Summary of findings 8. Culturally and literacy adapted medical instruction versus no health literacy intervention.
| Culturally and literacy adapted medical instruction versus no health literacy intervention | ||||||
| Patient or population: migrants Setting: all settings Intervention: culturally and literacy adapted medical instruction Comparison: no health literacy intervention (usual care, standard written information + verbal instruction) | ||||||
| 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 literacy adapted written information | |||||
|
Health literacy – Medication understanding Multiple measures used:
Higher scores are better Time point: short‐term (up to 1 week post‐intervention)*** |
Three RCTs reported on 3 health literacy outcomes related to the understanding of medical instructions. One RCT (n = 202) reported that health literacy informed medication instructions improved the correct dosage in the dosing tray immediately post‐intervention (IG: median 4.0, IQR: 3.0 to 5.0; CG: median: 3.0, IQR: 2.0 to 4.0). Another RCT (n = 123) reported that pictograms plus verbal instruction improved the correct interpretation of label contents in 10 out of 11 medical instructions immediately post‐intervention (no composite score reported). One RCT (n = 200) reported that a literacy adapted plain language text in combination with an illustrated medication list improved medication understanding assessed with MUQ at 1 week follow‐up (10 points higher (5.70 higher to 14.30 higher)). |
— | 478 (3 RCTs) |
⊕⊕⊝⊝ Lowa,b | Culturally and literacy adapted medical instructions compared to no health literacy intervention may improve medication understanding up to 1 week post‐intervention. | |
| Quality of life – not measured | — | — | — | — | — | The effect of the intervention on quality of life is unknown as there was no direct evidence. |
| Health outcome – not measured | — | — | — | — | — | The effect of the intervention on health outcomes is unknown as there was no direct evidence. |
| Health‐related knowledge – not measured | — | — | — | — | — | The effect of the intervention on health‐related knowledge is unknown as there was no direct evidence. |
|
Health behaviour – Medication adherence Assessed with:
Time point: short‐term (up to 1 week post‐intervention) |
The mean self‐reported medication adherence in the control group was 9.9% | The mean medication adherence score in the intervention group was 0.5 points higher (0.1 lower to 1.1 higher) | — | 200 (1 RCT) | ⊕⊕⊝⊝ Lowc,d | Culturally and literacy adapted medical instructions compared to no health literacy intervention may have little or no effect on health behaviour. |
| Health service use – not measured | — | — | — | — | — | The effect of the intervention on health service use is unknown as there was no direct evidence. |
| Self‐efficacy ‐ not measured | — | — | — | — | — | The effect of the intervention on self‐efficacy is unknown as there was no direct evidence. |
| Adverse events – not measured | — | — | — | — | — | The effect of the intervention on adverse events is unknown as there was no direct evidence. |
| *We report on our predefined outcome categories and assigned all outcomes that we considered eligible for this review to one of these categories (see Types of outcome measures). More detail on scoring and direction for each outcome measure is provided in Table 19; Table 4; **The risk in the intervention group (and its 95% confidence interval) 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. ARMS: Adherence to Refills and Medications Scale; CG: control group; CI: confidence interval; IG: intervention group; IQR: interquartile range; MUQ: Medication Understanding 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. | ||||||
aDowngraded by ‐1 for risk of bias: one study was at high risk of bias for blinding; unclear allocation concealment in one other study.
bDowngraded by ‐1 for imprecision: data from two studies were not reported in a way that made it possible to calculate an MD.
cDowngraded by ‐1 for risk of bias: high risk of bias for blinding.
dDowngraded by ‐1 for imprecision: results were based on a single study with a small sample size and the CI encompassed both an improvement and a worsening.