Chauhan Arohi, Linares-Jimenez Fernando Gregorio, Dash Girish Chandra, de Zeeuw Janine, Kumawat Archana, Mahapatra Pranab, de Winter Andrea F, Mohan Sailesh, van den Akker Marjan, Pati Sanghamitra
Public Health Consultant, New Delhi, India.
Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands.
BMJ Open. 2024 Dec 23;14(12):e073181. doi: 10.1136/bmjopen-2023-073181.
To examine existing literature regarding health literacy levels and their association with multimorbidity and the potential underlying mechanisms behind the said association.
Systematic review and meta-analysis.
The databases MEDLINE, EMBASE, CINAHL and Science Direct were searched for articles published between 1 January 2000 and 31 October 2023 using a systematic search strategy.
Included were all primary studies conducted in people over 18 years old with data on health literacy levels and the presence of multimorbidity. No language restrictions were used.
Two authors independently extracted data and assessed the bias using the Joanna Briggs Institute critical appraisal tools.
We included a total of 39 studies (36 quantitative, two qualitative and one mixed-method), representing 154 337 participants. We found a 32% proportion of limited health literacy among individuals with multimorbidity. Analysis of three articles using the Health Literacy Questionnaire tool (n=31 228) (Pooled OR 2.88 (95% CI 1.92 to 4.31)) and three articles using the Health Literacy Survey Questionnaire-European Union tool (n=35 358) (OR 1.16 (95% CI 1.07 to 1.25)) indicated that people with limited health literacy were likely to have multiple conditions. One of three articles studying underlying mechanisms reported that self-efficacy mediates the association between health literacy and multimorbidity. Additionally, substantial literature identified education and income as the most consistent determinants of health literacy among individuals with multimorbidity. Of the only two articles studying the effectiveness of health literacy-related interventions, both reported an improvement in clinical outcomes after the intervention.
Our review demonstrated a consistent association between health literacy and multimorbidity, indicating that people with lower health literacy levels are more likely to have multimorbidity. More evidence is needed regarding the effect of health literacy interventions on multimorbidity.
CRD42022301369.
研究关于健康素养水平及其与多种疾病并存的关联，以及上述关联背后潜在机制的现有文献。
系统评价和荟萃分析。
使用系统检索策略，在MEDLINE、EMBASE、CINAHL和Science Direct数据库中检索2000年1月1日至2023年10月31日发表的文章。
纳入所有针对18岁以上人群开展的、有健康素养水平和多种疾病并存情况数据的原发性研究。未设语言限制。
两位作者独立提取数据，并使用乔安娜·布里格斯研究所的批判性评价工具评估偏倚。
我们共纳入39项研究（36项定量研究、2项定性研究和1项混合方法研究），涉及154337名参与者。我们发现，多种疾病并存的个体中，健康素养有限的比例为32%。使用健康素养问卷工具的三篇文章（n = 31228）（合并比值比2.88（95%置信区间1.92至4.31））和使用欧盟健康素养调查问卷工具的三篇文章（n = 35358）（比值比1.16（95%置信区间1.07至1.25））分析表明，健康素养有限的人更可能患有多种疾病。研究潜在机制的三篇文章中有一篇报告称，自我效能在健康素养与多种疾病并存之间起中介作用。此外，大量文献指出，教育和收入是多种疾病并存个体健康素养最一致的决定因素。在仅有的两项研究健康素养相关干预措施效果的文章中，两项均报告干预后临床结局有所改善。
我们的综述表明，健康素养与多种疾病并存之间存在一致关联，这表明健康素养水平较低的人更有可能患有多种疾病。关于健康素养干预对多种疾病并存的影响，还需要更多证据。
PROSPERO注册号：CRD42022301369。
