University Hospital Cologne, Department of Psychosomatics and Psychotherapy, Weyertal 76, 50931, Cologne, Germany.
University of Cologne, Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), Albertus-Magnus-Platz, 50923, Cologne, Germany.
Soc Sci Med. 2020 Jan;245:112711. doi: 10.1016/j.socscimed.2019.112711. Epub 2019 Dec 3.
Health literacy (HL) plays a crucial role in the maintenance and improvement of individual health. Empirical findings highlight the relation between a person's HL-level and clinical outcomes. However, the role of HL in persons at risk for coronary heart disease (CHD) and patients with CHD has not been researched conclusively.
The aim of this study was to review systematically the current evidence on HL, its dimensions (access to, understanding, appraisal and apply of health-related information), and its important influencing factors, with regard to CHD risk.
We used a mixed-methods approach. Eligible articles needed to employ a validated tool for HL or mention the concept and at least one of its dimensions. After the screening process, 14 quantitative and 27 qualitative studies were included and referred to one or more dimensions of HL. Six observational studies measured HL with a validated tool.
Findings suggest that patients with lower HL feel less capable to perform lifestyle changes, exhibit fewer proactive coping behaviors, are more likely to deny CHD, are generally older, are less often employed, have lower educational levels and lower socioeconomic status, experience faster physical decline, and use the healthcare system less, compared to patients with higher HL. Barriers to HL include inadequate provision of information by health providers, lack of awareness of the risk factors for CHD, perceived impairment of quality of life due to lifestyle changes, and negative experiences with the healthcare system. Facilitators include a good patient-physician relationship based on good communicative competences of health providers.
The concept of HL yields a promising potential to understand the process from obtaining information to actual health behavior change, and the results clearly indicate the need for more systematic research on HL in CHD patients and persons at risk.
健康素养（HL）在维护和改善个人健康方面起着至关重要的作用。实证研究结果强调了一个人 HL 水平与临床结果之间的关系。然而，HL 在冠心病（CHD）高危人群和 CHD 患者中的作用尚未得到明确研究。
本研究旨在系统回顾与 CHD 风险相关的 HL 及其维度（获取、理解、评估和应用健康相关信息）及其重要影响因素的现有证据。
我们采用混合方法。合格的文章需要使用经过验证的 HL 工具或提及概念及其至少一个维度。经过筛选过程，纳入了 14 项定量研究和 27 项定性研究，涉及 HL 的一个或多个维度。有 6 项观察性研究使用经过验证的工具测量 HL。
研究结果表明，HL 较低的患者感觉自己更难以进行生活方式改变，表现出较少的主动应对行为，更有可能否认 CHD，年龄较大，就业机会较少，受教育程度和社会经济地位较低，身体衰退速度较快，对医疗保健系统的使用较少，与 HL 较高的患者相比。HL 的障碍包括卫生提供者提供的信息不足、对 CHD 危险因素缺乏认识、因生活方式改变而感知到生活质量受损，以及对医疗保健系统的负面体验。促进因素包括基于卫生提供者良好沟通能力的良好医患关系。
HL 这一概念具有很大的潜力，可以帮助理解从获取信息到实际健康行为改变的过程，研究结果明确表明需要对 CHD 患者和高危人群中的 HL 进行更系统的研究。
