In e na ional Jou nal o
En i onmen al Resea ch
and Public Heal h
Re iew
In e en ions o Imp o e Heal h among
Rep oduc i e-Age Women o Low Heal h Li e acy:
A Sys ema ic Re iew
Ra ael Vila-Candel 1,2 , F ancisco Miguel Ma ínez-A nau 3,* ,
Juan Ma ía de la Cáma a-de las He as 4, En ique Cas o-Sánchez 5and Pila Pé ez-Ros 2
1Depa men o Obs e ics and Gynaecology, Hospi al Uni e si a io de la Ribe a, 46600 Valencia, Spain;
a ael. ila@u .es
2Depa men o Nu sing and Podia y, Facul y o Nu sing and Podia y, Uni e si a de València,
46010 Valencia, Spain; ma ia.p.pe ez- os@u .es
3Depa men o Physio he apy, Uni e si a de València, 46010 Valencia, Spain
4Lib a y Depa men , Hospi al Uni e si a io de la Ribe a, FISABIO. C a. Co be a km 1,
46600 Valencia, Spain; [email p o ec ed]
5School o Heal h Sciences, Uni e si y o London, London EC1V, UK; En ique.Cas o-Sanchez@ci y.ac.uk
*Co espondence: ancisco.m.ma inez@u .es
Recei ed: 3 Sep embe 2020; Accep ed: 8 Oc obe 2020; Published: 12 Oc obe 2020
Abs ac :
Backg ound: Limi ed o low heal h li e acy (HL) has been associa ed wi h poo heal h
ou comes, including inadequa e sel -ca ing and p e en i e beha io s. A ew s udies ha e
sys ema ically summa ized he e ec o in e en ions o imp o e ep oduc i e heal h and ca e in
women wi h insu icien HL. The main objec i e o he s udy was o in es iga e heal h ca e p omo ion
in e en ions and examine hei e ec i eness on women wi h inadequa e HL h ough a sys ema ic
e iew o andomized con olled ials (RCT). Me hods: RCTs and quasi-expe imen al s udies ha
assessed HL in e en ions o imp o e ep oduc i e heal h o women wi h low HL we e included.
The s udy p o ocol was egis e ed wi h PROSPERO (CRD42020137059). Resul s: O he 292 eco ds
ini ially iden i ied, a o al o 6 a icles we e included o e iew. Fi e di e en HL sc eening ools
we eused. Fou di e en in e en ionswe e included: educa ionalin e en ion, communica ionskills,
a mul imedia in e ac i e ool, and ex adap a ion o enhance eading comp ehension. No enough
esea ch p ac ice has been conduc ed on he in luence o in e en ions on HL, and hus, i is
di icul o implemen e idence-based in e en ions. Conclusions: In e en ions aiming o bene i and
imp o e HL should conside he complex web o in e sec ional de e minan s ha end up shaping he
oppo uni ies o women o make op imal decisions ega ding hei heal h and ca e, and which may
equi e a en ion o much mo e han clinical o se ice deli e y ac o s.
Keywo ds: heal h li e acy; nume acy; eading abili y; eading skill; p egnan women; in e en ion
1. Backg ound
Heal h li e acy (HL) ela es o a pe son’s knowledge and skills in decision-making in a medical and
social con ex necessa y o mee ing he complex heal h demands o mode n socie y [
1
]. Essen ial HL
skills include eading, w i ing, nume acy, and sea ching o in o ma ion [
2
], using mul imedia
echnologies and sol ing p oblems, all o which a e essen ially pe sonal and social skills o na iga ing
he heal h sys em [
3
]. HL i is conside ed one o he mos impo an ac o s and de e minan s o
indi idual heal h and heal h se ice use [4].
A s ong he e ogenei y in de ining and measu ing HL be ween women and men has been
epo ed [
5
]. The e ha e been di e en s udies alida ing he co ela ion be ween poo o low HL in
In . J. En i on. Res. Public Heal h 2020,17, 7405; doi:10.3390/ije ph17207405 www.mdpi.com/jou nal/ije ph
In . J. En i on. Res. Public Heal h 2020,17, 7405 2 o 17
women and poo heal h ou comes [
6
,
7
]. A woman’s le el o HL has he po en ial o impac ing he
heal h ou come o he en i e amily [8,9].
Cu en ly, a ious s anda dized and alida ed ools ha e been p oposed o assessing HL, bu ,
o da e, none o hem a e conside ed he “gold s anda d” [
10
,
11
]. The e is cu en ly con o e sy
ega ding he ou ine use o HL sc eening o clinical pu poses, al hough mos disag eemen is
ocused on i s use on pa ien s o on speci ic indi iduals a he han he o e all popula ion [
12
].
Some au ho s ecommend conside ing he en i e popula ion as ha ing a low HL le el [
9
], claiming ha
ou ine sc eening o HL lacks bene i s and could ha e undesi ed e ec s. On he o he hand, di e en
p o essional o ganiza ions p omo e HL sc eening o each he la ges possible popula ion and p o ide
unde s andable and accessible in o ma ion, ega dless o he le el o HL [13].
