Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
Harvard TH Chan School of Public Health, Boston, MA, USA.
J Gen Intern Med. 2021 Mar;36(3):753-761. doi: 10.1007/s11606-020-06407-8. Epub 2021 Jan 5.
Many studies have shown that low health literacy (HL) is associated with several adverse outcomes. In this study, we systematically reviewed the prevalence of low HL in Europe.
PubMed, Embase, and Scopus were searched. Cross-sectional studies conducted in the European Union (EU), published from 2000, investigating the prevalence of low HL in adults using a reliable tool, were included. Quality was assessed with the Newcastle-Ottawa Scale. Inverse-variance random effects methods were used to produce pooled prevalence estimates. A meta-regression analysis was performed to assess the association between low HL and the characteristics of the studies.
The pooled prevalence of low HL ranged from of 27% (95% CI: 18-38%) to 48% (95% CI: 41-55%), depending on the literacy assessment method applied. Southern, Western, and Eastern EU countries had lower HL compared to northern Europe (β: 0.87, 95% CI: 0.40-1.35; β: 0.59, 95% CI: 0.25-0.93; and β: 0.72, 95% CI: 0.06-1.37, respectively). The assessment method significantly influenced the pooled estimate: compared to word recognition items, using self-reported comprehensions items (β: 0.61, 95% CI: 0.15-1.08), reading or numeracy comprehensions items (β: 0.77, 95% CI: 0.24-1.31), or a mixed method (β: 0.66, 95% CI: 0.01-1.33) found higher rates of low HL. Refugees had the lowest HL (β: 1.59, 95% CI: 0.26-2.92). Finally, lower quality studies reported higher rates of low HL (β: 0.56, 95% CI: 0.06-1.07).
We found that low HL is a public health challenge throughout Europe, where one in every three to almost one in every two Europeans may not be able to understand essential health-related material. Additional research is needed to investigate the underlying causes and to develop remedies.
CRD42019133377.
许多研究表明，低健康素养（HL）与多种不良后果相关。本研究系统地综述了欧洲 HL 水平较低的流行情况。
检索了 PubMed、Embase 和 Scopus。纳入了 2000 年以来在欧盟（EU）进行的、使用可靠工具调查成年人 HL 流行率的横断面研究。采用 Newcastle-Ottawa 量表评估质量。采用逆方差随机效应方法得出汇总流行率估计值。进行了 meta 回归分析以评估 HL 水平较低与研究特征之间的关系。
根据应用的不同文化程度评估方法，HL 水平较低的汇总流行率范围为 27%（95%CI：18-38%）至 48%（95%CI：41-55%）。与北欧相比，南欧、西欧和东欧国家的 HL 水平较低（β：0.87，95%CI：0.40-1.35；β：0.59，95%CI：0.25-0.93；β：0.72，95%CI：0.06-1.37）。评估方法显著影响汇总估计值：与单词识别项目相比，使用自我报告的理解项目（β：0.61，95%CI：0.15-1.08）、阅读或计算理解项目（β：0.77，95%CI：0.24-1.31）或混合方法（β：0.66，95%CI：0.01-1.33）发现 HL 水平较低的比例更高。难民的 HL 水平最低（β：1.59，95%CI：0.26-2.92）。最后，质量较低的研究报告 HL 水平较低的比例更高（β：0.56，95%CI：0.06-1.07）。
我们发现，HL 水平较低是整个欧洲的公共卫生挑战，每三至两个人中就有一个人可能无法理解基本的健康相关信息。需要进一步研究以调查其根本原因并制定补救措施。
PROSPERO 注册号：CRD42019133377。
