Skip to main content

Association Between Health Literacy, eHealth Literacy, and Health Outcomes Among Patients With Long-Term Conditions

A Systematic Review

Published Online:https://doi.org/10.1027/1016-9040/a000350

Abstract. The objective of this paper is to synthesize and update findings from systematic review on health literacy and health outcomes among patients with long-term conditions, and extend the review to the digital domain. Health outcomes include clinical outcomes, processes of care, and health service use. Data sources are the following: (1) studies which appeared in two previous systematic reviews in 2004 and 2011 whose participants were people with long-term conditions or elderly (n = 54); (2) articles on health literacy and health outcomes identified in an updated 2011–2016 search (n = 26); (3) articles on eHealth literacy and its association with health outcomes (n = 8). Strength of evidence was determined by a qualitative assessment of risk of bias, consistency, and directness. There was a lack of consistent evidence on the relationship between health literacy and clinical outcomes despite the consistent evidence on the association with mortality. There was low to insufficient evidence on the association between health literacy and self-rated health/function and emotional states of anxiety and depression, alongside high evidence on lack of association with quality of life. There was insufficient to low evidence on the association between health literacy and behavioral outcomes (medication adherence, other health behaviors) and finally also low to moderate evidence on the association between health literacy and use of health services such as hospitalization and emergency department. In the eHealth literacy domain, there were few studies reporting association with health behaviors and self-rated health with inconsistent results. In conclusion, it is advocated to examine performed heath literacy and eHealth literacy in large longitudinal studies.

References References included in the literature review are indicated with an asterisk

  • *Al Sayah, F., Majumdar, S. R., Egede, L. E. & Johnson, J. A. (2015). Associations between health literacy and health outcomes in a predominantly low-income African American population with type 2 diabetes. Journal of Health Communication, 20, 581–588. https://doi.org/10.1080/10810730.2015.1012235 First citation in articleCrossrefGoogle Scholar

  • *Al Sayah, F., Majumdar, S. R. & Johnson, J. A. (2015). Association of inadequate health literacy with health outcomes in patients with type 2 diabetes and depression: Secondary analysis of a controlled trial. Canadian Journal of Diabetes, 39, 259–265. https://doi.org/10.1016/j.jcjd.2014.11.005 First citation in articleCrossrefGoogle Scholar

  • Al Sayah, F., Majumdar, S. R., Williams, B., Robertson, S. & Johnson, J. A. (2013). Health literacy and health outcomes in diabetes: A systematic review. Journal of General Internal Medicine, 28, 444–452. https://doi.org/10.1007/s11606-012-2241-z First citation in articleCrossrefGoogle Scholar

  • Bailey, S. C., Brega, A. G., Crutchfield, T. M., Elasy, T., Herr, H., Kaphingst, K., … Schillinger, D. (2014). Update on health literacy and diabetes. Diabetes Educator, 40, 581–604. https://doi.org/10.1177/0145721714540220 First citation in articleCrossrefGoogle Scholar

  • Baker, D. W. (2006). The meaning and the measure of health literacy. Journal of General Internal Medicine, 21(8), 878–883. First citation in articleCrossrefGoogle Scholar

  • Baker, D. W., Gazmararian, J. A., Williams, M. V., Scott, T., Parker, R. M., Green, D., … Peel, J. (2002). Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. American Journal of Public Health, 92, 1278–1283. https://doi.org/10.2105/AJPH.92.8.1278 First citation in articleCrossrefGoogle Scholar

  • *Baker, D. W., Gazmararian, J. A., Williams, M. V., Scott, T., Parker, R. M., Green, D., … Peel, J. (2004). Health literacy and use of outpatient physician services by Medicare managed care enrollees. Journal of General Internal Medicine, 19, 215–220. https://doi.org/10.1111/j.1525-1497.2004.21130.x First citation in articleCrossrefGoogle Scholar

  • *Baker, D. W., Parker, R. M., Williams, M. V. & Clark, W. S. (1998). Health literacy and the risk of hospital admission. Journal of General Internal Medicine, 13, 791–798. https://doi.org/10.1046/j.1525-1497.1998.00242.x First citation in articleCrossrefGoogle Scholar

