Background
Methods
Definition of health literacy
Chronic diseases and related risk factors
Search strategy
Population | Risk (or Outcome) | Exposure (Intervention) |
---|---|---|
Men, or | Health Literacy, or | Smoking, or |
Male, or Masculine/Masculinity | Health Knowledge, Attitudes, Practice, or Cognitive Skill (and health), or Social Skill (and health), or | Physical inactivity, or Dietary imbalance/low fruit and vegetable intake, or |
Personal Skill (and health), or Knowledge (and health), or | Overweight and obesity, or Hypertension, or | |
Competence (and health) | High blood fats, or Ischaemic heart disease, or | |
Type 2 diabetes |
Inclusion and exclusion criteria
Quality and strength of evidence assessment
Results
Characteristics of included studies
Study, Year (Reference) | Design | Study sample participants, location and size | Component of health literacy | Outcome measure | Variables in multivariate analysis | Significant correlates |
---|---|---|---|---|---|---|
Aihara and Minai 2011 [32] | Cross-sectional | Japanese men ≥ 75 years from Odawara City, Kanagawa Prefecture (n = 347) | Health Literacy (Nutrition) | Adequate nutrition literacy vs. inadequate nutrition literacy | Age, education, economic status, cognitive difficulty, sensory impairment, social network, information resources, self-rated health, BMI | Adjusted odds ratio (95 % CI): |
Informational support, 5.59 (1.28–24.49); | ||||||
Friends as source of information, 2.16 (1.11–4.20); | ||||||
BMI ≥ 25 kg/m2, 2.17 (1.20–3.91) | ||||||
Kan and Tsai 2004 [39] | Cross-sectional | Taiwanese men from two townships (n = 1726) | Knowledge (Knowledge of health risks of obesity) | Probability of risk knowledge | Age, marital status, health, education, income, religion, vegetarian, work, housework, newspaper use, TV news, meets friends, community participation | Ordered probit coefficient (t-test): |
Education, IHD 0.06 (6.67), | ||||||
T2DM 0.05 (5.44); | ||||||
Income, IHD 0.01 (2.62); | ||||||
Newspaper reader, IHD 0.14 (2.15), T2DM 0.22 (3.46); | ||||||
Participates in community, IHD 0.14 (2.18), T2DM 0.15 (2.38) | ||||||
Kelly-Irving et al. 2010 [36]a | Cross-sectional | French West Indian men (n = 465) | Knowledge (Knowledge of risk factors for and prevention of stroke, IHD) | Correct vs. incorrect identification of preventability and >1 risk factor for stroke or IHD | Not specified | Percent (adjusted p-value) Education, IHD knowledge, 64 % < = 6 yrs, 78 % 7-11 yrs, 80% > = 12 yrs (p<0.001) |
Lutfiyya et al. 2008 [33] | Cross-sectional | U.S. men from 25 states/territories (n = 19,163) | Knowledge (Knowledge of heart attack and stroke symptoms) | Low knowledge vs. high knowledge | Age, education, health insurance, income, deferred medical care, primary care provider | Adjusted odds ratio (95 % CI): |
Age 18-34 years (vs. ≥55 years), 0.42 (0.42-0.42); | ||||||
Age 35-54 years (vs. ≥55 years), 0.24 (0.24-0.24); | ||||||
Education < high school, 2.42 (2.40-2.43); | ||||||
No primary care provider, 1.16 (1.15-1.16); | ||||||
Annual household income ≥ $35 k, 1.21 (1.21-1.22); | ||||||
Care deferred because of cost, 1.24 (1.23-1.24); | ||||||
No health insurance, 1.92 (1.91-1.93) | ||||||
Lutfiyya et al. 2010 [34] | Cross-sectional | U.S. Hispanic men from 23 states/territories (n = 2023) | Knowledge (Knowledge of heart attack and stroke symptoms) | Low knowledge vs. high knowledge | Age, education, health insurance, income, deferred medical care, primary care provider | Adjusted odds ratio (95 % CI): |
Age 18-34 years (vs. ≥55 years), 0.26 (0.25- 0.26); | ||||||
Age 35-54 years (vs. ≥55 years), 0.38 (0.37- 0.38); | ||||||
Education < high school, 16.27 (15.74-16.82); | ||||||
No primary care provider, 2.05 (2.02-2.09); | ||||||
Annual household income ≥ $35 k, 0.96 (0.95-0.97); | ||||||
Care not deferred because of cost, 2.10 (2.06-2.14); | ||||||
No health insurance, 1.54 (1.52-1.57) | ||||||
Murata et al. 2003 [35]b | Cross-sectional | U.S. Type 2 diabetic veterans from 3 VA clinics in 2 states (n = 180, 94 % male) | Knowledge (Diabetes knowledge) | Questionnaire raw score converted to per cent correctly answered | Age, years of schooling, treatment duration, MMSE score, depression score, sex | Linear regression coefficient (p-value): |
