13. PROGRESS‐plus framework.

PROGRESS								Plus	Health literacy
Study1	Place of residence; time living in host country	Race/ethnicity/culture/language	Occupation	Gender	Religion	Education	Socioeconomic status, social capital	Age, sexual orientation, disability, migrant status	Assessment tool, range
Bailey 2012 (No. analysed = 202)	Urban, USA 17 (0.7)*	Chinese, Korean, Russian, Spanish, Vietnamese Primary languages: Chinese, Korean, Russian, Spanish, Vietnamese	—	62.2% female	—	19.8% < 9 years, 14.4% 9 to 11 years, 29.2% 12 years or GED, 14.9% some college, 21.8% ≥ college graduate	Annual income: 44.7% < USD 10,000, 36.7% USD 10,000 to USD 19,999, 18.6% ≥ USD 20,000	63.6 (0.91)*, range 18 to 85 The sample included participants with prescribed medication in the past year; medication use 4.5 (0.2)*	—
Bloom 2014 Total N = 230	Urban, USA	Afghan Farsi, Pashto	—	100% female	Muslim	Low literacy, no further details	—	≥40 years Many with family history of breast cancer	—
Calderón 2014 (Total N = 240)	Urban, USA	Latino Spanish	—	81.7% female	—	86.7% < high school, 13.3% ≥ high school	Annual income: 75.6% < USD 10,000, 24.4% ≥ USD 10,000 Health insurance: 31.3% insured	20.7% 18 to 39 years, 88.6% 40 to 60 years, 20.7% > 60 years Participants sought health care at a clinic; 79% self‐reported fair or poor general health status	S‐TOFHLA, 0 to 36; 58.0% 0 to 16 (inadequate HL), 8.0% 17 to 21 (marginal HL), 34.0% 22 to 36 (adequate HL)
DeCamp 2020 (Total N = 157)	Urban, USA 7.3 (5.3)*	Latino Spanish	79.0% spouse or partner employed	—	—	40.8% ≤ 8th grade, 26.1% some high school, 33.1% high school or greater	Annual income: 42.7% < USD 20.000, 24.2% USD 20.000 to USD 30.000, 7.6% > USD 30.000, 19.1% did not report or unknown Health insurance: all children publicly insured 20.3% single, 79.6% spouse or partner	29.3 (6.2)*	NVS, 0 to 6; 48.4% 0 to 1 (limited HL), 38.2% 2 to 3 (marginal HL), 13.4% 4 to 6 (adequate HL) English proficiency was assessed using the US Census Bureau question "How well do you speak English?", overall results not reported
Elder 1998 (No. only Latinos = 341)	Urban, USA 45.0% < 3 y	Latino (86.7%), European, Asian, others Spanish	Students in English as second language classes	51.0% female	—	48.0% ≥ 9 y, 9.8 (3.7)*	Monthly income: 66.7% < USD 1099 33.3% married	28.7 (9.8)*	—
Gwede 2019 (Total N = 76)	Urban, USA 23.4* for those born outside the USA (n = 71)	Hispanic/Latino Spanish	n = 75 52.6% employed, 40.8% not employed, 4.0% retired, 1.0% student	67.1% female	—	43.4% elementary or less, 18.4% some high school, 17.1% high school graduate, > 21.0% high school	n = 70 Annual income: 44.3% < USD 10,000, 55.1% ≥ USD 10,000 Health insurance: 25.5% insured 69.7% married/living together, 13.1% divorced/separated, 7.9% widowed, 9.2% never married/single	57.2 (6.0)*, range 50 to 74 Participants received care at a clinic	SILS, 0 to 5; 47.4% always difficult reading written materials, 52.6% not always difficult reading written materials, 75.0% very confident in completing health forms, 25.0% less than very confident in completing health forms
Han 2017 (Total N = 560)	Urban, USA 15.4 (9.7)*, range 1 to 62	Korean Americans English proficiency: 40.5% not at all or poor, 36.1% fair, 23.4% fluent	57.9% working full/part‐time, 42.1% unemployed, retired or other	100% female	—	35.2% high school graduate or less, 64.8% some college or more	26.4% very comfortable or comfortable, 34.5% just OK, 39.5% uncomfortable or very uncomfortable Health insurance: 37.9% insured 85.5% married or partnered, 11.1% separated, widowed or divorced, 3.4% never married	46.1 (8.5)* 5.4% family history of breast cancer	AHL‐C, 0 to 52; 20.9*