  • Baker, D. W., Parker, R. M., Williams, M. V., Pitkin, K., Parikh, N. S., Coates, W. & Imara, M. (1996). The health care experience of patients with low literacy. Archives of Family Medicine, 5, 329–334. https://doi.org/10.1001/archfami.1996.01850430019010 First citation in articleCrossrefGoogle Scholar

  • *Baker, D. W., Wolf, M. S., Feinglass, J. & Thompson, J. A. (2008). Health literacy, cognitive abilities, and mortality among elderly persons. Journal of General Internal Medicine, 23, 723–726. https://doi.org/10.1007/s11606-008-0566-4 First citation in articleCrossrefGoogle Scholar

  • *Baker, D. W., Wolf, M., Feinglass, J., Thompson, J. A., Gazmararian, J. & Huang, J. (2007). Health literacy and mortality among elderly persons. Archives of Internal Medicine, 167, 1503–1509. https://doi.org/10.1001/archinte.167.14.1503 First citation in articleCrossrefGoogle Scholar

  • *Bauer, A. M., Schillinger, D., Parker, M. M., Katon, W., Adler, N., Adams, A. S., … Karter, A. J. (2013). Health literacy and antidepressant medication adherence among adults with diabetes: The diabetes study of Northern California (DISTANCE). Journal of General Internal Medicine, 28, 1181–1187. https://doi.org/10.1007/s11606-013-2402-8 First citation in articleCrossrefGoogle Scholar

  • *Bennett, C. L., Ferreira, M. R., Davis, T. C., Kaplan, J., Weinberger, M., Kuzel, T., … Sartor, O. (1998). Relation between literacy, race, and stage of presentation among low-income patients with prostate cancer. Journal of Clinical Oncology, 16, 3101–3104. https://doi.org/10.1200/jco.1998.16.9.3101 First citation in articleCrossrefGoogle Scholar

  • *Bennett, I. & Chen, J. (2009). The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. The Annals of Family Medicine, 7, 204–211. https://doi.org/10.1370/afm.940.Department First citation in articleCrossrefGoogle Scholar

  • Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J. & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155, 97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005 First citation in articleCrossrefGoogle Scholar

  • Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., Viera, A., Crotty, K., … Viswanathan, M. (2011). Health literacy interventions and outcomes: An updated systematic review. (Vol. Agency for). Research Triangle Park, NC. First citation in articleGoogle Scholar

  • *Blackstock, O. J., Cunningham, C. O., Haughton, L. J., Garner, R. Y., Norwood, C. & Horvath, K. J. (2016). Higher eHealth literacy is associated with HIV risk behaviors among HIV-infected women who use the Internet. Journal of the Association of Nurses in Aids Care, 27, 102–108. https://doi.org/10.1016/j.jana.2015.09.001 First citation in articleCrossrefGoogle Scholar

  • *Brega, A. G., Ang, A., Vega, W., Jiang, L., Beals, J., Mitchell, C. M., … Roubideaux, Y. (2012). Mechanisms underlying the relationship between health literacy and glycemic control in American Indians and Alaska Natives. Patient Education and Counseling, 88, 61–68. https://doi.org/10.1016/j.pec.2012.03.008 First citation in articleCrossrefGoogle Scholar

  • *Britt, R. K., Collins, W. B., Wilson, K. M., Linnemeier, G. & Englebert, A. M. (2015). The role of eHealth literacy and HPV vaccination among young adults: Implications from a planned behavior approach. Communication Research Reports, 32, 208–215. https://doi.org/10.1080/08824096.2015.1052963 First citation in articleCrossrefGoogle Scholar

  • *Cajita, M. I., Denhaerynck, K., Dobbels, F., Berben, L., Russell, C. L., Davidson, P. M. & Geest, S. De. (2016). Health literacy in heart transplantation: Prevalence, correlates and associations with health behaviors – findings from the international BRIGHT study. The Journal of Heart and Lung Transplantation, 36, 272–279. https://doi.org/10.1016/j.healun.2016.08.024 First citation in articleCrossrefGoogle Scholar

  • *Cho, Y. I., Lee, S.-Y. Y. D. Y., Arozullah, A. M. & Crittenden, K. S. (2008). Effects of health literacy on health status and health service utilization amongst the elderly. Social Science & Medicine (1982), 66, 1809–1816. https://doi.org/10.1016/j.socscimed.2008.01.003 First citation in articleCrossrefGoogle Scholar