Inadequa e HL se es as a po en ial media o o heal h dispa i ies, and has been ela ed o le el o
educa ion (less han high school), low socioeconomic s a us, Hispanic e hnici y, Black ace, and olde
age [
14
]. Limi ed o low HL has been associa ed wi h poo heal h ou comes, including inadequa e
sel -ca ing and p e en i e beha io s [15].
Di e en in e en ions ha e been al eady designed o imp o e he ou comes and expe ience
o pa ien s wi h low HL in ela ion o heal h p oblems o pa hologies su ounding ma e nal heal h:
ges a ional weigh gain [
16
], diabe es melli us [
17
], b eas eeding p omo ion [
18
]; Zika i us [
19
],
medica ion e o s [
20
], b eas cance [
21
], and down synd ome sc eening [
22
]. These in e en ions ha e
ocused on inc easing heal h- ela ed knowledge in hese p ocesses, inc easing pa ien s’ comp ehension,
imp o ing adhe ence o ea men , o imp o ing pa ien –p o ide communica ion. Fu he mo e,
hese in e en ions include a a ie y o app oaches and componen s, om ace- o- ace communica ion
o pe sonalized eaching classes wi h in-pe son counselling, and in e ac i e o echnology-assis ed o
educa ion mul i-media wi h in e pe sonal in e ac ions.
O e all, he e has been ela i ely li le sys ema ic esea ch compa ing he e ec i eness o
in e en ions, speci ically wi h ega ds o any ela ionships be ween HL and heal h ou comes [
23
,
24
].
Mo e e idence is needed o iden i y he op imal way o design in e en ions o dec ease heal h
dispa i ies in women wi h low HL. Among hese a eas o esea ch, u he alida ion o he bene i s o
clea e heal h communica ion on heal h ou comes, assessmen o media o s o he han communica ion
in he pa hway be ween li e acy and poo heal h ou comes, and u he assessmen o he homogenei y
o pe sons wi h low HL a e equi ed o de elop app op ia e in e en ions o hem [
25
]. Thus,
he objec i es o his s udy we e o in es iga e he b ead h, dep h and quali y o he li e a u e ela ing
o he ollowing ques ions:
1.
Wha sc eening ools ha e been used o measu e he le el o heal h li e acy o women o
p egnan women?
2. Wha in e en ions and cha ac e is ics we e ca ied ou in his g oup?
3.
Wha is he e ec o in e en ions ca ied ou on women wi h limi ed o inadequa e heal h li e acy,
including p egnan women, in o de o imp o e heal h ca e?
2. Me hods
The PICO o ma (popula ion/in e en ion/compa a ion/ou comes) was used o p epa e he
esea ch ques ion, as shown in Table 1[
26
]. To add ess hese ques ions, a sys ema ic e iew o
published esea ch was conduc ed be ween Oc obe o No embe 2019 ollowing guidelines ou lined
in he Coch ane Handbook o Sys ema ic Re iews o In e en ions. The de ails o he p o ocol o his
sys ema ic e iew we e egis e ed on PROSPERO ID: CRD42020137059.
In . J. En i on. Res. Public Heal h 2020,17, 7405 3 o 17
Table 1. PICO s a egy: ca ego y, de ini ion, and sea ch e ms in da abases.
Ca ego y De ini ion Sea ch Te ms o Embase P egnancy Sea ch Te ms o Medline P egnancy Sea ch Te ms o CINAHL
Popula ion Women o p egnan women exp PREGNANCY/o exp WOMEN/. i,kw. exp P egnancy/o Women
p ep egnancy OR p e p egnancy OR
p egnan p econcep ion* OR p e
concep ion* OR pe iconcep ion* OR
women
In e en ion
In e en ions ha au ho s epo a e
designed speci ically o mi iga e he
e ec s o low heal h li e acy. Uses
single o mul iple
li e acy-di ec ed s a egies.
(“poo heal h li e acy” o “heal h li e acy” o
“li e acy, heal h”).mp. o exp “heal h
li e acy”/use oemezd o exp “Heal h
Li e acy”/use medall
heal h li e acy OR li e acy OR nume acy OR
eading abili y OR eading skills OR poo
heal h li e acy OR li e cy, heal h
heal h li e acy OR poo heal h li e acy
OR li e acy, heal h
Compa isons No applicable
Ou comes Heal h ca e, obs e ic ca e,
ep oduc i e ca e
exp OBSTETRIC PROCEDURE/o exp
BREAST FEEDING/o exp BREAST
FEEDING EDUCATION/o exp BIRTH/o
exp CHILDBIRTH/o CHILDBIRTH
EDUCATION/o LABOR PAIN/o (an e na al
o an ena al* o p e na al* o p ena al* o
pue pe * o pos na al* o pos pa um o pos
pa um o pos na al* o pe ipa um o pe i
pa um o p ep egnancy o p e p egnancy o
p econcep ion* o p e concep ion* o
pe iconcep ion* o pe i concep ion* o o
(p egnancy o p egnancies o
p egnan )((p e e m o p ema u e) and (labo
o labou )) o eclamp* o p eeclamp* o p e
eclamp* o amniocen es* o cho ion* ill* o
b eas e* o b eas e* o lac a ion* o
cesa ean o caesa ean o cesa ian o caesa ian
o cesa ien o caesa ien o newbo n* o new
bo n* o ocoly* o e al o oe al o e us o
oe us o misca iage*) o ca e o heal h
ca e. i,ab,kw.
