Table 4.

Effective interventions for health literacy

Effective interventions	Participants	Setting	Quality^	RCT	SNAPW#
GROUP EDUCATION
4 to 5 group empowerment sessions over 7 months [22]	Patients with diabetes from 7 primary care centres	Community health	H	RCT
*40 hour group education session over 4 weeks with participants following preset dietary goals [23]	Mostly white American	Other (Centre of Excellence)	H	RCT	N, P, W
Church-based program tailored and culturally relevant that included awareness raising activities and exercise and cooking classes over 2 years [24]	Samoan and Tongan	Community	H		W
*Language specific self management program of 2.5 hour weekly sessions for 6 weeks with audiocassette and booklet [25]	Greek, Vietnamese, Chinese and Italian	Community	M	RCT	P
Culturally sensitive curriculum in small and large groups and support over 10 months [26]	Mexican American/Latina women of low socio-economic, low education	Community	M		P
2.5 day program then weekly group education over 6 months and small group support [27]	Mostly Caucasian	Primary Care clinic	M	RCT	N, P
*Chronic disease self management group program of 15 hours over 6 weeks [28]	Mostly Mexican born, low socio-economic, low education	Community	M		N, P
*Small groups that met for an hour one night a week for 16 weeks and then every second week for a further 8 weeks [29]	Mean age 46 yrs	Community	M	RCT	P
Monthly group meetings over 6 months and an additional individual session if requested by patient or needed [30]	Mostly white American	Primary care	M		N
Classes and follow-up phone calls over 1 year [31]	Women 20 to 50 yrs	Community	M
*10 weekly group education sessions [32]	Mean age around 73	Hospital outpatient	M	RCT
*6 × 2 hour classes targeting stage of change and culturally appropriate resources and decision tree with periodic group support meetings after the class series [33]	Mostly Latino then African American, low socio-economic, low education	Community	M
3 × 2 hr Prochaska-based stage matched group education sessions [34]	Low socio-economic and education	Primary care	M	RCT	N
WRITTEN MATERIALS
*Computer generated tailored nutrition newsletters & profile feedback related to stage of change [35]	Majority African Americans	General practice	H	RCT	N
3 iterative letters [36]	Educated, mean age 49 yrs	Community	M	RCT	N, P
*3 repeated mailings of self help manuals and motivational messages related to stage of change [37]	Mostly Caucasian	Community	M		P
1 tailored or non-tailored letter [38]	Smokers aged 17 to 65 yrs	General practice	M	RCT	S
*12 week mailed lifestyle intervention program [39]	Primarily Caucasian women	Community	L		P
3 computer generated reports based on stage of change for each risk factor [40]	Mostly Caucasian	Primary care	M	RCT	S, N
3 computer generated reports based on stage of change for each risk factor [41]	Mostly Caucasian	Community	M	RCT	S, N
INDIVIDUAL COUNSELING
Lifestyle counseling by a doctor with video and written materials [42]	Mean age about 53 yrs	Primary health care	H
Exercise prescription provided by GP, 1 counseling session with nurse and materials [43]	Mean age 59 yrs	Primary health care	H		P
1–3 individual brief counseling by a nurse [44]	Low socio-economic, low education	Primary health care	M	RCT	P
One individual consultation by a nurse [45]	Practice nurses and their patients	Primary health care	M
One individual counseling by a registrar [46]	Mean age 41 yrs	Primary health care	M
*One motivational counseling and patient setting targets [47]	Mostly female	Primary health care	M	RCT	P
*Two individual counseling sessions by a physician and two follow-up phone calls [48]	Hypertension and/or hypercholesterolemia and/or non insulin dependent diabetes	General practice	M	RCT	P
*12 to 20 week individual counseling for COPD patients [49]	Scandinavian	Primary health care	L	RCT	S, P
MULTIPLE INTERVENTIONS
6 or 7 × 60min classes and multiple mail/telephone follow-up calls (Stanford Nutrition Action Program) [50]	Mostly Hispanic born in the US, poor, low education and literacy	Community	H	RCT	N
*1 mailing of stage based booklets with provider endorsement and 2 motivational phone counseling sessions [51]	Majority Caucasian	General practice	M	RCT	N
*Interactive computer sessions with feedback from a nurse, a risk factor manual, brief audio tapes, stress management and exercise instructions [52]	Mostly African American	Primary health care	M		S
Group education sessions with individual counseling [53]	47% high school education or greater	General practice	M	RCT	W
Various interventions designed by neighbourhood coalitions that have GP representation [54]	Low socio-economic, low education	Community	M		N
Stages of change based and counseling and written materials provided by a nurse [55]	Mostly female (70%) mean age 42.4 yrs	General practice	L		P
Range of health promotion activities by lay community members [56]	Japanese. Age range 30 to 59 yrs	Community	M		N, P
TELEPHONE
Two individual education sessions over the phone plus a mailed brochure [57]	Mostly middle aged, married, Non Hispanic black men	Community	H	RCT
6 months telephone counseling and exercise logs [58]	Well educated Caucasian	Community	L
COMPUTER
*Self guided interactive program with 2 reminder phone calls [59]	Low socio economic, African and white American women	Community	M		N

^Quality of study H = High, M = Medium, L = Low; ^# SNAPW significant positive outcome reported, S = Smoking, N = Nutrition, A = Alcohol, P = Physical activity, W = Weight; *Follow-up < 6 months.