Self-management of chronic diseases is rather complex, especially for patients with limited health literacy. In this review, we aim to disentangle the specific difficulties patients with limited health literacy face in relation to self-management and their associated needs with respect to self-management support.
Methods
We performed a literature search in five databases. We used a broad definition of health literacy and self-management was categorized into four types of activities: medical management, changing lifestyle, communicating and navigating through the health care system and coping. Included reviews described the relationship between health literacy and different domains of self-management and were published after 2010.
Results
A total of 28 reviews were included. Some clear difficulties of patients with limited health literacy emerged, predominantly in the area of medical management (especially adherence), communication and knowledge. Other associations between health literacy and self-management were inconclusive. Barriers from the patients’ perspective described mainly medical management and the communication and navigation of the health care system.
Discussion
Patients with limited health literacy experience difficulties with specific domains of self-management. For a better understanding of the relationship between health literacy and self-management, a broader conceptualization of health literacy is warranted, including both cognitive and behavioural aspects.
MegariK. Quality of life in chronic disease patients. Health Psychol Res2013; 1: e27.
3.
BarlowJWrightCSheasbyJ,et al.Self-management approaches for people with chronic conditions: a review. Patient Educ Couns2002; 48: 177–187.
4.
BallesterMOrregoCHeijmansM, et al.Comparing the effectiveness and cost-effectiveness of self-management interventions in four high-priority chronic conditions in Europe (COMPAR-EU): a research protocol. BMJ open2020; 10: e034680.
5.
BaylissEASteinerJFFernaldDH,et al.Descriptions of barriers to self-care by persons with comorbid chronic diseases. Ann Family Med2003; 1: 15–21.
6.
van HoutumLRijkenMHeijmansM,et al.Patient-perceived self-management tasks and support needs of people with chronic illness: generic or disease specific?Ann Behav Med2015; 49: 221–229.
JerantAFvon Friederichs-FitzwaterMMMooreM. Patients’ perceived barriers to active self-management of chronic conditions. Patient Educ Couns2005; 57: 300–307.
9.
Van Der HeideIHeijmansMSchuitAJ,et al.Functional, interactive and critical health literacy: varying relationships with control over care and number of GP visits. Patient Educ Couns2015; 98: 998–1004.
10.
BerkmanNDSheridanSLDonahueKE,et al.Low health literacy and health outcomes: an updated systematic review. Ann Intern Med2011; 155: 97–107.
11.
SørensenKVan den BrouckeSFullamJ, et al.Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health2012; 12: 1–13.
12.
RademakersJHeijmansM. Beyond reading and understanding: health literacy as the capacity to act. Int J Environ Res Public Health. 2018; 15: 1676.
13.
BrachCHarrisLM. Healthy people 2030 health literacy definition tells organizations: make information and services easy to find, understand, and use. J Gen Intern Med. 2021; 36: 1084–1085.
14.
BrachCKellerDHernandezLM, et al.Ten attributes of health literate health care organizations. NAM Perspect2012. Discussion Paper. Washington, DC: National Academy of Medicine. https://doi.org/10.31478/201206a
15.
van der HeideIPoureslamiIMiticW,et al.Health literacy in chronic disease management: a matter of interaction. J Clin Epidemiol2018; 102: 134–138.
16.
ArkseyHO’MalleyL. Scoping studies: towards a methodological framework. Int J Soc Res Methodol2005; 8: 19–32.
17.
LevacDColquhounHO’BrienKK. Scoping studies: advancing the methodology. Implement Sci2010; 5: 69.
18.
Al SayahFMajumdarSRWilliamsB,et al.Health literacy and health outcomes in diabetes: a systematic review. J Gen Intern Med2013; 28: 444–452.
19.
BaileySCBregaAGCrutchfieldTM, et al.Update on health literacy and diabetes. Diabetes Educ2014; 40: 581–604.
20.
BarnasonSWhite-WilliamsCRossiLP, et al.Evidence for therapeutic patient education interventions to promote cardiovascular patient self-management: a scientific statement for healthcare professionals from the American Heart Association. Circ: Cardiovasc Qual Outcomes2017; 10: e00002.
21.