Hernandez 2013 (Total N = 146)	Urban, USA 7.7% < 5 y; 34.0% 6 to 10 y, 57.7% > 10 y	Latinas (78.8% Mexican, 21.1% other) 82.3% not bilingual	33.8% employed	100% female	—	36.6% grade school, 25.3% middle school, 14.0% some high school, 10.5% high school or GED, 10.5% some college or beyond	Annual income: 69.7% < USD 19,000, 19.0% USD 20,000 to USD 30,000, 11.2% > USD 30,000 Health insurance: 45.0% insured 58.4% married, 24.6% living with partner, 7.7% never married, 9.1% divorced or widowed	Range 18 to 55 At risk for depression	S‐TOFHLA, 0 to 36; 28.1% 0 to 16 (inadequate HL), 12.6% 17 to 21 (marginal HL), 59.1% 22 to 36 (adequate HL)
Kaur 2019 (Total N = 140)	Urban, Canada	Punjabs Punjabi	63.6% full‐time workers (including 14.3% self‐employed), 5.0% part‐time workers, 1.4% occasional workers, 22.1% homemakers, 2.9% unemployed	60.0% female	—	37.7% college/technical education, 26.8% university education; 35.5% high school or less	Annual income: 52.1% CAD 0 to 49,999, 19.3% CAD 50,000 to 89,999, 6.4% CAD 90,000+, 20.7% unknown Health insurance: 72.9% insured	26.4% 18 to 31 y, 46.4% 32 to 45 y, 27.1% 46 to 60 y; range 18 to 60	TS‐REALD
Kheir 2014 (Total N = 123)	Urban, Qatar Time in Arabic speaking country: 4.6 to 6.1 y	Asians 0.8% Malayalam, 16.3% Nepal, 1.6% Urdu, 8.9% Tagalog, 22.8% Bangla, 49.6% other Level of English: 13.8% good, 16.3% average, 94.3% poor	Workers at Qatar Petroleum Company	100% male	—	Years of schooling: 6.1 (3.4)*	Each participant received QR 50 (equivalent to about USD 14), translating to 2 to 3 days average wage	32.1 (8.5)*	—
Kim 2009 (No. analysed = 79)	Urban, USA 53.2% > 20 y	Korean Americans Korean	70.3% employed	44.3% female	—	48.1% higher level of education	Annual income: 59.2% > USD 40.000 87.3% married	56.4 (7.9)* Type 2 diabetes	—
Kim 2014 (No. analysed = 369)	Urban, USA 25.0 (11.0)*	Korean Americans Korean	—	69.9% female	—	37.4% ≤ middle school graduate, 28.2% high school graduate, 34.4% ≥ some college	Health insurance: 82.7% insured	70.9 (5.3)* Diagnosed with hypertension for 9.6 (8.8)* years; 85.4% reported being on antihypertension; 46.3% had successfully controlled hypertension (BP < 140/90 mmHg or < 130/80 mmHg for diabetes patients)	HBP‐HLS, 0 to 43; 24.6*
Kim 2020 (No. analysed = 209)	Urban, USA 23.8 (11.0)*	Korean Americans Korean	59.3% working full/part‐time	43.1% female	—	Years of education: 13.4 (3.0)*	Monthly income, mean (SD): USD 3780 (3411)*, 63.2% own housing, 67.7% comfortable living Health insurance: 50.2% insured 89.5% married, family size, persons: 3.0 (1.2)*	58.7 (8.4)* Type 2 diabetes	REALM, 0 to 66; 32.1 (1.5)***, indicating 6th grade reading level DM‐REALM, 0 to 88; 51.3 (1.7)***, 7.3 points above the scale’s midpoint Comprehension scale, 0 to 28; 15.3 (0.6)*** S‐TOFHLA, numeracy subscale, 0 to 7; 4.2 (0.2)*** NVS, 0‐6; 1.7 (0.1)***
Kiropoulos 2011 (Total N = 202)	Urban, Australia 43.8 (9.0)*	Greeks and Italians Participants rated their English proficiency "good" for simple situations and "poor/fair" for more difficult situations	5.0% never worked, 57.9% unskilled, 31.2% tradesperson/clerical, 4.0% manager/professional, 28.2% working now, 70.8% are not working now	71.3% female	—	15.3% no/incomplete primary, 42.1% completed primary, 24.3% some secondary school, 9.9% all secondary school, 8.4% some/completed tertiary	28.2% married,71.8% not married, 14.9% living with spouse, 52.0% living with children, 24.8% living with other relatives, 14.4% currently living alone, 85.6% not currently living alone	65.4 (8.57)* Depression	D‐Lit, 0 to 22; 9.5*