exp P egnancy Complica ions/o exp
Obs e ics/o exp B eas Feeding/o exp
P ena al Educa ion/o exp Labo Pain/o
(b eas - eeding educa ion o pa u i ion o
an e na al an ena al* o p e na al* o
p ena al* o pue pe * o pos na al* o
pos pa um o pos pa um o pos na al* o
pe ipa um o pe i pa um o p ep egnancy
o p e p egnancy o p econcep ion* o p e
concep ion* o pe iconcep ion* o pe i
concep ion* o ((p e e m o p ema u e) and
(labo o labou )) o eclamp* o p eeclamp*
o p e eclamp* o amniocen es* o cho ion*
ill* o b eas e* o b eas e* o lac a ion* o
cesa ean o caesa ean o cesa ian o caesa ian
o cesa ien o caesa ien o newbo n* o new
bo n* o ocoly* o e al o oe al o e us o
oe us o misca iage* o p egnancy o
p egnancies o p egnan ) o ca e o heal h
ca e. i,ab,k .
(an ena al* OR p ena al* OR pue pe *
OR pos na al* OR pos pa um* OR pos
pa um OR pos na al* OR pe ipa um
OR pe i pa um) OR ca e OR heal h
ca e OR
PICO: popula ion/in e en ion/compa a ion/ou comes; CINAHL: Cumula i e Index o Nu sing and Allied Heal h Li e a u e.
In . J. En i on. Res. Public Heal h 2020,17, 7405 4 o 17
2.1. Sea ch S a egy
S udies we e iden i ied om MEDLINE ( om OVID SP), he Cumula i e Index o Nu sing and
Allied Heal h Li e a u e (CINAHL om EBSCO), Embase ( om OVID SP), and he Coch ane Da abase
o Sys ema ic Re iews ( om OVID SP). Each da abase was sea ched using he sea ch e ms shows in
Table 1as a single sea ch e m o in combina ion using Medical Subjec s Heading (MeSH) e ms wi h
he Boolean ope a o s AND/OR [27].
The sea ch o unpublished s udies included an elec onic sea ch o ial eco ds: cu en
con olled ials (h p://www.con olled- ials.com), he Na ional Ins i u e o Clinical Heal h Da abases
(h ps://clinical ials.go ), he Uni e sal Index o Doc o al Disse a ions in P og ess, Medna , e iew o
he g ey li e a u e and Google sea ch.
2.2. Inclusion and Exclusion C i e ia
The inclusion c i e ia we e as ollows: (a) pee e iewed; (b) s udies on in e en ions epo ed as
speci ically designed o mi iga e he e ec s o low HL in women o p egnan women; (c) a icles ha
measu ed HL using a p e iously alida ed HL assessmen ; (d) ou come measu es p o ided e idence
on he ela ionship be ween HL and ep oduc i e heal h ou comes o ela ed knowledge o beha io s;
(e) s udies published in English o Spanish languages; ( ) s udies om Janua y 1995 o No embe 2019;
(g) andomized clinical ials and quasi-expe imen al s udies conduc ed wi h compa ison g oups wi h
le el o HL.
2.3. Da a Ex ac ion and Quali y Assessmen
The au ho s c ea ed a da a ex ac ion o m ailo ed o his in es iga ion using he guidelines
ou lined in he Coch ane Handbook o Sys ema ic Re iews o In e en ions [
28
]. Two independen
au ho s e iewed he pape s. The da a ex ac ion p ocedu e was conduc ed in wo phases: (1) by i le
and abs ac , and (2) by ull ex . Following he assessmen o i le and abs ac , he p ima y e iewe
(RVC) and seconda y e iewe (FMMA) pe o med he ull- ex e alua ion. A hi d e iewe (PPR)
ac ed o esol e any disag eemen s.
The i s and second au ho s ho oughly e iewed each s udy and ex ac ed he main da a:
s udy design, sample cha ac e is ics, sample size, loca ion o he s udy, he HL sc eening ool,
heal h in e en ion cha ac e is ics, HL measu es, ou come measu es, and epo ed esul s.
Any coding disc epancies be ween he wo au ho s we e esol ed h ough subsequen e iew.
Abs ac ed da a we e hen compiled, e iewed, and summa ized in able o ma by one s udy au ho
(RVC). A e de e mining a icle inclusion, one e iewe en e ed da a abou each s udy on o he
e idence ables, wi h he second au ho checking and alida ing he in o ma ion o accu acy.
2.4. Assessmen o Risk o Bias wi hin Selec ed S udies
Two e iewe s independen ly a ed he quali y o s udies using he Coch ane p o ocol ha
assesses bias (RoB2). The RoB2 ool comp ises se en domains: andom sequence gene a ion; alloca ion
concealmen ; blinding o pa icipan s and pe sonnel; blinding o ou come assessmen ; incomple e
ou come da a; selec i e epo ing; and o he sou ces o bias. Each e alua ion was classi ied by wo
independen au ho s o a high isk o bias, a low isk o bias, o an unclea bias.
2.5. Da a Syn hesis and Analysis
As he numbe o s udies wi h simila ou comes was modes , and he in e en ions he e ogeneous,
a na a i e syn hesis was ag eed upon. Howe e , o cen al endency and dispe sion alues con ibu ed
by he au ho s a he p e- and pos -momen , a pe cen age o change in he main a iables was calcula ed
o acili a e compa ison be ween he g oups.
