17. Outcomes considered in this review ‐ components of health literacy.
| Study ID | (Disease‐specific) health literacy* | Prerequisites** | Steps of health information processing | Timing of outcome assessment considered | |||
| Knowledge*** | Competencies | Understand | Appraise | Apply | |||
| 1 Culturally and literacy adapted self‐management programme vs no health literacy intervention | |||||||
| Bloom 2014 | — | Breast health/breast cancer knowledge, not specified, no further details reported | — | — | — | — | After 6 months1 |
| Koniak‐Griffin 2015 | — | Heart disease knowledge; 10‐items adapted from previous survey (true/false), 0 to 10 |
— | — | — | — | Short‐term, immediately post‐intervention, medium‐term (3 months post‐intervention) |
| Rosal 2011 | — | Diabetes knowledge; Audit of Diabetes Knowledge (ADK) (subset of 25 items, true/false), no range of score reported |
— | — | — | — | Short‐term (immediately post‐intervention) |
| van Servellen 2005 | HIV health literacy; modified REALM (24 additional HIV‐relevant medical terms); 0 to 24 (recognition of terms); 0 to 24 (understand (explain) terms) |
HIV knowledge; HIV Illness and Treatment Knowledge and Misconceptions measure (0 to 17) |
— | — | — | — | Short‐term (immediately post‐intervention) |
| 2 Culturally and literacy adapted self‐management programme vs written information on the same topic | |||||||
| Han 2017 | Cancer health literacy; AHL‐C; sub‐scales on print literacy and functional health literacy, 0 to 53 | Cervical and breast cancer knowledge; Breast Cancer Knowledge Test (0 to 18); Cervical Cancer Knowledge Test (0 to 20) |
— | — | Decisional balance measure (weighing pros and cons), 5 pros and 9 cons on 5‐point Likert scale | — | Short‐term (immediately post‐intervention) |
| Kaur 2019 | Oral health literacy; TS‐REALD; word recognition test, 27 to 73 | Oral hygiene self‐care knowledge; no range of scores reported | — | — | — | — | Short‐term (immediately post‐intervention) |
| Kim 2009 | — | Diabetes knowledge; Diabetes Knowledge Test (DKT) (0 to 14) |
— | — | — | — | Short‐term (immediately post‐intervention) |
| Kim 2014 | HBP health literacy; HBP Health Literacy Scale, sub‐scales of print/functional literacy and numeracy, 0 to 43 |
HBP knowledge; HBP knowledge questionnaire (0 to 26) | — | — | — | — | Short‐term and medium‐term (immediately post‐intervention and at 6‐month follow‐up) |
| Kim 2020 | (1) Print literacy: REALM, 0 to 66 (2) Diabetes‐specific literacy: DM‐REALM, 0 to 83 (3) Health numeracy: TOFHLA, 7‐item numeracy subscale (NVS), 0 to 6 |
Diabetes knowledge; Diabetes Knowledge Test (DKT) (0 to 14) |
— | — | — | — | Short‐term (immediately post‐intervention) |
| Rosal 2005 | — | Diabetes knowledge; Audit of Diabetes Knowledge Scale (ADKnowl), 23 item‐sets (104 items) on various diabetes‐related topics, true/false/"don't know", no range of score reported | — | — | — | — | Short‐term (2 weeks post‐intervention) and medium‐term (4.5 months after programme completion) |
| 4 Culturally adapted health literacy skills building course vs no/unrelated health literacy intervention | |||||||
| Otilingam 2015 | Health numeracy; NVS, 0 to 6 | Dietary fat knowledge, 9 items (0 to 9) | — | — | — | — | Short‐term (at 1 month post intervention) |
| Soto Mas 2018 | Functional health literacy; TOFHLA, 0 to 100 | — | — | — | — | — | Short‐term (immediately post‐ intervention) |
| Wong 2020 | Depression literacy; D‐Lit, 0 to 22 | Knowledge on cognitive behavioural therapy (CBT); 9 items (multiple choice) | — | — | — | — | Short‐term (immediately post‐intervention and at 2‐month follow‐up) |
| Elder 1998 | — | Nutrition‐related knowledge; nutrition knowledge test, 12 items (0 to 12) | — | — | Intention to change nutritional habits (questionnaire: 3 items (1 to 3)) |
Medium‐term (6‐month follow‐up) | |
| Taylor 2011 | — | Hepatitis B knowledge; questionnaire, 5 items (0 to 5) | — | — | — | — | Medium‐term (at 6‐month follow‐up) |