Koniak‐Griffin 2015 (Total N = 223)	Urban, USA 18.6 (8.3)*	Latinas Spanish	74.6% unemployed	100% female	—	52.5% ≤ 8th grade, 33.6% 9th to 12th grade, 12.6% ≥ 13 years	Annual income: 54.7% ≤ USD 20,000, 28.7% USD 20,001 to 40,.000, 16.6% USD 40,001 to 75,000 Health insurance: 31.8% insured 72.2% married/living with a partner, 27.8% divorced/widowed/single	44.6 (7.9)* 6.3% diabetes (clinical data), 12.1% hypertension ((BP ≥ 140/90, self‐report); 25% felt depressed or "bothered by loss of interest", 22.0% both	—
Lepore 2012 (No. analysed = 431 for survey data, N = 490 for medical claims data)	Urban, USA	Black African descent (77.4% Caribbean)	—	100% male	—	N = 490 31.3% < high school degree, 31.8% high school degree, 36.9% college education or degree	"all had a primary care physician and access to health insurance that covered prostate cancer tests." 83.7% married	55.04 (6.29)*	—
Mohan 2014 (No. analysed = 200)	Urban, USA	Latinos 99.5% of patients identified Spanish as their primary language spoken at home	—	69.5% female	—	29% at least high school education, years of education: 8*	—	50* Diagnosis of diabetes in the medical chart; prescription of at least 1 chronic medication	BHLS, 3 to 15; 10.4*
Ochoa 2020 (No. analysed = 109)	Urban, USA 25.12*	Latinas English‐speaking proficiency: 29.4% very well/well, 70.6% not very well/not at all; English reading proficiency: 35.6% very well/well, 64.4% not very well/not at all; English writing proficiency: 31.0% very well/well, 69.0% not very well/not at all	—	100% female	—	N = 232 49.8% < high school, 31.25% high school, 19.0% some college degree	N = 232 Annual income: 41.6% < USD 20,000, 35.4% USD 20,000 to < 40,000, 16.05% USD 40,000 to < 60,000, 6.9% ≥ USD 60,000 Health insurance: 73.45% insured 78.95% married/living with partner, 10.7% separated/divorced/widowed, 10.35% never married (single)	Range 25 to 45 Health status: 1.4% very poor or poor, 13.2% fair, 3.8% good, 17.65% very good, 30.9% excellent	—
Otilingam 2015 (Total N = 100)	Urban, USA 34.3*	Latinas Language preference Spanish: 78.0%	—	100% female	—	(Highest degree): 41.0% none or elementary, 35.0% high school, 10.0% community/technical college, 14.0% college	Annual family income: 39.0% < USD 20,000/year Number of children living at home < age 17: 2.1*	58.9*, range 48 to 84	n = 73 NVS, 0 to 6; 1.39* (wait‐list control II post‐test only)
Payán 2020 (No. analysed = 193)	Urban, USA 69.9% ≥ 15 y (N = 240)	Latinas English proficiency: 4.2% very well, 13.8% well, 31.3% not well, 28.3% almost none, 22.5% not at all well (N = 240)	—	100% female	—	N = 240 64.2% ≥ 6th grade level of education	N = 240 Annual household income: 93.4% < USD 30,000 Health insurance: 79.6% insured 46.8% married, 30.5% separated, 22.7% single	52.3 (8.8)*, range 35 to 72	—
Poureslami 2016a (No. analysed = 85)	Urban, Canada Participants had immigrated to Canada within the past 5 y	Chinese and Punjabs 49.0% Chinese; 51.0% Punjabi	21.2% employed, 29.4% unemployed, 43.5% retired, 5.9% volunteer job	50.6% female	—	17.6% never attended formal school, 24.7% completed elementary school, 34.1% completed high school, 23.5% post‐high school education	—	62.9 (15.3)*, range 21 to 87 Asthma	—
Poureslami 2016b (Total N = 91)	Urban, Canada Participants immigrated within the past 12 y at the time of the study (inclusion criterion)	Chinese 19.8% Mandarin, 80.2% Cantonese	—	21.9% female	—	46.2% low education, 53.8% high education	—	40.7% ≤ 75 years, 59.3% > 75 years; 75** Chronic obstructive pulmonary disease (COPD)	—