In . J. En i on. Res. Public Heal h 2020,17, 7405 5 o 17
3. Resul s
3.1. Cha ac e is ics o Clinical T ials
The sea ch e ie ed 292 a icles. A e he s udy selec ion p ocess, six a icles we e included in
he analysis. The ull s udy selec ion p ocess is p esen ed in Figu e 1as pe ecommended p e e ed
epo ing i ems o sys ema ic e iews and me a-analyses (PRISMA) c i e ia [29].
In . J. En i on. Res. Public Heal h 2020, 16, x 5 o 18
3. Resul s
3.1. Cha ac e is ics o Clinical T ials
The sea ch e ie ed 292 a icles. A e he s udy selec ion p ocess, six a icles we e included in
he analysis. The ull s udy selec ion p ocess is p esen ed in Figu e 1 as pe ecommended p e e ed
epo ing i ems o sys ema ic e iews and me a-analyses (PRISMA) c i e ia [29].
Figu e 1. P e e ed epo ing i ems o sys ema ic e iews and me a-analyses (PRISMA) low
diag am.
De ails o he s udy cha ac e is ics a e p esen ed in Table 2. The included s udies we e published
be ween 2011 and 2019. Six s udies om h ee coun ies me he c i e ia: The Uni ed S a es o Ame ica
(n = 3), I an (n = 2) and Aus alia (n = 1). Fi e s udies applied an RCT design, while only one used
quasi-expe imen al design. The sample sizes anged om 80 o 1126 pa ien s.
The hemes in which HL we e e alua ed, including sel -ca e in p egnan women, each-back in
eleheal h se ices o women, ges a ional diabe es in p egnan women, p e e m p e en ion in
p egnan women, p ena al gene ic in o ma ion in p egnan women, and in o med consen in ubal
s e iliza ion.
3.2. Resul s o Heal h Li e acy Sc eening Tools
Table 2 p esen s he i e HL sc eening ools used. Two s udies (33.3%) used he Single I em
Li e acy Sc eene (SILS) es . The emaining ools we e he Ma e nal Heal h Li e acy and P egnancy
Ou come Ques ionnai e (MHLAPQ), he I anian Heal h Li e acy Ques ionnai e (IHLQ), he Sho
e sion o he Tes o Func ional Heal h Li e acy in Adul s (S-TOFHLA), and he Rapid Es ima e o
Adul Li e acy in Medicine (REALM).
Figu e 1.
P e e ed epo ing i ems o sys ema ic e iews and me a-analyses (PRISMA) low diag am.
De ails o he s udy cha ac e is ics a e p esen ed in Table 2. The included s udies we e published
be ween 2011 and 2019. Six s udies om h ee coun ies me he c i e ia: The Uni ed S a es o Ame ica
(n=3), I an (n=2) and Aus alia (n=1). Fi e s udies applied an RCT design, while only one used
quasi-expe imen al design. The sample sizes anged om 80 o 1126 pa ien s.
The hemes in which HL we e e alua ed, including sel -ca e in p egnan women, each-back
in eleheal h se ices o women, ges a ional diabe es in p egnan women, p e e m p e en ion
in p egnan women, p ena al gene ic in o ma ion in p egnan women, and in o med consen in
ubal s e iliza ion.
In . J. En i on. Res. Public Heal h 2020,17, 7405 6 o 17
Table 2. Cha ac e is ics o he s udies included in he e iew.
Au ho Design S udy Pe iod nTheme Age Coun y HL Tool
Solhi e al., 2019 [30] RCT Jan o June 2016 80
Sel -ca e in
p egnan
women
>18 yea s I an MHLAPQ
Mo ony e al., 2018 [31] QES July o Oc 2018
637 calle s
and 18
nu ses
Teach-back in
eleheal h
se ice
31.3 ±6.5 Aus alia SILS
Gha auchou lo e al.,
2018 [32]RCT
6 weeks (1.5-h
session once a
week)
84
P egnan
women wi h
ges a ional
diabe es
IG: 31.5 ±4.4
CG: 30.8 ±3.8
p=0.734
I an IHLQ
Webb e al., 2014 [33] RCT Sep 2004 o
Aug 2008 1126
P e e m
p e en ion
p ojec
25.6 ±6.6 USA
S-TOFHLA
Yee e al., 2014 [34] RCT Aug 2010 o
Ma ch 2011 150 P ena al gene ic
in o ma ion 26.6 ±5.3 USA REALM
Zi e e al., 2011 [35] RCT
May o July 2010
203
In o med
consen in ubal
s e iliza ion
21–45 yea s USA SILS
HL: Heal h Li e acy; RCT: andomized clinical ial; MHLAPQ: Ma e nal Heal h Li e acy and P egnancy Ou come
Ques ionnai e; QES: quasi-expe imen al s udy; SILS: Single I em Li e acy Sc eene Tes ; IG: in e en ion g oup;
CG: con ol g oup; IHLQ: I anian Heal h Li e acy Ques ionnai e; S-TOFHLA: Sho e sion o he Tes o Func ional
Heal h Li e acy in Adul s; REALM: Rapid Es ima e o Adul Li e acy in Medicine.