Bos-TouwenIJonkmanNWestlandH, et al.Tailoring of self-management interventions in patients with heart failure. Curr Heart Fail Rep2015; 12: 223–235.
22.
BrowneTMerighiJR. Barriers to adult hemodialysis patients’ self-management of oral medications. Am J Kidney Dis2010; 56: 547–557.
23.
Cabellos-GarciaACMartinez-SabaterACastro-SanchezE,et al.Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review. BMC Public Health. 2018; 18: 1157.
24.
CajitaMICajitaTRHae-RaH. Health literacy and heart failure. J Cardiovasc Nurs2016; 31: 121–130.
25.
CassidyBPGetchellLEHarwoodL,et al.Barriers to education and shared decision making in the chronic kidney disease population: a narrative review. Can J Kidney Health Dis2018; 5. http://doi.org/2054358118803322
26.
ChatterjeeSDaviesMJHellerS,et al.Diabetes structured self-management education programmes: a narrative review and current innovations. Lancet Diabetes Endocrinol2018; 6: 130–142.
27.
ChenPYElmerSCallisayaM,et al.Associations of health literacy with diabetic foot outcomes: a systematic review and meta-analysis. Diabetic Med2018; 35: 1470–1479.
28.
CudjoeJDelvaSCajitaM,et al.Empirically tested health literacy frameworks. Health Lit Res Pract2020; 4: e22–e44.
29.
DahalPKHosseinzadehH. Association of health literacy and diabetes self-management: a systematic review. Aust J Prim Health2019; 25: 526–533.
DelgadoJMRupparTM. Health literacy in Older Latinos with heart failure: a systematic review. J Cardiovasc Nurs2017; 32: 125–134.
32.
DislerRTGallagherRDDavidsonPM. Factors influencing self-management in chronic obstructive pulmonary disease: an integrative review. Int J Nurs Stud2012; 49: 230–242.
33.
DuSZhouYFuC,et al.Health literacy and health outcomes in hypertension: an integrative review. Int J Nurs Sci2018; 5: 301–309.
34.
EdwardJCarreonLYWilliamsMV,et al.The importance and impact of patients’ health literacy on low back pain management: a systematic review of literature. Spine J2018; 18: 370–376.
35.
EvangelistaLSRasmussonKDLarameeAS, et al.Health literacy and the patient with heart failure--implications for patient care and research: a consensus statement of the Heart Failure Society of America. J Card Fail2010; 16: 9–16.
36.
FransenMPvon WagnerCEssink-BotML. Diabetes self-management in patients with low health literacy: ordering findings from literature in a health literacy framework. Patient Educ Couns2012; 88: 44–53.
37.
JagerMde ZeeuwJTulliusJ, et al.Patient perspectives to inform a health literacy educational program: a systematic review and thematic synthesis of qualitative studies. Int J Environ Res Public Health2019; 16: 4300.
38.
KadirveluASadasivanSNgSH. Social support in type II diabetes care: a case of too little, too late. Diabetes, Metab Syndr Obes: Targets Ther2012; 5: 407–417.
39.
LokeYKHinzIWangX,et al.Systematic review of consistency between adherence to cardiovascular or diabetes medication and health literacy in older adults. Ann Pharmacother2012; 46: 863–872.
40.
MackeyLMDoodyCWernerEL,et al.Self-management skills in chronic disease management: what role does health literacy have?Med Decis Making2016; 36: 741–759.
41.
MarcianoLCameriniALSchulzPJ. The role of health literacy in diabetes knowledge, self-care, and glycemic control: A meta-analysis. J Gen Intern Med2019; 34: 1007–1017.
42.
PapadakosJKHasanSMBarnsleyJ, et al.Health literacy and cancer self-management behaviors: a scoping review. Cancer2018; 124: 4202–4210.
ShahinWKennedyGAStupansI. The impact of personal and cultural beliefs on medication adherence of patients with chronic illnesses: a systematic review. Patient Prefer Adherence2019; 13: 1019–1035.
45.
XuXYLeungAYMChauPH. Health literacy, self-efficacy, and associated factors among patients with diabetes. Health Lit Res Pract2018; 2: e67–e77.