  • Cutilli, C. C. (2007). Health literacy in geriatric patients: An integrative review of the literature. Orthopaedic Nursing/National Association of Orthopaedic Nurses, 26, 43–48. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17273109 First citation in articleGoogle Scholar

  • Davis, T. C., Long, S. W., Jackson, R. H., Mayeaux, E. J., George, R. B., Murphy, P. W. & Crouch, M. A. (1993). Rapid estimate of adult literacy in medicine: A shortened screening instrument. Family Medicine, 25(6), 391–395. First citation in articleGoogle Scholar

  • *Devraj, R., Borrego, M., Vilay, A. M., Gordon, E. J., Pailden, J. & Horowitz, B. (2015). Relationship between health literacy and kidney function. Nephrology, 20, 360–367. https://doi.org/10.1111/nep.12425 First citation in articleCrossrefGoogle Scholar

  • DeWalt, D. A., Berkman, N. D., Sheridan, S., Lohr, K. N. & Pignone, M. P. (2004). Literacy and health outcomes: A systematic review of the literature. Journal of General Internal Medicine, 19, 1228–1239. https://doi.org/10.1111/j.1525-1497.2004.40153.x First citation in articleCrossrefGoogle Scholar

  • DeWalt, D. A., Dilling, M. H., Rosenthal, M. S. & Pignone, M. P. (2007). Low parental literacy is associated with worse asthma care measures in children. Ambulatory Pediatrics, 7, 25–31. https://doi.org/10.1016/j.ambp.2006.10.001 First citation in articleCrossrefGoogle Scholar

  • Diviani, N., van den Putte, B., Giani, S. & van Weert, J. C. M. (2015). Low health literacy and evaluation of online health information: A systematic review of the literature. Journal of Medical Internet Research, 17, 1–17. https://doi.org/10.2196/jmir.4018 First citation in articleCrossrefGoogle Scholar

  • *Eckman, M. H., Wise, R., Leonard, A. C., Dixon, E., Burrows, C., Khan, F. & Warm, E. (2012). Impact of health literacy on outcomes and effectiveness of an educational intervention in patients with chronic diseases. Patient Education and Counseling, 87, 143–151. https://doi.org/10.1016/j.pec.2011.07.020 First citation in articleCrossrefGoogle Scholar

  • *Estrada, C. A., Martin-Hryniewicz, M., Peek, B. T., Collins, C. & Byrd, J. C. (2004). Literacy and numeracy skills and anticoagulation control. The American Journal of the Medical Sciences, 328, 88–93. https://doi.org/10.1097/00000441-200408000-00004 First citation in articleCrossrefGoogle Scholar

  • *Fang, M. C., Machtinger, E. L., Wang, F. & Schillinger, D. (2006). Health literacy and anticoagulation-related outcomes among patients taking warfarin. Journal of General Internal Medicine, 21, 841–846. https://doi.org/10.1111/j.1525-1497.2006.00537.x First citation in articleCrossrefGoogle Scholar

  • *Gatti, M. E., Jacobson, K. L., Gazmararian, J. A., Schmotzer, B. & Kripalani, S. (2009). Relationships between beliefs about medications and adherence. Journal of Health-System Pharmacy, 66, 657–664. https://doi.org/10.2146/ajhp080064 First citation in articleCrossrefGoogle Scholar

  • *Gazmararian, J. A., Baker, D. W., Parker, R. M. & Blazer, D. G. (2000). A multivariate analysis of factors associated with depression. Archives of Internal Medicine, 160, 3307–3314. https://doi.org/10.1001/archinte.160.21.3307 First citation in articleCrossrefGoogle Scholar

  • *Gazmararian, J. A., Kripalani, S., Miller, M. J., Echt, K. V., Ren, J. & Rask, Kimberly. (2006). Factors associated with medication refill adherence in cardiovascular-related diseases. Journal of General Internal Medicine, 21, 1215–1221. https://doi.org/10.1111/j.1525-1497.2006.00591.x First citation in articleCrossrefGoogle Scholar