3.2. Resul s o Heal h Li e acy Sc eening Tools
Table 2p esen s he i e HL sc eening ools used. Two s udies (33.3%) used he Single I em
Li e acy Sc eene (SILS) es . The emaining ools we e he Ma e nal Heal h Li e acy and P egnancy
Ou come Ques ionnai e (MHLAPQ), he I anian Heal h Li e acy Ques ionnai e (IHLQ), he Sho
e sion o he Tes o Func ional Heal h Li e acy in Adul s (S-TOFHLA), and he Rapid Es ima e o
Adul Li e acy in Medicine (REALM).
3.3. Resul s o In e en ions o Suppo Women wi h Low Heal h Li e acy
Table 3p esen s he esul s o in e en ions o six s udies. Fou di e en componen s we e
included: educa ional sessions, communica ion skills by elephone, a mul imedia in e ac i e ool,
and ex adap a ion o enhance eading comp ehension. Th ee s udies used educa ional in e en ion
(50.0%), and he o he s used communica ion skills by elephone (16.7%), a mul imedia in e ac i e ool
(16.7%), and ex adap a ion (16.7%).
In . J. En i on. Res. Public Heal h 2020,17, 7405 7 o 17
Table 3. Desc ip ion o a icles ha explo ed heal h li e acy.
Au ho In e en ion Heal h In e en ions Ou come 1
In e en ion
G oup
A e age
and SD
Con ol
G oup
A e age
and SD
O he
Repo ed
Findings
Ou come 2
In e en ion
G oup
A e age
and SD
Con ol
G oup
A e age
and SD
Solhi e al., 2019 [30]
Con ol g oup (n=40)
ecei ed he ou ine
educa ional p og am. The
in e en ion g oup (n=40)
ecei ed he ou ine
educa ional p og am and
addi ionally ollowed he
educa ional in e en ion
sessions.
Educa ional
in e en ion sessions o
45 min each in he o m
o lec u es, g oup
discussion, ques ion
and answe session,
counselling, p ac ical
exe cises, and
educa ional ma e ials
(e.g., bookle s and ilms
abou p egnancy).
De e mine he e ec o
heal h li e acy
educa ion on sel -ca e
in p egnan women.
Be o e
in e en ion
30.9 ±5.3
1 mon h a e
in e en ion
40.0 ±3.5
2 mon hs a e
in e en ion
40.6 ±3.1
Be o e
in e en ion
30.4 ±4.9
1 mon h a e
in e en ion
30.9 ±4.6
2 mon hs a e
in e en ion
31.6 ±4.6
Be o e
in e en ion
p=0.62
1 mon h a e
in e en ion
p<0.001
2 mon hs a e
in e en ion
p<0.001
Sel -ca e
ques ionnai e
Be o e
in e en ion
62.9 ±6.3
1 mon h a e
in e en ion
76.8 ±4.3
2 mon hs a e
in e en ion
78.0 ±3.9
Be o e
in e en ion
62.6 ±6.5
1 mon h a e
in e en ion
65.0 ±6.2
2 mon hs a e
in e en ion
66.0 ±6.7
Mo ony e al., 2018 [31]
T aining in heo y and
skills o using each-back
was a 2-h “communica ion
skills” wo kshop. Fo he
du a ion o he s udy,
nu ses we e encou aged o
e lec a e each call on
how e ec i ely hey
communica ed and how
well he calle unde s ood.
Calle ou comes we e
assessed in a single
elephone su ey
conduc ed by popula ion
esea ch labo a o y PRL
app oxima ely one week
ollowing ini ial con ac .
Handling o elephone
calls by means o he
each-back me hod.
E alua e he impac o
each-back on
communica ion quali y
in a na ional
elephone-based
eleheal h se ice o
calle s a ying in
heal h li e acy.
45.5% (n=
116) in highes
ca ego y
40.2% (n=
150) in highes
ca ego y
Odd a io
OR=0.77 (95%
CI 0.44–1.37);
p=0.37
Sa is ac ion o
calle s and
nu ses
72.3% (n=
188) in highes
ca ego y
70.7% (n=
266) in highes
ca ego y
In . J. En i on. Res. Public Heal h 2020,17, 7405 8 o 17
Table 3. Con .
Au ho In e en ion Heal h In e en ions Ou come 1
In e en ion
G oup
A e age
and SD
Con ol
G oup
A e age
and SD
O he
Repo ed
Findings
Ou come 2
In e en ion
G oup
A e age
and SD
Con ol
G oup
A e age
and SD
Gha auchou lo e al.,
2018 [32]
Six weeks (1.5 h sessions
once a week)
IG (n=50): ecei ed
counselling on ou ine
p egnancy
ca e and a heal h li e acy
app oach o counselling o
modi ying
li es yle.
CG (n=50): ecei ed
counselling on ou ine
p egnancy
ca e as well as a aining
package
con aining all he subjec s
discussed in he
in e en ion g oup.
Educa ional
in e en ion wi h
counselling on ou ine
p egnancy ca e and a
heal h li e acy
app oach o counselling
o modi ying li es yle.
In es iga e he e ec o
a heal h li e acy
app oach o
counselling on he
li es yle o women wi h
ges a ional diabe es.
