective health literacy questionnaire answered on a five-point Likert scale | Functional | Limited (total score = 3–9) or adequate (total score = 10–15) health literacy (or limited health literacy ≤ 5 points and adequate health literacy > 5 points[32]) |
Functional Communicative Critical Health Literacy scale (FCCHL) | 2 (4) | 105 | Five items for each sub-scale of functional and communicative health literacy, and four for critical health literacy, this 14-item self-report measure was rated on a range of 1–4 (never to often) for each item | Functional Communicative Critical | Mean scale scores obtained by reversing the item scores on each domain, summing them and dividing them by the total number of items, with scores ranging from 1 (limited health literacy) to 4 (high health literacy) for each domain. The FCCHL scales do not classify patients’ health literacy levels as adequate or inadequate |
Health Literacy Scale-14 (HLS-14) | 1 (2) | 275 | 14 items with 5-point scales that indicate how much the respondent agrees or disagrees with the item (‘strongly disagree’ to ‘strongly agree’) | Functional Communicative Critical | The scores on the items are summed up to give the total health literacy score, as well as functional, communicative, and critical health literacy scores. Higher scores indicate a better health literacy |
Short-form Mandarin Health Literacy Scale | 1 (2) | 410 | 11 items to assess functional health literacy in terms of the person’s ability to read, comprehend, and utilize basic health information when making individual health decisions | Functional | Total scores range from 0 to 11, with higher scores reflecting better health literacy |
Single Item Literacy Screen (SILS) | 1 (2) | 2274 | "How often do you need to have someone help you when you read instructions, pamphlets, or other written material from your doctor or pharmacy?" Possible responses are 1-Never, 2-Rarely, 3-Sometimes, 4-Often, and 5-Always | Functional | ≤ 2 adequate health literacy 3–5 limited health literacy |
Health Literacy Survey Questionnaire (HLSEU-Q47) | 1 (2) | 200 | 47 questions related to the domains of health care, disease prevention and health promotion, and the four competencies of health information access, understanding, evaluation, and utilization Response choices for each of the 47 questions are as follows: “Very easy” (four points), “Fairly easy” (three points), “Fairly difficult” (two points), “Very difficult” (one point), “Do not know/not applicable” (zero points) | Functional Communicative Critical | The scores of each item are summed to determine the total score Health literacy was categorised into the following four levels based on total score: “inadequate”, 0–25 points; “problematic” 25–33 points; “sufficient”, 33–42 points; and “excellent”, 42 points or more. “Inadequate” and “problematic” with 33 points or less were defined as “limited” [63] |
Mandarin Multidimensional Health Literacy Questionnaire (MMHLQ) | 1 (2) | 208 | 20 self-reported items across 5 dimensions: accessing, understanding, appraising, and applying health information, and communication/interaction | Functional Communicative Critical | Total health literacy score = (sum of the average scores of the five dimensions—1) × 50/3. Health literacy is then graded as: inadequate (score range (SR): 0–25), limited/problematic (SR: 26–33), sufficient (SR: 34–42), and excellent (SR: 43–50) |