Rosal 2005 (No. analysed = 25)	Urban, USA	Hispanic (Puerto Rican) 95% spoke Spanish only	24.0% housewife, 20.0% disabled, 4.0% unemployed, 4.0% never worked, 48.0% pension	80.0% female	—	50.0% ≤ 5th grade, 24.0% 6th to 8th grade, 24.0% 9th to 12th grade	Annual income: 84.0% ≤ USD 10,000/per year, 16.0% USD 10,001 to 20,000 Health insurance: 40.0% Medicaid only, 60.0% Medicaid and supplemental	62.6 (8.6)*, range 45 to 82 Type 2 diabetes; perceived health: 4.0% excellent, 4.0% very good, 8.0% good, 72.0% fair, 12.0% poor; years with diagnosed diabetes 8.2 (5.8)*, 16.0% diabetes related complications, 84.0% 1 complication, 84.0% ≥ 1 family member with diabetes	—
Rosal 2011 (Total N = 252)	Urban, USA	(Caribbean) Latinos 93.3% monolingual Spanish; language chosen for assessment Spanish 100%	n = 230 11.3% working full or part‐time, 3.5% unemployed/looking for a job, 61.7% disabled, 10.9% retired, 12.6% housewife	76.6% female	—	28.0% ≤ 4th grade, 28.0% 5th to 8th grade, 19.2% 9th to 12th grade (not high school graduate), 24.8% ≥ high school	Annual income: 55.3% < USD 10,000 Health insurance: 89.3% public insurance, 6.0% commercial insurance, 2.8% free care, 2.0% no insurance 25.8% married or living with partner, 39.0% divorced/widowed/separated, 25.2% never married	16.3% 18 to 44 y, 29.8% 45 to 54 y, 32.9% 55 to 64 y, 21.0% ≥ 65 y Documented diagnosis of type 2 diabetes; HbA1c (previous 7 months) ≥ 7.5%	—
Soto Mas 2018 (Total N = 181)	Urban, USA 2.2% < 1 y (n = 4); 12.7% 1 to 3 y (n = 23); 8.3% 4 to 7 y (n = 15); 70.2% 8 y or more (n = 127); 6.6% missing (n = 12)	Latino Spanish	—	79.0% female	—	n = 155 5.2% elementary school, 11.7% middle school, 40.9% high school, 18.8% associate/technical degree, 20.1% bachelor's degree, 1.9% master's degree, 1.3% doctoral degree	—	n = 155 9.0% 20 to 30 years, 38.7% 31 to 45 years, 52.3% ≥ 46	n = 155 TOFHLA, 0 to 100; 62.7*
Sudore 2018 (No. of Spanish‐speaking participants = 445)	Urban, USA 26*	98.9% White Latino or Hispanic, 0.2% White non‐Latino or Hispanic, 0.9% Multiethnic or other Spanish	—	72.0% female	49.9% fairly to extremely religious, 59.6% fairly to extremely spiritual	83.6% ≤ high school	27.4% not enough to make ends meet, financial social standing (1 to 10 score): 5.6* Measure of social support score (total, 11 to 55): 36.7*, 37.5% in a marriage or long‐term relationship, 88.8% have adult children, 98.0% have a potential surrogate	64* Self‐rated health: 57.1% reported fair to poor health	S‐TOFHLA, 0 to 36; 60.9% limited HL
Taylor 2011 (Total N = 180)	Urban, Canada Years since immigration: 45.0% < 2 y; 55.0% ≥ 2	Asian Cantonese, Farsi, Korean, Mandarin, Punjabi	—	68.0% female	—	65.0% < 16 years, 35.0% ≥ 16 years	86.0% currently married, 14.0% not currently married	Age: 46.0% < 40 years, 54.0% ≥ 40 years	—
Thompson 2012 (Total N = 170)	Urban, USA 6.05* (n = 158)	Latinos Spanish	—	92.5% female	—	n = 159 41.0% < 6 y, 51.0% 7 to 12 y, 8.0% some or all of university degree	Income: "low‐income" population Health insurance: "More than 95% of clinic patients are publicly insured"	27.55*	—
Tong 2017 (Total N = 329)	Urban, USA 15.4 (9.7)*, range 1 to 62, 83.6% > 10 years, 16.4% ≤ 10 years	Hmong Americans (born in Laos) 89.4% speak only Hmong at home, 70.5% speak English poorly or not at all	90.9% not employed	74.2% female	—	88.8% no formal education	Annual income: 53.8% < USD 20,000, 4.0% USD 20,000 or more, 42.2% don't know/missing Health insurance: 95.1% insured 65.3% married or living with a partner	60.4*	—