  • *Gerber, B. S., Cho, Y. I., Arozullah, A. M. & Lee, S. Y. D. (2010). Racial differences in medication adherence: A cross-sectional study of Medicare enrollees. American Journal Geriatric Pharmacotherapy, 8, 136–145. https://doi.org/10.1016/j.amjopharm.2010.03.002 First citation in articleCrossrefGoogle Scholar

  • *Gordon, M.-M., Hampson, R., Capell, H. A. & Madhok, R. (2002). Illiteracy in rheumatoid arthritis patients as determined by the Rapid Estimate of Adult Literacy in Medicine (REALM) score. Rheumatology, 41, 750–754. https://doi.org/10.1093/rheumatology/41.7.750 First citation in articleCrossrefGoogle Scholar

  • *Graham, J., Bennett, I. M., Holmes, W. C. & Gross, R. (2007). Medication beliefs as mediators of the health literacy – antiretroviral adherence relationship in HIV-infected individuals. AIDS and Behavior, 11, 385–392. https://doi.org/10.1007/s10461-006-9164-9 First citation in articleCrossrefGoogle Scholar

  • *Grubbs, V., Gregorich, S. E., Perez-Stable, E. J. & Hsu, C. Y. (2009). Health literacy and access to kidney transplantation. Clinical Journal of the American Society of Nephrology, 4, 195–200. https://doi.org/10.2215/CJN.03290708 First citation in articleCrossrefGoogle Scholar

  • *Hahn, E. A., Burns, J. L., Jacobs, E. A., Ganschow, P. S., Garcia, S. F., Rutsohn, J. P. & Baker, D. W. (2015). Health literacy and patient-reported outcomes: A cross-sectional study of underserved English- and Spanish-Speaking patients with type 2 diabetes. Journal of Health Communication, 20(Supplement 2), 4–15. https://doi.org/10.1080/10810730.2015.1061071 First citation in articleCrossrefGoogle Scholar

  • *Hahn, E. A., Cella, D., Dobrez, D. G., Weiss, B. D., Du, H., Lai, J. S., … Garcia, S. F. (2007). The impact of literacy on health-related quality of life measurement and outcomes in cancer outpatients. Quality of Life Research, 16, 495–507. https://doi.org/10.1007/s11136-006-9128-6 First citation in articleCrossrefGoogle Scholar

  • *Halladay, J. R., Donahue, K. E., Cené, C. W., Li, Q., Cummings, D. M., Hinderliter, A. L., … DeWalt, D. (2016). The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial. Patient Education and Counseling, 100, 542–549. https://doi.org/10.1016/j.pec.2016.10.015 First citation in articleCrossrefGoogle Scholar

  • *Halverson, J., Martinez-Donate, A., Trentham-Dietz, A., Walsh, M. C., Strickland, J. S., Palta, M., … Cleary, J. (2013). Health literacy and urbanicity among cancer patients. The Journal of Rural Health, 29, 392–402. https://doi.org/10.1111/jrh.12018 First citation in articleGoogle Scholar

  • *Heinrich, C. & Kuiper, R. A. (2012). Using handheld devices to promote medication adherence in chronic illness. The Journal for Nurse Practitioners, 8, 288–293. https://doi.org/10.1016/j.nurpra.2011.10.010 First citation in articleCrossrefGoogle Scholar

  • Hesse, B. W., Nelson, D. E., Kreps, G. L., Croyle, R. T., Arora, N. K., Rimer, B. K. & Viswanath, K. (2005). Trust and sources of health information. Archives of Internal Medicine, 165, 2618–2624. https://doi.org/10.1001/archinte.165.22.2618 First citation in articleCrossrefGoogle Scholar

  • *Hope, C. J., Wu, J., Tu, W., Young, J. & Murray, M. D. (2004). Association of medication adherence, knowledge, and skills with emergency department visits by adults 50 years or older with congestive heart failure. American Journal of Health-System Pharmacy, 61, 2043–2049. Retrieved from http://www.ajhp.org/content/61/19/2043.short First citation in articleGoogle Scholar

  • *Howard, D. H., Sentell, T. & Gazmararian, J. A. (2006). Impact of health literacy on socioeconomic and racial differences in health in an elderly population. Journal of General Internal Medicine, 21, 857–861. https://doi.org/10.1111/j.1525-1497.2006.00530.x First citation in articleCrossrefGoogle Scholar

