Table 1.

Summary details of included original research studies and approaches to assessing distributed health literacy

Author	Aims and/or research questions	Study population	Study location	Study type		Methods	Approaches to assessing distributed health literacy
				Qual	Quant
Edwards et al. (2015) 7	To examine the ‘distributed’ nature of health literacy and explore how participants with a range of long‐term conditions draw on people within their social network(s) for support with health literacy‐related tasks	People living with a long‐term health condition	United Kingdom	✓		Longitudinal qualitative methodology (including serial interviews)	Included interview questions that sought to identify ‘in what situations participants were supported by the health literacy, knowledge or skills of others (e.g., in searching for online information, making informed decisions and communicating with health professionals)’
Abreu et al. (2018a) 19	How do patients with type 2 diabetes draw on their social network for support with identified health literacy‐related tasks?	People living with type 2 diabetes	Porto District, Northern Portugal	✓		Qualitative interviews	Included two topic questions to explore the role of ‘health mediators’ for people diagnosed with asthma and type two diabetes (Do you usually go accompanied to the medical visits (if yes, by whom)? If we ask you to choose someone to help you in a health‐related issue, who would you choose and why?). Provide a visual ‘map’ of health literacy mediators (e.g., partner; children) and practices (e.g., attends consultations; gives advice)
Abreu et al. (2018b) 20	How do adults diagnosed with asthma draw on their social network for support with health literacy‐related tasks, mapping out health literacy mediators for each individual, and how they enable self‐management skills and knowledge about asthma?	Adults diagnosed with asthma	Porto District, Northern Portugal	✓		Qualitative interviews	As above
Dayyani et al. (2019) 17	To explore how non‐Western ethnic minority pregnant women with gestational diabetes (GDM) in Denmark experience the hospital‐based information about GDM and how they integrate this information into their everyday life. The secondary aim was to investigate the role played by health literacy and distributed health literacy	Non‐Western ethnic minority pregnant women with gestational diabetes	Aarhus University Hospital, Denmark	✓		Qualitative interviews	Asked participants about their experience with different health professionals and whether and how they receive support from family and friends about how to live with gestational diabetes
McKinn et al. (2019) 21	To examine the nature of maternal health literacy in Dien Bien Provence by exploring which formal and informal sources of health information ethnic minority women access and trust, and how women draw on these resources and their social and family networks to apply their understanding of health information and make health decisions	Ethnic minority women who were currently pregnant, or mothers or grandmothers of children younger than age 5 years	Dien BienProvence, Vietnam	✓		Focus groups	Asked three explicit questions about the role of family and community during their focus groups (How is your family involved with the baby? Does anyone give you advice about the pregnancy and having the baby? Are there things that your family/community expect you to do while you are pregnant?)
Uwamahoro et al. (2019) 18	What health literacy‐related knowledge and skills do Young People Living with HIV (YPLHIV) in Malawi require to cope with life, take control of adverse social and environmental circumstances, and live healthy lives? How can the existing health literacy frameworks (functional, critical, interactive and distributed health literacy) be modified to incorporate the specific needs of YPLHIV in Malawi?	HIV‐positive young people (YPLWHIV) aged 18–35 years	Southern (Blantyre), Central (Lilongwe) and Northern (Mzuzu) regions, Malawi	✓		Focus group discussions and semi‐structured one‐to‐one interviews	Contextualized the definitions of four health literacy dimensions (including distributed health literacy) to ensure appropriateness to HIV in Malawian youth, and report that this initial conceptualization was used to develop the discussion and interview guides for their study
Lorini et al. (2020) 22	Aim: To assess the role of health literacy as the country‐level ecological variable in predicting the health disparities among immigrants in different European Union countries. Research Question: Does the health literacy of a country influence the health disparities among immigrants?	Immigrants living in eight European countries	Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain		✓	Secondary analysis of data	Country‐level health literacy data were obtained from the publicly available first European Health Literacy Survey reports. Individual‐level data on citizenship, perceived health status, body mass index, smoking habits, physical activity and attendance at breast and cervical cancer screening were extracted from the European Health Interview Survey of Eurostat. The country‐specific odds ratio (OR) for the association between the participants' citizenship and other individual health‐relevant characteristics was pooled into summary OR using random‐effects models. Meta‐regression was used to explore whether the health literacy of a country could explain part of the between‐countries heterogeneity. Health literacy was measured ecologically using the HLS‐EU‐Q47, with the authors including the average value and proportion of the country population with values of health literacy judged as ‘inadequate’ or ‘problematic or inadequate’ in their meta‐regression analysis