Background
Methods
Statistical analysis
Results
Characteristics of eligible studies on the relation between HL and QOL
Author | Design | Survey time | Location | Study population | QOL instrument | HL instrument | Quality score |
---|---|---|---|---|---|---|---|
Chunhua L, et al. 2013 [17] | Cross-sectional | April–June, 2012 | Guangzhou,China | 2109 college students (age: 15–28 years, 55.2% female) | EQ-5D | Self-developed scales: Three aspects of HL, Five types of HL | 9 |
Nan W, et al. 2012 [18] | Cross-sectional | – | Jiaozuo, China | 600 community elders (age: over 45 years, 57.5% female) | SF-36 | Questionnaire on the health literacy of Chinese citizens | 6 |
Liu L, et al. 2016 [19] | Cross-sectional | January–September, 2015 | Urumqi,China | 556 coronary heart disease patients (age: 45–83 years, 31.1% female) | EQ-5D | Self-developed questionnaire containing Four dimensions of HL: knowledge, attitude, behaviors, skills. | 9 |
Yan Z, et al. 2012 [43] | Cross-sectional | – | Jilin, China | 192 empty nest elders(over 65 years, 57.8% female) | SF-36 | Self-developed questionnaire measuring health literacy of elderly | 6 |
Qiyuan L, et al. 2011 [42] | Cross-sectional | May–November, 2010. | Yanji, China | 331 Hypertensive elderly (over 60 years, 63.4% female) | Self-developed questionnaire containing Global QOL, Psychological general well-being, Symptom bother | Self-developed questionnaire measuring health literacy about hypertension | 9 |
Wenning D, et al. 2015 [41] | Cross-sectional | November–December, 2014. | Kunming, China | 500 college students (age: 17–24 years, 56.7% female) | Self-developed questionnaire measuring QOL of college students | Self-developed questionnaire measuring health literacy of college students | 8 |
Couture EM, et al. 2017 [34] | Cross-sectional | – | Quebec, Canada | 247 chronic Participants (age: 18–85 years, 55.5% female) | SF-12v2 | NVS | 7 |
Halverson JL, et al. 2015 [35] | Cross-sectional | 2006s-sect | Wisconsin, America | 1841 Wisconsin residents, newly diagnosed with lung, prostate, breast, or colorectal cancer(age: over 18 years, 50.8% female) | FACT-G | Self-developed questionnaire containing four questions validated in STOFHLA and REALM | 8 |
Naimi AJ, et al. 2017 [11] | Cross-sectional | – | Tehran, Iran | 400 hypertensive patients (age: 18–89 years, 45.0% female) | SF-36 | HELIA | 6 |
Song S, et al. 2017 [38] | Cross-sectional | October ectionale patie | South Korea | 305 non-institutionalized adults (age: 20–60 years, 50.5% female) | SF-36 | REALM | 6 |
Wang C, et al. 2015 [31] | Cross-sectional | – | Northwestern China | 913 poor rural women (age: 23–57) | EQ-5D | R-CAHLQ | 6 |
Wang C, et al. 2017 [13] | Cross-sectional | 2001s-sec | Six towns,China | 882 hypertensive patients (age: over 35 years, 56.1% female) | SF-36 | Self-developed questionnaire validated three-item BHLS | 7 |
Rocha PC, et al. 2017 [37] | Cross-sectional | – | Belo Horizonte,Brazil | 384 adolescents (age: 15 and 19 years, 70.3% female). | PedsQL | Self-developed questionnaire, composed of closed questions | 5 |
Macabasco OA, et al. 2011 [30] | Cross-sectional | 2007–2009 | America | 605 patients with symptomatic heart failure (age: over 18 years, 48.0% female) | HFSS | TOFHLA | 7 |
Johnston MV, et al. 2005 [36] | Cross-sectional | – | new jersey,America | 107 patients with spinal cord injury (age: over 18 years, 17.8% female) | SF-12,SWLS | TOFHLA | 6 |
Ownby RL, et al. 2014 [12] | Cross-sectional | – | Central and South America as well as Mexico and the US | 475 English- and Spanish-speaking community-dwelling volunteers(age: 18–81 years, 60% female) | SF-36,EQ-5D | TOFHLA, REALM | 5 |