  • *Hsu, W., Chiang, C. & Yang, S. (2014). The effect of individual factors on health behaviors among college students: The mediating effects of eHealth literacy. Journal of Medical Internet Research, 16, e287. https://doi.org/10.2196/jmir.3542 First citation in articleCrossrefGoogle Scholar

  • *Ishikawa, H. & Yano, E. (2011). The relationship of patient participation and diabetes outcomes for patients with high vs. low health literacy. Patient Education and Counseling, 84, 393–397. https://doi.org/10.1016/j.pec.2011.01.029 First citation in articleCrossrefGoogle Scholar

  • *Jain, D., Sheth, H., Green, J. A., Bender, F. H. & Weisbord, S. D. (2015). Health literacy in patients on maintenance peritoneal dialysis: Prevalence and outcomes. Peritoneal Dialysis International, 35, 96–98. https://doi.org/10.3747/pdi.2013.00342 First citation in articleCrossrefGoogle Scholar

  • *Johnston, M. V., Diab, M. E., Kim, S.-S. & Kirshblum, S. (2005). Health literacy, morbidity, and quality of life among individuals with spinal cord injury. The Journal of Spinal Cord Medicine, 28, 230–240. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=16048141&site=ehost-live&scope=site First citation in articleCrossrefGoogle Scholar

  • *Kalichman, S. C., Benotsch, E., Suarez, T., Catz, S., Miller, J. & Rompa, D. (2000). Health literacy and health-related knowledge among persons living with HIV/AIDS. American Journal of Preventive Medicine, 18, 325–331. https://doi.org/10.1016/S0749-3797(00)00121-5 First citation in articleCrossrefGoogle Scholar

  • *Kalichman, S. C., Pope, H., White, D., Cherry, C., Amaral, C. M., Swetzes, C., … Kalichman, M. O. (2008). Association between health literacy and HIV treatment adherence: Further evidence from objectively measured medication adherence. Journal of the International Association of Physicians in AIDS Care (Chicago, Ill.: 2002), 7, 317–323. https://doi.org/10.1177/1545109708328130 First citation in articleCrossrefGoogle Scholar

  • *Kalichman, S. C., Ramachandran, B. & Catz, S. (1999). Adherence to combination antiretroviral therapies in HIV patients of low health literacy. Journal of General Internal Medicine, 14, 267–273. https://doi.org/10.1046/j.1525-1497.1999.00334.x First citation in articleCrossrefGoogle Scholar

  • *Kalichman, S. C. & Rompa, D. (2000). Emotional reactions to health status changes and emotional well-being among HIV-positive persons with limited reading literacy. Journal of Clinical Psychology in Medical Settings, 7, 203–211. https://doi.org/10.1023/A:1009528429865 First citation in articleCrossrefGoogle Scholar

  • Karnoe, A. & Kayser, L. (2015). How is eHealth literacy measured and what do the measurements tell us? A systematic review. Knowledge Management and E-Learning, 7, 576–600. First citation in articleGoogle Scholar

  • Kiechle, E. S., Bailey, S. C., Hedlund, L. A., Viera, A. J. & Sheridan, S. L. (2015). Different measures, different outcomes? A systematic review of performance-based versus self-reported measures of health literacy and numeracy. Journal of General Internal Medicine, 30, 1538–1546. https://doi.org/10.1007/s11606-015-3288-4 First citation in articleCrossrefGoogle Scholar

  • *Kim, S. H. (2009). Health literacy and functional health status in Korean older adults. Journal of Clinical Nursing, 18, 2337–2343. https://doi.org/10.1111/j.1365-2702.2008.02739.x First citation in articleCrossrefGoogle Scholar

  • Knapp, C., Madden, V., Wang, H., Sloyer, P. & Shenkman, E. (2011). Internet use and eHealth Literacy of low-income parents whose children have special health care needs. Journal of Medical Internet Research, 13, 1–15. https://doi.org/10.2196/jmir.1697 First citation in articleCrossrefGoogle Scholar

  • *Kripalani, S., Gatti, M. E. & Jacobson, T. A. (2010). Association of age, health literacy, and medication management strategies with cardiovascular medication adherence. Patient Education and Counseling, 81, 177–181. https://doi.org/10.1016/j.pec.2010.04.030 First citation in articleCrossrefGoogle Scholar