| Tong 2017 | — | Colorectal cancer knowledge; questionnaire, 5 items (0 to 5) | — | — | — | — | Medium‐term (at 3‐month follow‐up) |
| 5 Culturally and literacy adapted telephone education vs unrelated culturally and literacy adapted telephone education | |||||||
| Lepore 2012 | — | Knowledge on prostate cancer screening; 14 items (true/false), percent correct | — | — | — | Testing intention; decision made to get tested for prostate cancer (yes/no) | Long‐term (8 months after randomisation, approx 7 months post‐intervention) |
| 6 Culturally and literacy adapted audio‐/visual education without personal feedback vs no health literacy intervention | |||||||
| DeCamp 2020 | — | Infant health knowledge; true/false, (0 to 5) | — | — | — | — | Short‐term (immediately up to 3 months post‐intervention)2 |
| Hernandez 2013 | — | Depression knowledge; Depression Knowledge Scale (0 to 17) |
— | — | — | Intention to seek treatment for depression; intention to seek treatment for depression scale (0 to 32) | Short‐term (immediately post‐intervention) |
| Kiropoulos 2011 | Depression literacy; D‐Lit, 0 to 22 | — | — | — | — | — | Short‐term (1 week post‐intervention) |
| Thompson 2012 | — | Parental nutrition and feeding knowledge 12‐item true/false questions and 7 multiple choice questions (4 options), 0 to 19 | — | — | — | Planned changes in behaviour: 3 questions; 1 question related to planned changes in behaviour (yes, perhaps, no), 1 open‐ended question on exactly what behaviours they want to change, and 1 question on plans about talking to the child's doctor, family or friends about the information (yes, probably, no), no score reported | Short‐term (immediately post‐intervention) |
| 6 Culturally and literacy adapted audio‐/visual education without personal feedback vs written information on the same topic | |||||||
| Calderón 2014 | Diabetes Health Literacy; DHLS, 37 items on 4 constructs related to diabetes type; 21 items on knowledge and 16 items on knowledge and cultural perceptions |
— | — | — | — | — | Short‐term (immediately post‐ intervention) |
| Gwede 2019 | — | Awareness of colorectal cancer and screening tests; 6 items (0 to 11) | — | — | — | — | Medium‐term (at 3‐month follow‐up) |
| Payán 2020 | — | Breast cancer risk knowledge; questionnaire, true/false (0 to 16) | — | — | — | — | Short‐term (immediately post‐intervention) and medium‐term (at 3‐month follow‐up) |
| Poureslami 2016a | — | Asthma‐related knowledge, questionnaire, 5‐point Likert scale, range of scores not reported | Inhaler use technique; direct observation (2 observers); participants demonstrated correct use and had to describe each step (0 to 9 standard checklist), higher score is better | Understanding of and adherence to physician's instructions: 5 items, asking participants to explain the instruction in their own words, 0 = incorrect, 1 = correct, higher score is better | — | — | Short‐term (immediately post‐ intervention) and medium‐term (at 3‐month follow‐up)3 |
| Poureslami 2016b | — | — | Inhaler use technique; direct observation (2 observers); participants demonstrated correct use and had to describe each step; 0 to 10, validated checklist, higher score is better | Understanding of pulmonary rehabilitation; text passage based on Canadian Thoracic Society COPD assessment guidelines, developed by the research team and related questions answered by participants. (correct = 1 or incorrect = 0), higher score is better | — | — | Short‐term (at 4 weeks (immediately post‐intervention and medium‐term (at 3‐ month follow‐up) |
| Sudore 2018 | — | — | — | — | — | Engagement in ACP actions; subscale of ACP Engagement survey, 0 to 25, higher score is better |
Long‐term (15 months after enrolment) |
| Unger 2013 | — | Depression knowledge; depression knowledge scale (0 to 17) | — | — | — | Willingness to seek help for depression; modified intention to seek depression care scale (4 to 8) | Short‐term (immediately post‐intervention) |