Unger 2013 (No. analysed = 139)	Urban, USA 43.2% 11 y or more, 18.7% 6 to 10 y, 13.7% 1 to 5 y, 5.8% less than 1 y, missing 2.9%	Hispanics/Latinos Language spoken at home: 28.1% only Spanish, 38.1% mostly Spanish, 27.3% English and Spanish equally, 4.3% mostly English, 1.4% only English, 0.7% missing	—	47.5% female	—	62.6% less than high school, 37.4% high school or more	—	35.8 (12.9)*, range 18 to 90	—
Valdez 2015 (Total N = 708)	Urban, USA 93.6% foreign‐born); 14.9% < 5 y, 18.9% 6 to 10 y, 28.4% 11 to 15 y, 37.9% 16+ y	Latinos and Koreans 49.7% Spanish, 43.8% Korean, 6.5% English	—	n = 707 92.2% female	—	19.6% < 6, 16.7% 7 to 11 years, 18.5% 12 years, 9.9% 13 to 15 years, 35.3% 16+	n = 707 83.9% child has regular doctor Number of children: 2.8*; 52.3% 1 to 2, 39.4% 3 to 4, 8.3% 5+; 72.7% married/living together	n = 691 41.7*; 12.3% < 35 years, 22.3% 35 to 39 years, 34.6% 40 to 44 years, 17.2% 45 to 49 years, 11.2% 50+ years	—
Valdez 2018 (No. analysed = 727)	Urban, USA 80.0% foreign‐born; 26.0% 1 to 5 y, 18.0% 6 to 10 y, 20.0% 11 to 15 y, 36.0% 16+ y (N = 943)	Latinas Language of pre‐test: 73.0% Spanish, 7.0% English (N = 943)	—	100% female	—	N = 943 8.2 (3.8)*, 39.0% 1 to 6 years, 34.0% 7 to 11 years, 21.0% 12 years, 6.0% 13+ years	Inclusion criteria: annual household income of ≤ USD 24,680 Health insurance: 51.0% insured (N = 943) 21.0% single, 43.0% married, 15.0% living together, 15.0% divorced/separated, 5.0% widowed; number of children: 3.0 (2.2)*; 10.0% no children, 14.0% one child, 21.0% two children, 22.0% three children, 15.0% four children, 18.0% 5+ children (n = 943)	39.1 (11.8)* Participants were recruited from a community clinic, where they had a clinic appointment independently from the study	—
van Servellen 2005 (No. analysed = 85)	Urban, USA	Latinos Language spoken at home: 75.25% Spanish	—	9.4% female	—	81.0% < 12 years	Monthly income: 41.0% ≤ USD 500	40.7*, range 21 to 78 49.4% male‐to‐male sex risk factor HIV	Modified REALM, 0 to 24; global recognition score 17.9*, global understanding score 13.1* (n = 81)
Wong 2020 (No. analysed = 39)	Urban, Singapore Note: time working in Singapore: 9.45* (range 1 to 24 years)	Filipino	100% foreign domestic workers	100% female	n = 38 71.85% Roman Catholic, 28.15% other Christian faith	n = 38 72.0% completed high school (secondary) 4 years, 28.0% completed university	n = 38 48.4% were single or never married, 25.8% were married, 25.8% were separated, divorced or widowed	38.6 (6.3)* At risk for depression Foreign domestic workers, not protected under the Singaporean Employment Act	n = 37 DLQ, 22‐item, true/false questions, 0 to 22 (validated tool) Intervention group, mean: 11.06*

¹Not all studies reported numbers on all participants randomised to either the intervention or control arm. Here we report the number of participants randomised, if not otherwise stated.

*Mean (SD), **Median (SD), ***Mean (SE)

Abbreviations:

AHL‐C: Assessment of Health Literacy in Cancer screening; BHLS: Brief Health Literacy Screen; BP: blood pressure; D‐Lit/DLQ: Depression Literacy Questionnaire; DM‐REALM: Diabetes‐specific Rapid Estimate of Adult Literacy in Medicine; GED: general educational development; HBP‐HLS: high blood pressure health literacy scale; HL: health literacy; NVS: newest vital sign; QR: Qatari riyal; REALM: Rapid Estimated of Adult Literacy in Medicine; SD: standard deviation; SILS: Single Item Literacy Screener; TOFHLA: Test of Functional Health Literacy in Adults; TS‐REALD: Two Stage Rapid Estimate of Adult Literacy in Dentistry; y: years