  • *Kripalani, S., Henderson, L. E., Chiu, E. Y., Robertson, R., Kolm, P. & Jacobson, T. A. (2006). Predictors of medication self-management skill in a low-literacy population. Journal of General Internal Medicine, 21, 852–856. https://doi.org/10.1111/j.1525-1497.2006.00536.x First citation in articleCrossrefGoogle Scholar

  • *Lai, A. Y., Ishikawa, H., Kiuchi, T., Mooppil, N. & Griva, K. (2013). Communicative and critical health literacy, and self-management behaviors in end-stage renal disease patients with diabetes on hemodialysis. Patient Education and Counseling, 91, 221–227. https://doi.org/10.1016/j.pec.2012.12.018 First citation in articleCrossrefGoogle Scholar

  • *Lee, E.-H., Lee, Y. W. & Moon, S. H. (2016). A structural equation model linking health literacy to self-efficacy, self-care activities, and health-related quality of life in patients with type 2 diabetes. Asian Nursing Research, 10, 82–87. https://doi.org/10.1016/j.anr.2016.01.005 First citation in articleCrossrefGoogle Scholar

  • *Lee, S.-Y. D., Arozullah, A. M., Cho, Y. I., Crittenden, K. & Vicencio, D. (2009). Health literacy, social support, and health status among older adults. Educational Gerontology, 35, 191–201. https://doi.org/10.1080/03601270802466629 First citation in articleCrossrefGoogle Scholar

  • Lee, T. W., Lee, S. H., Kim, H. H. & Kang, S. J. (2012). Effective intervention strategies to improve health outcomes for cardiovascular disease patients with low health literacy skills: A systematic review (Provisional abstract). Asian Nursing Research, 6, 128–136. https://doi.org/10.1016/j.anr.2012.09.001 First citation in articleCrossrefGoogle Scholar

  • *Lee, Y.-M., Yu, H. Y., You, M.-A. & Son, Y.-J. (2015). Impact of health literacy on medication adherence in older people with chronic diseases. Collegian, 24, 1–8. https://doi.org/10.1016/j.colegn.2015.08.003 First citation in articleGoogle Scholar

  • *Lincoln, A., Paasche-Orlow, M. K., Cheng, D. M., Lloyd-Travaglini, C., Caruso, C., Saitz, R. & Samet, J. H. (2006). Impact of health literacy on depressive symptoms and mental health-related quality of life among adults with addiction. Journal of General Internal Medicine, 21, 818–822. https://doi.org/10.1111/j.1525-1497.2006.00533.x First citation in articleCrossrefGoogle Scholar

  • *Lindau, S. T., Basu, A. & Leitsch, S. A. (2006). Health literacy as a predictor of follow-up after an abnormal pap smear: A prospective study. Journal of General Internal Medicine, 21, 829–834. https://doi.org/10.1111/j.1525-1497.2006.00534.x First citation in articleCrossrefGoogle Scholar

  • Mackert, M., Champlin, S. E., Holton, A., Muñoz, I. I. & Damásio, M. J. (2014). eHealth and health literacy: a research methodology review. Journal of Computer-Mediated Communication, 19(3), 516–528. First citation in articleCrossrefGoogle Scholar

  • *Mancuso, C. A. & Rincon, M. (2006). Impact of health literacy on longitudinal asthma outcomes. Journal of General Internal Medicine, 21, 813–817. https://doi.org/10.1111/j.1525-1497.2006.00528.x First citation in articleCrossrefGoogle Scholar

  • *Mancuso, J. M. (2010). Impact of health literacy and patient trust on glycemic control in an urban USA population. Nursing and Health Sciences, 12, 94–104. https://doi.org/10.1111/j.1442-2018.2009.00506.x First citation in articleCrossrefGoogle Scholar

  • *Mayben, J. K., Kramer, J. R., Kallen, M. A., Franzini, L., Lairson, D. R. & Giordano, T. P. (2007). Predictors of delayed HIV diagnosis in a recently diagnosed cohort. AIDS Patient Care STDS, 21, 195–204. https://doi.org/10.1089/apc.2006.0097 First citation in articleCrossrefGoogle Scholar