Age, −0.47 (<0.001); | ||||||
Years of schooling, 1.03 (0.003); | ||||||
Duration of treatment, 0.25 (0.03); | ||||||
MMSE score, 1.62 (0.001) | ||||||
Periera et al. 2009 [37] | Cross-sectional | Portuguese hypertensive men from the city of Porto (n = 889) | Knowledge (Hypertension awareness) | Aware vs. unaware | Age, BMI, alcohol intake, triglycerides, diabetic, marital status, health care setting | Adjusted odds ratio (95 % CI): |
Age 16-60 year (vs. ≤ 15 years), 3.43 (1.68-7.00); | ||||||
Age ≥61 year (vs. ≤15 years), 3.69 (1.89-7.21); | ||||||
BMI 25–29 kg/m2 (vs. <25 kg/m2), 2.18 (1.35-3.52); | ||||||
BMI ≥ 30 kg/m2 (vs. <25 kg/m2), 2.86 (1.59-5.16); | ||||||
Not married, 0.45 (0.25-0.81) | ||||||
Sohn et al. 2007 [40] | Cross-sectional | South Korean men hospitalised for CVD (n = 97) | Personal skill (Confidence in quitting smoking) | High confidence vs. low confidence | Age, education, marital status, alcohol dependence, age commenced smoking | Adjusted odds ratio (95 % CI): |
Married, 5.54 (1.33-23.08); | ||||||
CAGE score ≥2, 3.25 (1.20-8.80); | ||||||
Age commenced smoking ≤20 year, 2.96 (1.14-7.68) | ||||||
Wyatt et al. 2008 [38] | Cross-sectional | U.S. hypertensive African American men from Jackson, Mississippi (n = 927) | Knowledge (Hypertension awareness) | Aware vs. unaware | Age, weight, smoker, T2DM, CVD, high cholesterol, health insurance,accesses preventive care | Adjusted odds ratio (95 % CI): |
BMI ≥30 kg/m2 (vs. < 25 kg/m2), 3.82 (1.79-8.11); | ||||||
T2D present, 2.82 (1.10-7.20); | ||||||
Preventative care, 4.32 (2.55-7.34); | ||||||
Current smoker, 0.29 (0.15-0.54); | ||||||
Age, 1.05 (1.02-1.07) |
Study | Risk of selection bias | Confounders | Data collection methods | Withdrawals and dropouts | Analysis | Quality rating |
---|---|---|---|---|---|---|
Aihara and Minai [32] | Mod | Strong | Weak | Mod | Mod | Mod |
Kan and Tsai [39] | Mod | Strong | Weak | Mod | Mod | Mod |
Kelly-Irving et al. [36] | Weak | Weak | Mod | Mod | Weak | Weak |
Lutfiyya et al. [33] | Mod | Strong | Mod | Mod | Mod | Mod |
Lutfiyya et al. [34] | Mod | Strong | Mod | Mod | Mod | Mod |
Murata et al. [35] | Mod | Weak | Strong | Weak | Mod | Mod |
Periera et al. [37] | Mod | Weak | Weak | Strong | Mod | Mod |
Sohn et al. [40] | Weak | Weak | Strong | Weak | Mod | Weak |
Wyatt et al. [38] | Strong | Strong | Mod | Mod | Mod | Mod |
Correlates of health literacy and its components
Education
Correlate | Component | Study design | Number of studies (Adjusted:Unadjusted for confounders) | Resultsa | Evidence rating | |
---|---|---|---|---|---|---|
Adjusted | Unadjusted | |||||
Education | Nutrition literacy; knowledge; personal skill | Cross-sectional | 7 (4:3) | 3 | 3 | Moderate |
Age | Knowledge | Cross-sectional | 8 (6:2) | 4 | 1 | Low |
Health insurance | Knowledge | Cross-sectional | 2 (2:0) | 2 | Low | |
Income | Knowledge | Cross-sectional | 3 (3:0) | 2 | Low | |
Marital status | Knowledge; personal skill | Cross-sectional | 3 (3:0) | 2 | Low | |
Overweight or obese | Nutrition literacy; knowledge | Cross-sectional | 3 (2:1) | 2 | Low | |
Primary care service access | Knowledge | Cross-sectional | 2 (2:0) | 2 | Low | |
Accesses preventive care | Knowledge | Cross-sectional | 1 (0:1) | 1 | Low | |
Community connected | Knowledge | Cross-sectional | 1 (1:0) | 1 | Low | |
Friends source of nutrition information | Nutrition literacy | Cross-sectional | 1 (1:0) | 1 | Low | |
Information from social supports | Nutrition literacy | Cross-sectional | 1 (1:0) | 1 | Low | |
Regular newspaper reader | Knowledge | Cross-sectional | 1 (1:0) | 1 | Low | |
Treatment duration | Knowledge | Cross-sectional | 1 (1:0) | 1 | Low | |
Care deferred because of cost | Knowledge | Cross-sectional | 2 (2:0) | 2 | Very low | |
Cognitive ability | Knowledge | Cross-sectional | 2 (1:1) | 1 | 1 | Very low |
Alcohol consumption | Personal skill | Cross-sectional | 2 (2:0) | 1 | Very low | |
Age commenced smoking | Personal skill | Cross-sectional | 1 (1:0) | 1 | Very low | |
Smoking status | Knowledge | Cross-sectional | 1 (0:1) | 1 | Very low | |
T2 diabetic | Knowledge | Cross-sectional | 2 (1:1) | 1 | Very low | |
Visually impaired | Nutrition literacy | Cross-sectional | 1 (0:1) | 1 | Very low |