Summary of findings 9. Female migrants' benefit of any health literacy intervention versus male migrants' benefit of any health literacy intervention.
| Female migrants' benefit of any health literacy intervention versus male migrants' benefit of any health literacy intervention | ||||||
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Patient or population: migrants Settings: all settings Intervention: any health literacy intervention Comparison: no health literacy intervention, or written information on the same topic, or unrelated health literacy intervention | ||||||
| Outcome category– outcome(s) | Illustrative comparative risks** (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk for female migrants | Corresponding risk for male migrants | |||||
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Health literacy – Multiple outcomes and measures used: (1) Generic health literacy
(2) Disease‐specific health literacy
Higher scores are better Time point: short‐term (immediately post‐intervention)*** |
(1) Generic functional health literacy One RCT that compared a health literacy skills building course to no health literacy intervention reported that female migrants scored higher in functional health literacy immediately post‐intervention (2.78 points higher (4.35 lower to 9.91 higher)) |
— | 77 (1 RCT) |
⊕⊝⊝⊝ Very lowa,b | We are uncertain whether female migrants' generic functional health literacy improves more than that of male migrants when receiving health literacy skills building courses. | |
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(2) Disease‐specific health literacy One RCT that compared audio‐/visual education without personal feedback to written information on the same topic found that the intervention may improve diabetes health literacy in women more than in men (MD 5.00 higher (0.62 higher to 9.38 higher)). The mean diabetes health literacy score in men was 56%1 |
— | 118 (1 RCT) |
⊕⊕⊝⊝ Lowc | Female migrants' diabetes‐specific health literacy may improve slightly more than that of male migrants, when receiving audio‐/visual education intervention. | ||
| Quality of life – not measured | — | — | — | — | The effect of any health literacy intervention on female compared to male migrants' quality of life is unknown as there was no direct evidence identified. | |
| Health‐related knowledge – not measured | — | — | — | — | The effect of any health literacy intervention on female compared to male migrants' health‐related knowledge is unknown as there was no direct evidence identified. | |
| Health outcome – not measured | — | — | — | — | The effect of any health literacy intervention on female compared to male migrants' health outcome is unknown as there was no direct evidence identified. | |
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Health behaviour – Time point a: short‐term (immediately post‐intervention) Cardiovascular health behaviour
Higher score is better Time point b: long‐term (approx. 12 months post‐intervention) New documentation of advance care planning
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Time point a: short‐term Cardiovascular health behaviour One RCT that compared a health literacy skills building course to no health literacy intervention (standard ESL course) found that women scored higher on the cardiovascular health behaviour questionnaire than men in the intervention group (MD 2.07 (5.04 lower to 9.18 higher)) |
— | 77 (1 RCT) |
⊕⊝⊝⊝ Very lowb,d | We are uncertain whether female migrants' cardiovascular health behaviour improves more than that of male migrants when receiving health literacy skills building courses. | |
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Time point b: long‐term New documentation of advance care planning One RCT that compared audio‐/visual education without personal feedback to written information on the same topic found that health behaviour improved in both men and women in the intervention group. Female migrants were slightly more likely to have new documentation of advance care planning than male migrants (RR 1.27, 95% CI 0.90 to 1.79) 12 months post‐intervention. |
— | 219 (1 RCT) |
⊕⊕⊝⊝ Lowc | Audio‐/visual education without personal feedback may have little or no effect on new documentation of advance care planning between female and male migrants 12 months post‐intervention. | ||
| Health service use – not measured | — | — | — | — | The effect of any health literacy intervention on female compared to male migrants' health service use is unknown as there was no direct evidence identified. | |
| Self‐efficacy – not measured | — | — | — | — | The effect of any health literacy intervention on female compared to male migrants' self‐efficacy is unknown as there was no direct evidence identified. | |
| Adverse events – not measured | — | — | — | — | The effect of any health literacy intervention on adverse events for female compared to male migrants is unknown as there was no direct evidence identified. | |
| *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 and Table 5; **The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (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. CI: confidence interval; CSC: Cardiovascular Health Behaviour Questionnaire; DHLS: Diabetes Health Literacy Survey; ESL: English as a second language; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio; TOFHLA: Test of Functional Health Literacy in Adults | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
1Scoring of diabetes health literacy wasinadequate ≤ 59%, marginal 60% to 70% or adequate ≥ 75%.
aDowngraded by ‐1 for risk of bias: unclear risk of bias for random sequence generation and allocation concealment.
bDowngraded by ‐2 for imprecision: results were based on a single study with a small sample size (fewer than 100) and/or CIs encompassed values favouring either female or male migrants.
cDowngraded by ‐2 for imprecision: results were based on a single study with a small sample size and CIs were wide or encompassed values favouring either female or male migrants.
dDowngraded by ‐1 for risk of bias: unclear risk of bias for random sequence generation and allocation concealment, high risk of bias for blinding and outcome was subjectively measured.