  • *Miller-Matero, L. R., Bryce, K., Hyde-Nolan, M. E., Dykhuis, K. E., Eshelman, A. & Abouljoud, M. (2016). Health literacy status affects outcomes for patients referred for transplant. Psychosomatics, 57, 522–528. https://doi.org/10.1016/j.psym.2016.04.001 First citation in articleCrossrefGoogle Scholar

  • *Milne, R. A., Puts, M. T. E., Papadakos, J., Le, L. W., Milne, V. C., Hope, A. J., … Pignone, M. P. (2012). Predictors of high eHealth literacy in primary lung cancer survivors. BMC Health Services Research, 30, 685–692. https://doi.org/10.1007/s13187-014-0744-5 First citation in articleGoogle Scholar

  • *Mitsutake, S., Shibata, A., Ishii, K. & Oka, K. (2012). Association of eHealth Literacy with colorectal cancer knowledge and screening practice among Internet users in Japan. Journal of Medical Internet Research, 14, 406–416. https://doi.org/10.2196/jmir.1927 First citation in articleCrossrefGoogle Scholar

  • *Mitsutake, S., Shibata, A., Ishii, K. & Oka, K. (2016). Associations of eHealth literacy with health behavior among adult Internet users. Journal of Medical Internet Research, 18, e192. https://doi.org/10.2196/jmir.5413 First citation in articleCrossrefGoogle Scholar

  • Moher, D., Liberati, A., Tetzlaff, J. & Altman, D. G. (2009). Research methods & reporting – Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement-David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses. British Medical Journal (CR)-Print, 338(7716), 332. First citation in articleGoogle Scholar

  • *Morris, N. S., MacLean, C. D. & Littenberg, B. (2006). Literacy and health outcomes: A cross-sectional study in 1002 adults with diabetes. BMC Family Practice, 7, 49. https://doi.org/10.1186/1471-2296-7-49 First citation in articleCrossrefGoogle Scholar

  • Mõttus, R., Johnson, W., Murray, C., Wolf, M. S., Starr, J. M. & Deary, I. J. (2014). Towards understanding the links between health literacy and physical health. Health Psychology, 33, 164–173. https://doi.org/10.1037/a003143 First citation in articleCrossrefGoogle Scholar

  • *Muir, K. W., Santiago-Turla, C., Stinnett, S. S., Herndon, L. W., Allingham, R. R., Challa, P. & Lee, P. P. (2008). Health literacy and vision-related quality of life. The British Journal of Ophthalmology, 92, 779–782. https://doi.org/10.1136/bjo.2007.134452 First citation in articleCrossrefGoogle Scholar

  • Muñoz, R. F. (2010). Using evidence-based internet interventions to reduce health disparities worldwide. Journal of Medical Internet Research, 12, e60. https://doi.org/10.2196/jmir.1463 First citation in articleCrossrefGoogle Scholar

  • *Murphy, D. A., Lam, P., Naar-King, S., Robert Harris, D., Parsons, J. T., Muenz, L. R., … Muenz, L. R. (2010). Health Literacy and antiretroviral adherence among HIV-infected adolescents. Patient Education and Counseling, 144, 25–29. https://doi.org/10.1016/j.pec.2009.07.014 First citation in articleCrossrefGoogle Scholar

  • *Murray, M. D., Tu, W., Wu, J., Morrow, D., Smith, F. & Brater, D. C. (2009). Factors associated with exacerbation of heart failure include treatment adherence and health literacy skills. Clinical Pharmacology and Therapeutics, 85, 651–658. https://doi.org/10.1038/clpt.2009.7 First citation in articleCrossrefGoogle Scholar

  • *Neter, E. & Brainin, E. (2012). eHealth Literacy: Extending the digital divide to the realm of health information. Journal of Medical Internet Research, 14, e19. https://doi.org/10.2196/jmir.1619 First citation in articleCrossrefGoogle Scholar

  • Neter, E. & Brainin, E. (2017). Perceived and performed eHealth literacy: Survey and simulated performance test. JMIR Human Factors, 4, e2. https://doi.org/10.2196/humanfactors.6523 First citation in articleCrossrefGoogle Scholar

  • Neter, E., Brainin, E. & Baron-Epel, O. (2015). The dimensionality of health literacy and eHealth literacy. Bulletin of the European Health Psychologist, 17, 275–280. First citation in articleGoogle Scholar

