Summary of findings 5. Culturally and literacy adapted audio‐/visual education without personal feedback versus no health literacy intervention.
| Culturally and literacy adapted audio‐/visual education without personal feedback versus no health literacy intervention | ||||||
| Patient or population: migrants Setting: all settings Intervention: culturally and literacy adapted audio‐/visual education without personal feedback Comparison: no health literacy intervention (usual care, wait‐list control or placebo intervention) | ||||||
| Outcome category – outcome(s)* | Anticipated absolute effects** (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with no health literacy intervention | Risk with audio‐/visual education | |||||
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Health literacy – (1) Depression literacy Assessed with:
Higher scores are better (2) Applying health information Multiple measures used:
Higher scores are better Time point: short‐term (immediately up to 1 week post‐intervention)*** |
The mean depression literacy score in the control group was 8.22 points | The mean depression literacy score in the intervention group was 8.62 points higher (7.51 higher to 9.73 higher) | — | 202 (1 RCT) | ⊕⊕⊕⊝ Moderatea | Audio‐/visual education without personal feedback compared to no health literacy intervention probably improves depression literacy 1 week post‐intervention, when compared to no health literacy intervention. |
| One study reported that the intervention improved the intention to seek treatment for depression (MD 1.8 points higher (0.43 higher to 3.17 higher)) | — | 120 (1 RCT)1 | ⊕⊕⊝⊝ Lowb,c | Audio‐/visual education without personal feedback may slightly improve the intention to seek treatment for depression immediately post‐intervention, when compared to no health literacy intervention. | ||
| Quality of life – not measured | — | — | — | — | — | The effect of audio‐/visual education without personal feedback on quality of life is unknown, as there was no direct evidence identified. |
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Health‐related knowledge – Any health‐related knowledge standardised on score 0 (no knowledge) to 100 (perfect knowledge) Time point: short‐term (up to 1 month post‐intervention) |
The mean knowledge score across control groups ranged from 61.8% to 67.4%2 | The mean knowledge score in the intervention groups was 8.44 higher (2.56 lower to 19.44 higher) | — | 293 (2 RCTs) | ⊕⊕⊝⊝ Lowd,e | Audio‐/visual education without personal feedback compared to no health literacy intervention may slightly improve health‐related knowledge up to 1 month post‐intervention, but the effect sizes appear to vary considerably. |
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Health outcome ‐ Depression Multiple measures used:
Lower score is better Time point: immediately up to 3 months post‐intervention |
— | The mean depression score in the intervention groups was 0.15 SMD lower (0.40 lower to 0.10 higher) than in the control groups | — | 337 (2 RCTs) |
⊕⊕⊝⊝ Lowf,g | Audio‐/visual education without personal feedback compared to no health literacy intervention may have little or no effect on any depression immediately up to 3 months post‐intervention. |
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Health behaviour – Child's up‐to‐date immunisation Assessed with:
Time point: short‐term (immediately up to 3 months post‐intervention) |
794 per 1000 | 849 per 1000 (722 to 992) | RR 1.07 (0.91 to 1.25) | 135 (1 RCT) | ⊕⊕⊕⊝ Moderatea | Audio‐/visual education without personal feedback probably has little or no effect on child's up‐to‐date immunisation immediately up to 3 months post‐intervention, when compared to no health literacy intervention. |
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Self‐efficacy – Self‐efficacy to identify need for treatmentfor depression Assessed with:
Higher score is better Time point: short‐term (immediately post‐intervention) |
One RCT reported that audio‐/visual education improved self‐efficacy to identify the need for treatment for depression (MD 3.51 higher (2.53 higher to 4.49 higher)) immediately post‐intervention | — | 133 (1 RCT) |
⊕⊕⊝⊝ Lowa,c | Audio‐/visual education without personal feedback may improve self‐efficacy to identify the need for treatment for depression immediately post‐intervention, when compared to no health literacy intervention. | |
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Health service use – Child's emergency room visits Assessed with:
Higher scores indicate higher levels of emergency room visits Time point: short‐‐term (immediately up to 3 months post‐intervention) |
The mean rate of emergency room visits in the control group was 1.82 | The mean rate of child's emergency room visits in the intervention group was 0.59 points lower (1.11 lower to 0.07 lower) | — | 157 (1 RCT) |
⊕⊕⊕⊝ Moderateh |
Audio‐/visual education without personal feedback compared to no health literacy intervention probably reduces child's emergency room visits up to 3 months post‐intervention. |
| Adverse events – not measured | — | — | — | — | — | The effect of audio‐/visual education without personal feedback on adverse events is unknown, as there was no direct evidence identified. |
| *More detail on scoring and direction for each outcome measure is provided in Table 2; Table 10; Table 3; Table 4; Table 5; Table 6; Table 13; **The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI), ***Short‐term: immediately up to 6 weeks after the total intervention programme was completed; medium‐term: from 6 weeks up to and including 6 months after the total intervention programme was completed; long‐term: longer than 6 months after the total intervention programme was completed. BDI‐II: Beck Depression Inventory; CI: confidence interval; D‐Lit: Depression Literacy Questionnaire; FIT: faecal immunochemical test; PHQ‐8: Patient Health Questionnaire; RCT: randomised controlled trial; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
1One additional RCT could not be included in the narrative synthesis due to missing data in the control group (Thompson 2012).
2Based on reported values from four studies included in the analysis, as one study reported change scores only (Unger 2013).
aDowngraded by ‐1 for imprecision: result was based on a single study with a small sample size.
bDowngraded by ‐2 for imprecision: wide CI and result was based on a single study with a small sample size.
cDowngraded by ‐1 for risk of bias: high risk of bias for blinding and outcome was subjectively measured; unclear risk of bias for allocation concealment.
dDowngraded by ‐1 for inconsistency: there was considerable statistical heterogeneity (> 75%). One study found a large effect whereas the other study found a small effect. However, the direction of effects appeared to be consistent.
eDowngraded by ‐1 for imprecision: small sample size and final SDs for one study were obtained from reported baseline scores, as post‐intervention SDs were not reported.
fDowngraded by ‐1 for risk of bias: high risk of bias for blinding and outcome was subjectively measured.
gDowngraded by ‐1 for imprecision: small sample size and the CI encompassed values indicating both improvement and worsening in this outcome.
hDowngraded by ‐1 for imprecision: result was based on a single study with a small sample size and CI was wide, encompassing a large effect but also little or no effect.