HL: Be o e
in e en ion
9.95 ±2.52
A e
in e en ion
14.4 ±1.3
3 weeks a e
in e en ion
13.2 ±1.8
HL: Be o e
in e en ion
10.4 ±2.1
A e
in e en ion
11.7 ±1.9
3 weeks a e
in e en ion
11.3 ±1.9
p<0.001; F =
278.7
Li es yle
Ques ionnai e
(LSQ)
Be o e
in e en ion
144.7 ±21.5
A e
in e en ion
175.6 ±12.8
3 weeks a e
in e en ion
184.0 ±12.2
Be o e
in e en ion
143.5 ±19.9
A e
in e en ion
151.3 ±18.3
3 weeks a e
in e en ion
153.4 ±16.6
Webb e al., 2014 [33]
Women andomized in o
he ea men g oup (n=
565) we e egula ly
assessed o he p esence o
he p e-speci ied isk
ac o s and in i ed o a ail
hemsel es o he
s a e-o - he-a ea men
and se ices o e ed as pa
o he Philadelphia
Collabo a i e P e e m
P e en ion p ojec PCPPP
p o ocol. Women who
we e andomized in o he
con ol g oup (n=561)
we e adminis e ed
iden ical assessmen s as he
in e en ion g oup, we e
in o med o he esul s, and
we e e e ed o
app op ia e medical o
social se ice p o ide s in
he communi y.
Educa ional
in e en ion wi h
speci ic managemen o
isk ac o s in
in e en ion g oup.
The e icacy o
indi idual le el
isk- educ ion e o s
designed o p e en
p e e m/ epea p e e m
(desc ibe low li e acy as
hei main ou come).
P e alence o
low HL 22.5%
(n=106)
No speci ied
Women on
Medicaid o
wi hou
insu ance
we e mo e
likely han
women wi h
p i a e
insu ance o
ha e low HL
(26.2% s.
14.1%)
Accep ance
a e and
pa icipa ion
a e
Accep ance
a e (68.9%; n
=73) and
pa icipa ion
a e (40.2%, n
=43)
No speci ied
In . J. En i on. Res. Public Heal h 2020,17, 7405 9 o 17
Table 3. Con .
Au ho In e en ion Heal h In e en ions Ou come 1
In e en ion
G oup
A e age
and SD
Con ol
G oup
A e age
and SD
O he
Repo ed
Findings
Ou come 2
In e en ion
G oup
A e age
and SD
Con ol
G oup
A e age
and SD
Yee e al., 2014 [34]
CG (n=75): ecei ing
s anda d o ca e
counselling.
IG (n=75): ecei ing
s anda d o ca e
counselling and an
in e ac i e pa ien
educa ion ool o p ena al
sc eening and diagnosis
es s.
In e ac i e educa ion
ool.
De e mine whe he an
in e ac i e compu e
p og am could imp o e
pa ien knowledge
ega ding gene ic
sc eening and
diagnos ic concep s.
% o ques ions
co ec ly
answe ed: p e
69.4 ±14.2
pos 23 days:
60.6 ±16.0
% o ques ions
co ec ly
answe ed: p e
46.0 ±15.2
pos 23 days:
49.7 ±18.9
p e- es
p<0.001
pos - es
p=0.001
Zi e e al., 2011 [35]
Each pa icipan was
p o ided wi h a copy o
ei he he s anda d (n=99)
o he low-li e acy
Medicaid-Ti le XIX SCF (n
=102) and an alloca ed
s e iliza ion consen o m
a e ha .
Tex adap a ion o HL
le el.
To es ima e whe he he
Medicaid-Ti le XIX
S e iliza ion Consen
Fo m (SCF) o ma
s anda d compa ed
wi h low li e acy is
associa ed wi h
women’s
unde s anding o ubal
s e iliza ion.
77.5% o
co ec
answe s
49.0% o
co ec
answe s
p<0.01
women
andomized
o he
low-li e acy
Medicaid-Ti le
XIX SCF
g oup be e
unde s ood
he leng h o
ime equi ed
be ween
signing he
o m and
unde going
s e iliza ion
P e e ence o
subjec s
94% (n=189)
p e e ed
low-li e acy
Medicaid-Ti le
XIX SCF
6% (n
=12) p e e ed
Medicaid-Ti le
XIX SCF
In . J. En i on. Res. Public Heal h 2020,17, 7405 16 o 17
17.
Finb å en, H.S.; Pe e sen, K.S.; Wilde-La sson, B.; No ds öm, G.; T oll ik, A.; Gu e s ud, Ø. Valida ing
he Eu opean Heal h Li e acy Su ey Ques ionnai e in People wi h Type 2 Diabe es: La en T ai Analyses
Applying Mul idimensional Rasch Modelling and Con i ma o y Fac o Analysis. J. Ad . Nu s.
2017
.
[C ossRe ]
18.
Macke , M.; Guadagno, M.; Laza d, A.; Champlin, S.; Pounde s, K.; Walke , L. Imp o ing Ges a ional
Weigh Gain and B eas eeding P omo ion: Visual Communica ion o O e come Heal h Li e acy Ba ie s.
J. Commun. Heal hc. 2016. [C ossRe ]
19.