| Valdez 2015 | — | HPV and cervical cancer knowledge; 12 items on HPV knowledge and awareness, and additional questions related to the intervention content (0 to 12) | — | — | Decisional Conflict Scale, subscales informed decision, values clarity, support, 0 to 100 (each scale), lower score is better | Made informed decision; 3 criteria, composite score: (1) making a vaccination choice, (2) affirming that the decision was an informed choice and (3) having a knowledge score of at least 7 out of 12 knowledge items, higher score is better | Short‐term (at 1‐ month follow‐up) |
| Valdez 2018 | — | Knowledge on cervical cancer, human papillomavirus (HPV) and Pap testing: adapted scale from Pathfinder intervention study, 5 items, yes/no | — | — | — | — | Medium‐term (at 6‐month follow‐up) |
| 7 Culturally and literacy adapted audio‐/visual education without personal feedback vs another culturally and literacy adapted audio‐/visual education without personal feedback | |||||||
| Ochoa 2020 | — | Knowledge regarding Pap test, HPV and cervical cancer; 8 open‐ended questions summed to knowledge score | — | — | — | Cervical cancer screening intention; 2 questions: (1) "When did you have your most recent Pap test" and (2) "Since you saw the film, did you make an appointment for a Pap test?" (yes/no, do not know) | Short‐term and medium‐term (knowledge at 2‐weeks post‐test and at 6‐month follow‐up), behavioural intentions at 22 weeks post‐test and at 6‐month follow‐up |
| 8 Culturally and literacy adapted medical instruction vs no health literacy intervention | |||||||
| Bailey 2012 | — | — | — | Comprehension of medical instruction; demonstration by means of correct dosage in dosing tray (demonstrate correct dose, frequency and spacing; 0 to 5; 0 = incorrect, 1 = correct), numbers of instructions understood, RR, 95% CI | — | — | Short‐term (immediately post‐intervention) |
| Kheir 2014 | — | — | — | Comprehension of medical instructions through interpretation of label contents; level of comprehension (1 to 3; 1 no comprehension to 3 full comprehension) | — | — | Short‐term (immediately post‐intervention) |
| Mohan 2014 | — | — | — | Medication understanding: Medication Understanding Questionnaire (MUQ), 0 to 100 (0 to 3 for each medication), higher score is better | — | — | Short‐term (1 week post‐intervention) |
*Outcomes to be considered in this review; see Characteristics of included studies for an overview of all outcomes assessed within the included studies.
**No study reported a measure for assessing either motivation or the step of accessing health information.
***Results for the outcome category 'health‐related knowledge' were reported separately in the results section as well as in the summary of findings tables.
1Not enough information to categorise into short‐, medium‐ or long‐term assessment.
2Participants were not all assessed at one time point (immediately post intervention up to three months post‐intervention). We report the results as short‐term outcomes.
3Authors only report results of a 3‐month follow‐up assessment.
ACP: advance care planning; ADK: Audit of Diabetes Knowledge; ADKnowl: Audit of Diabetes Knowledge Scale; AHL‐C: Assessment of Health lIteracy in Cancer; CI: confidence interval; COPD: chronic obstructive pulmonary disease; DHLS: Diabetes Health Literacy Survey; DKT: Diabetes Knowledge Test; D‐Lit/DLQ: Depression Literacy Questionnaire; DM‐REALM: Diabetes‐specific Rapid Estimate of Adult Literacy in Medicine; HBP: high blood pressure; HPV: human papillomavirus; MUQ: Medication Understanding Questionnaire; NVS: Newest Vital Sign; REALM: Rapid Estimate of Adult Literacy in Medicine; RR: risk ratio; TOFHLA: Test of Functional Health Literacy in Adults; TS‐REALD: Two Stage Rapid Estimate of Adult Literacy in Dentistry