Zhang XH, et al. 2009 [40] | Cross-sectional | – | a tertiary referral center,Singapore | 199 patients with rheumatic diseases (over 18 years, 70.5% female) | SF-36,EQ-5D, and SF-6D. | REALM | 6 |
Wallace LS, et al. 2008 [39] | Cross-sectional | September, 2004 | Tennesseans,America | 249 patients (age: over 18 years, 65.1% female) | Self-developed: fouritems developed and validated by CDC | REALM | 8 |
Son YJ, et al. 2016 [32] | Longitudinal cohort | June 2012–July 2013 | Cheonan,Korean | 238 PCI patients (33.2% female) | Self-developed: a validating 10-item questionnaire | Self-developed containing the three-item set of brief screening questions | 9 |
Mancuso CA, et al. 2006 [33] | Longitudinal cohort | 1995–1999 | New York,America | 175 asthma patients (mean age: 40 years, 83% female) | AQLQ | TOFHLA | 9 |
Al SF, et al. 2016 [29] | Longitudinal cohort | December 2011–December 2013 | Alberta,Canada | 1948 Patients with type 2 diabetes (age: over 18 years, 45.0% female) | EQ-5D,SF-36 | BHLS | 7 |
Montbleau KE, et al. 2017 [10] | Cohort | – | an urban, safety-net hospital,America | 40 patients with Atrial fibrillation (age: over 60 years, 45.0% female) | SF-36 | STOFHLA | 6 |
Husson O, et al. 2015 [20] | Longitudinal | 2000–2009 | southern part of the Netherlands | 1626 Colorectal cancer survivors (age: over 18 years, 42.9% female) | EORTC QLQ-C30 | SBSQ | 9 |
Methodological quality
The correlation between HL and QOL
General correlation
The correlation between HL and two dimensions of QOL
The correlation between QOL and four dimensions of HL
Subgroup analysis
Subgroup | Sample size | No. of studies | correlation coefficient [95%CI] | P |
---|---|---|---|---|
Total | 12,303 | 19 | 0.35 [0.25; 0.44] | < 0.01 |
PopulationI | ||||
College students | 2609 | 2 | 0.12 [0.01; 0.23] | 0.02 |
Community residents | 1572 | 4 | 0.46 [0.13; 0.69] | < 0.01 |
PopulationII | ||||
Patients | 8122 | 13 | 0.35 [0.25; 0.44] | < 0.01 |
Health | 4181 | 6 | 0.35 [0.14; 0.53] | < 0.01 |
Nation | ||||
China | 6083 | 8 | 0.45[0.27; 0.61] | < 0.01 |
America | 3452 | 6 | 0.29 [0.16; 0.42] | < 0.01 |
Other Asian countries | 1142 | 4 | 0.21 [0.10; 0.32] | 0.01 |
HL questionnaire | ||||
REALM | 753 | 3 | 0.17 [0.06; 0.28] | 0.08 |
TOFHLA | 1362 | 4 | 0.35 [0.12; 0.54] | < 0.01 |
Other instruments | 10,188 | 12 | 0.39 [0.27; 0.51] | < 0.01 |
QOL questionnaire | ||||
EQ-5D | 2665 | 2 | 0.45 [0; 0.80] | < 0.01 |
SF | 4073 | 9 | 0.38 [0.22; 0.53] | < 0.01 |
Other instruments | 5565 | 8 | 0.29 [0.17; 0.39] | < 0.01 |
Study design | ||||
Cross-sectional | 10,264 | 16 | 0.33 [0.22; 0.44] | < 0.01 |
Cohort | 2039 | 3 | 0.45 [0.24; 0.62] | < 0.01 |
Study quality | ||||
High | 7625 | 9 | 0.34 [0.20; 0.46] | < 0.01 |
Medium | 4678 | 10 | 0.36 [0.21; 0.50] | < 0.01 |
Low | 0 | 0 | ||
Time | ||||
Before 2012.01 | 5709 | 7 | 0.37 [0.21; 0.51] | < 0.01 |
After 2012.01 | 3708 | 5 | 0.27 [0.01; 0.49] | < 0.01 |
No found | 2886 | 7 | 0.39 [0.21; 0.54] | < 0.01 |
Publication bias
Sensitivity and meta-regression analysis
Variables | Estimate | 95%CI | P-value | |
---|---|---|---|---|
Intercept | 0.93 | [0.37 1.49] | 0.001 | |
Sample size | −0.00 | [−0.00–0.00] | 0.000 | |
Design | Cross-sectional | ref | ||
Cohort | 0.47 | [0.11 0.83] | 0.011 | |
Area | America | Ref | ||
China | 0.37 | [0.06 0.69] | 0.021 | |
Asia other country | 0.26 | [−0.18 0.72] | 0.246 | |
Population | Health | ref | ||
Patient | −0.25 | [−0.55 0.05] | 0.097 | |
HL questionnaires | TOFHLA | ref | ||
REALM | −0.41 | [−0.85 0.02] | 0.059 | |
QOL questionnaires | EQ-5D | ref | ||
SF | −0.74 | [−1.50 0.01] | 0.053 | |
Study quality | High | ref | ||
medium | 0.22 | [−0.34 0.77] | 0.443 | |
Time | After 2012 | ref | ||
Before 2012 | 0.61 | [0.12 1.09] | 0.014 |