Thompson, E.L.; Vamos, C.A.; Ligge , L.G.; G ine , S.B.; Daley, E.M. Using a Heal h Li e acy Analy ic
F amewo k o Explo e Zika Vi us and Rep oduc i e Heal h. HLRP Heal h Li . Res. P . 2018. [C ossRe ]
20.
Ha is, L.M.; D eye , B.P.; Mendelsohn, A.L.; Bailey, S.C.; Sande s, L.M.; Wol , M.S.; Pa ke , R.M.; Pa el, D.A.;
Kim, K.Y.A.; Jimenez, J.J.; e al. Liquid Medica ion Dosing E o s by Hispanic Pa en s: Role o Heal h
Li e acy and English P o iciency. Acad. Pedia . 2017. [C ossRe ]
21.
Jibaja-Weiss, M.L.; Volk, R.J.; G anchi, T.S.; Ne , N.E.; Robinson, E.K.; Spann, S.J.; Aoki, N.; F iedman, L.C.;
Beck, J.R. En e ainmen Educa ion o B eas Cance Su ge y Decisions: A Randomized T ial among Pa ien s
wi h Low Heal h Li e acy. Pa ien Educ. Couns. 2011. [C ossRe ] [PubMed]
22.
Delanoë, A.; L
é
pine, J.; Lei a Po oca e o, M.E.; Robi aille, H.; Tu co e, S.; L
é
esque, I.; Wilson, B.J.;
Gigu
è
e, A.M.; L
é
ga
é
, F. Heal h Li e acy in P egnan Women Facing P ena al Sc eening May Explain Thei
In en ion o Use a Pa ien Decision Aid: A Sho Repo . BMC Res. No es
2016
,9, 339. [C ossRe ] [PubMed]
23.
Lo ini, C.; San omau o, F.; Donzellini, M.; Capecchi, L.; Bechini, A.; Boccalini, S.; Bonanni, P.; Bonacco si, G.
Heal h Li e acy and Vaccina ion: A Sys ema ic Re iew. Hum. Vaccin. Immuno he . 2017. [C ossRe ]
24.
Zibellini, J.; Musca , D.M.; Kizi ian, N.; Go don, A. E ec o Heal h Li e acy In e en ions on P egnancy
Ou comes: A Sys ema ic Re iew. Women Bi h 2020. in P ess. [C ossRe ] [PubMed]
25.
Sudo e, L.R.; Schillinge , D. In e en ions o Imp o e Ca e o Pa ien s wi h Limi ed Heal h Li e acy. J. Clin.
Ou comes Manag. 2009,16, 20–29.
26.
E iksen, M.B.; F andsen, T.F. The Impac o Pa ien , In e en ion, Compa ison, Ou come (Pico) as a Sea ch
S a egy Tool on Li e a u e Sea ch Quali y: A Sys ema ic Re iew. J. Med. Lib . Assoc.
2018
,106, 420–431.
[C ossRe ] [PubMed]
27.
B ame , W.M.; Re hle sen, M.L.; Kleijnen, J.; F anco, O.H. Op imal Da abase Combina ions o Li e a u e
Sea ches in Sys ema ic Re iews: A P ospec i e Explo a o y S udy. Sys . Re . 2017,6, 245. [C ossRe ]
28.
Li, T.; Higgins, J.; Deeks, J. Chap e 5: Collec ing Da a. In Coch ane Handbook o Sys ema ic Re iews o
In e en ions Ve sion 6.0 (Upda ed July 2019); Higgins, J., Thomas, J., Chandle , J., Cumps on, M., Li, T.,
Page, M., Welch, V., Eds.; John Wiley and Sons: Hoboken, NJ, USA, 2019.
29.
Mohe , D.; Libe a i, A.; Te zla , J.; Al man, D.G.; Al man, D.; An es, G.; A kins, D.; Ba bou , V.; Ba owman, N.;
Be lin, J.A.; e al. P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses: The PRISMA
S a emen . PLoS Med. 2009,6, e1000097. [C ossRe ]
30.
Solhi, M.; Abbasi, K.; Aza , F.E.F.; Hosseini, A. E ec o Heal h Li e acy Educa ion on Sel -Ca e in P egnan
Women: A Randomized Con olled Clinical T ial. In . J. Communi y Based Nu s. Midwi e y
2019
,7, 2–12.
[C ossRe ]
31.
Mo ony, S.; Wei , K.R.; Bell, K.J.L.; Biggs, J.; Duncan, G.; Nu beam, D.; McCa e y, K.J. A S epped Wedge
Clus e Randomised T ial o Nu se-Deli e ed Teach-Back in a Consume Teleheal h Se ice. PLoS ONE
2018
,
13, e0206473. [C ossRe ]
32.
Mahmoodi, Z.; Gha achou lo, M.; Akba i Kam ani, M.; Teh anizadeh, M.; Kabi , K. The E ec o a Heal h
Li e acy App oach o Counselling on he Li es yle o Women wi h Ges a ional Diabe es: A Clinical T ial.
F1000Resea ch 2018. [C ossRe ]
33.
Webb, D.A.; Ma hew, L.; Culhane, J.F. Lessons Lea ned om he Philadelphia Collabo a i e P e e m
P e en ion P ojec : The P e alence o Risk Fac o s and P og am Pa icipa ion Ra es among Women in he
In e en ion G oup. BMC P egnancy Childbi h 2014. [C ossRe ] [PubMed]
34.
