Cudjoe Joycelyn, Delva Sabianca, Cajita Mia, Han Hae-Ra
Health Lit Res Pract. 2020 Feb 11;4(1):e22-e44. doi: 10.3928/24748307-20191025-01.
Health literacy is a significant determinant of health behaviors, but the pathways through which health literacy influences health behaviors are not completely clear nor consistent. The purpose of this systematic review is to critically appraise studies that have empirically tested the potential pathways linking health literacy to health behavior.
We performed searches of the electronic databases PubMed, Embase, and CINAHL to identify studies that proposed a conceptual framework and empirically tested the proposed mechanism through which health literacy influences certain health behaviors. Twenty eligible studies were included for analysis.
The 20 studies addressed various health behaviors: chronic disease self-management (n = 8), medication adherence (n = 2), overall health status (n = 4), oral care (n = 1), cancer screening (n = 1), shared decision-making (n = 1), health information sharing (n = 1), physical activity and eating behaviors (n = 1), and emergency department visits (n = 1). Most studies were conducted in the United States (n = 13) and used a cross-sectional design (n = 15). The Short Test of Functional Health Literacy in Adults was commonly used to assess health literacy levels. Selection of variables and their operationalization were informed by a theoretical model in 12 studies. Age, gender, race/ethnicity, and insurance status were reported antecedents to health literacy. The most commonly tested mediators were self-efficacy (n = 8) and disease knowledge (n = 4). Fit indices reported in the studies ranged from acceptable to excellent.
Current evidence supports self-efficacy as a mediator between health literacy and health behavior. Further research is needed to identify how health literacy interplays with known psychosocial factors to inform people's use of preventive care services. Future studies should include more disadvantaged populations such as immigrants with high disease burden and those with low health literacy. Theory-based, empirically tested health literacy models can serve as the conceptual basis for developing effective health interventions to improve health behaviors and ultimately decrease the burden of disease in such vulnerable populations. [HLRP: Health Literacy Research and Practice. 2020;4(1):e21-e44.] PLAIN LANGUAGE SUMMARY: This review systemically compiles, and critically appraises 20 existing studies that test conceptual frameworks that propose potential pathways through which health literacy affects health behaviors. The findings from this review can help inform the development of health literacy-focused interventions to improve the health behaviors of populations with disease burdens.
健康素养是健康行为的重要决定因素，但健康素养影响健康行为的途径尚不完全清晰且不一致。本系统评价的目的是严格评估那些通过实证检验健康素养与健康行为之间潜在途径的研究。
我们检索了电子数据库PubMed、Embase和CINAHL，以识别那些提出概念框架并通过实证检验健康素养影响某些健康行为的机制的研究。纳入20项符合条件的研究进行分析。
这20项研究涉及多种健康行为：慢性病自我管理（8项）、药物依从性（2项）、总体健康状况（4项）、口腔护理（1项）、癌症筛查（1项）、共同决策（1项）、健康信息共享（1项）、身体活动和饮食行为（1项）以及急诊科就诊（1项）。大多数研究在美国进行（13项），采用横断面设计（15项）。成人功能性健康素养简短测试常用于评估健康素养水平。12项研究中变量的选择及其操作化以理论模型为依据。年龄、性别、种族/族裔和保险状况被报告为健康素养的前置因素。最常检验的中介变量是自我效能感（8项）和疾病知识（4项）。研究报告的拟合指数从可接受到优秀不等。
目前的证据支持自我效能感作为健康素养与健康行为之间的中介变量。需要进一步研究以确定健康素养如何与已知的心理社会因素相互作用，从而指导人们使用预防性保健服务。未来的研究应纳入更多弱势群体，如疾病负担高的移民和健康素养低的人群。基于理论且经过实证检验的健康素养模型可作为开发有效健康干预措施的概念基础，以改善健康行为并最终减轻此类弱势群体的疾病负担。[《健康素养研究与实践》。2020年；4(1):e21 - e44。] 通俗易懂的总结：本综述系统地汇编并严格评估了20项现有研究，这些研究检验了提出健康素养影响健康行为潜在途径的概念框架。本综述的结果有助于为以健康素养为重点的干预措施的开发提供信息，以改善有疾病负担人群的健康行为。
