- The relationship between health literacy and health outcomes requires further investigation
- Results of several studies were inconclusive
- HIV-specific health literacy instruments should be used in the future
Health literacy has emerged as a major area of interest and essential to research in a variety of chronic illness. This review is the first to critically appraise published literature related to health literacy and outcomes in HIV.
The extended guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, as well as A Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist were used. Four reviewers used multiple electronic databases for the search: PubMed, CINAHL, EBSCO, PsychInfo, Cochrane Library and literature available on U.S. government websites. Search terms were used in a variety of combinations and included HIV, health literacy, adherence, and health outcomes. The literature search took place between November 1, 2017 and February 1, 2018.
Of the 48 studies retained, 37 were of a quantitative cross-sectional design, 7 were quantitative intervention studies, and 4 were qualitative. The authors created a data extraction form that was specifically developed via Research Electronic Data Capture for this study and based on the Cochrane Handbook for Systematic Review of Interventions. Following data were extracted: study design, sample characteristics, sample size, location, intervention characteristics, health literacy measure, adherence, and outcome measures including viral load, CD4 count, HIV knowledge, medication knowledge, depression, and substance use disorders. Additional outcomes clustered into broad categories were included: risky behaviours, resources and capacity, patient-provider relationship and various aspects of management, knowledge, and interpretation of information.
All of the studies addressed the key significance of health literacy within the scope of living with HIV disease, but several of them had equivocal or contradictory results without statistical significance. The high level of heterogeneity among the studies did not make meta-analysis of the outcomes of HIV and health literacy feasible. Of note, the most frequently utilized instruments for measurement were not specific for HIV disease.