Yee, L.M.; Wol , M.; Mullen, R.; Be ge on, A.R.; Coope Bailey, S.; Le ine, R.; G obman, W.A. A Randomized
T ial o a P ena al Gene ic Tes ing In e ac i e Compu e ized In o ma ion Aid. P ena . Diagn.
2014
. [C ossRe ]
[PubMed]
35.
Zi e, N.B.; Wallace, L.S. Use o a Low-Li e acy In o med Consen Fo m o Imp o e Women’s Unde s anding
o Tubal S e iliza ion: A Randomized Con olled T ial. Obs. Gynecol. 2011. [C ossRe ] [PubMed]
In . J. En i on. Res. Public Heal h 2020,17, 7405 17 o 17
36.
Nu beam, D.; McGill, B.; P emkuma , P. Imp o ing Heal h Li e acy in Communi y Popula ions: A Re iew o
P og ess. Heal h P omo . In . 2018,33, 901–911. [C ossRe ]
37.
Mojoyinola, J. In luence o Ma e nal Heal h Li e acy on Heal hy P egnancy and P egnancy Ou comes o
Women A ending Public Hospi als in Ibadan, Oyo S a e, Nige ia. A . Res. Re . 2011,5. [C ossRe ]
38.
Sø ensen, K.; Pelikan, J.M.; Rö hlin, F.; Ganahl, K.; Slonska, Z.; Doyle, G.; Fullam, J.; Kondilis, B.; Ag a io is, D.;
Ui e s, E.; e al. Heal h Li e acy in Eu ope: Compa a i e Resul s o he Eu opean Heal h Li e acy Su ey
(HLS-EU). Eu . J. Public Heal h 2015,25, 1053–1058. [C ossRe ] [PubMed]
39.
Osbo ne, R.H.; Ba e ham, R.W.; Elswo h, G.R.; Hawkins, M.; Buchbinde , R. The G ounded Psychome ic
De elopmen and Ini ial Valida ion o he Heal h Li e acy Ques ionnai e (HLQ). BMC Public Heal h
2013
,13,
658. [C ossRe ]
40.
So ensen, K.; Van den B oucke, S.; Pelikan, J.M.; Fullam, J.; Doyle, G.; Slonska, Z.; Kondilis, B.; S o els, V.;
Osbo ne, R.H.; B and, H.; e al. Measu ing Heal h Li e acy in Popula ions: Illumina ing he Design and
De elopmen P ocess o he Eu opean Heal h Li e acy Su ey Ques ionnai (HLS-EU-Q). BMC Public Heal h
2013,13, 948. [C ossRe ]
41.
Vila-Candel, R.; So iano-Vidal, F.J.; Cas o-S
á
nchez, E. Midwi es, accines and heal h li e acy:
An unde explo ed ela ion? Gac. Sani . 2016. [C ossRe ]
42.
Mangham-Je e ies, L.; Pi , C.; Cousens, S.; Mills, A.; Schellenbe g, J. Cos -E ec i eness o S a egies
o Imp o e he U iliza ion and P o ision o Ma e nal and Newbo n Heal h Ca e in Low-Income and
Lowe -Middle-Income Coun ies: A Sys ema ic Re iew. BMC P egnancy Childbi h
2014
,14. [C ossRe ]
[PubMed]
43.
Haun, J.N.; Pa el, N.R.; F ench, D.D.; Campbell, R.R.; B adham, D.D.; Lapce ic, W.A. Associa ion be ween
Heal h Li e acy and Medical Ca e Cos s in an In eg a ed Heal hca e Sys em: A Regional Popula ion Based
S udy. BMC Heal h Se . Res. 2015,15. [C ossRe ] [PubMed]
44.
Le in, J.B.; Pe e son, P.N.; Dolansky, M.A.; Boxe , R.S. Heal h Li e acy and Hea Failu e Managemen in
Pa ien -Ca egi e Dyads. J. Ca d. Fail. 2014,20, 755–761. [C ossRe ] [PubMed]
45.
Man will, S.; Mones el-Umaña, S.; Schulz, P.J. The Rela ionship be ween Heal h Li e acy and Heal h
Dispa i ies: A Sys ema ic Re iew. PLoS ONE 2015,10, e0145455. [C ossRe ] [PubMed]
46.
Shieh, C.; Mays, R.; McDaniel, A.; Yu, J. Heal h Li e acy and I s Associa ion wi h he Use o In o ma ion
Sou ces and wi h Ba ie s o In o ma ion Seeking in Clinic-Based P egnan Women. Heal h Ca e Women In .
2009. [C ossRe ]
47.
Mo ison, A.K.; My ik, M.P.; B ousseau, D.C.; Ho mann, R.G.; S anley, R.M. The Rela ionship be ween
Pa en Heal h Li e acy and Pedia ic Eme gency Depa men U iliza ion: A Sys ema ic Re iew. Acad. Pedia .
2013. [C ossRe ]
©
2020 by he au ho s. Licensee MDPI, Basel, Swi ze land. This a icle is an open access
a icle dis ibu ed unde he e ms and condi ions o he C ea i e Commons A ibu ion
(CC BY) license (h p://c ea i ecommons.o g/licenses/by/4.0/).