  • Nguyen, T. H., Paasche-Orlow, M. K. & McCormack, L. A. (2017). The state of the science of health literacy measurement. Information Services & Use, 37, 189–203. https://doi.org/10.3233/ISU-170827 First citation in articleCrossrefGoogle Scholar

  • *Nokes, K. M., Coleman, C. L., Cashen, M., Dole, P., Sefcik, E., Hamilton, M. J., … Holzemer, W. (2007). Health literacy and health outcomes in HIV seropositive persons. Research in Nursing and Health, 30, 620–627. https://doi.org/10.1002/nur.20219 First citation in articleCrossrefGoogle Scholar

  • Norgaard, O., Furstrand, D., Klokker, L., Karnoe, A., Batterham, R., Kayser, L. & Osborne, R. H. (2015). The e-health literacy framework: A conceptual framework for characterizing e-health users and their interaction with e-health systems. Knowledge Management & E-Learning, 7, 522–540. First citation in articleGoogle Scholar

  • Norman, C. D. & Skinner, H. A. (2006). eHEALS: The eHealth literacy scale. Journal of Medical Internet Research, 8(4). First citation in articleCrossrefGoogle Scholar

  • Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15, 259–267. https://doi.org/10.1093/heapro/15.3.259 First citation in articleCrossrefGoogle Scholar

  • Nutbeam, D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67, 2072–2078. https://doi.org/10.1016/j.socscimed.2008.09.050 First citation in articleCrossrefGoogle Scholar

  • *Oramasionwu, C. U., Bailey, S. C., Duffey, K. E., Shilliday, B. B., Brown, L. C., Denslow, S. A. & Michalets, E. L. (2014). The association of health literacy with time in therapeutic range for patients on warfarin therapy. Journal of Health Communication, 19(Suppl 2), 19–28. https://doi.org/10.1080/10810730.2014.934934 First citation in articleCrossrefGoogle Scholar

  • *Osborn, C. Y., Bains, S. S. & Egede, L. E. (2010). Health literacy, diabetes self-care, and glycemic control in adults with type 2 diabetes. Diabetes Technology & Therapeutics, 12, 913–919. https://doi.org/10.1089/dia.2010.0058 First citation in articleCrossrefGoogle Scholar

  • *Osborn, C. Y., Paasche-Orlow, M. K., Davis, T. C. & Wolf, M. S. (2007). Health literacy. An overlooked factor in understanding HIV health disparities. American Journal of Preventive Medicine, 33, 374–378. https://doi.org/10.1016/j.amepre.2007.07.022 First citation in articleCrossrefGoogle Scholar

  • Owens, D. K., Lohr, K. N., Atkins, D., Treadwell, J. R., Reston, J. T., Bass, E. B., … Helfand, M. (2010). AHRQ Series Paper 5: Grading the strength of a body of evidence when comparing medical interventions-Agency for Healthcare Research and Quality and the Effective Health-Care Program. Journal of Clinical Epidemiology, 63, 513–523. https://doi.org/10.1016/j.jclinepi.2009.03.009 First citation in articleCrossrefGoogle Scholar

  • *Paasche-Orlow, M. K., Cheng, D. M., Palepu, A., Meli, S., Faber, V. & Samet, J. H. (2006). Health literacy, antiretroviral adherence, and HIV-RNA suppression: A longitudinal perspective. Journal of General Internal Medicine, 21, 835–840. https://doi.org/10.1111/j.1525-1497.2006.00527.x First citation in articleCrossrefGoogle Scholar

  • *Paasche-Orlow, M. K., Riekert, K. A., Bilderback, A., Chanmugam, A., Hill, P., Rand, C. S., … Krishnan, J. A. (2005). Tailored education may reduce health literacy disparities in asthma self-management. American Journal of Respiratory and Critical Care Medicine, 172, 980–986. https://doi.org/10.1164/rccm.200409-1291OC First citation in articleCrossrefGoogle Scholar

  • Paasche-Orlow, M. K. & Wolf, M. S. (2007). The causal pathways linking health literacy to health outcomes. American Journal of Health Behavior, 31(Suppl 1), S19–S26. https://doi.org/10.5993/AJHB.31.s1.4 First citation in articleCrossrefGoogle Scholar

  • *Pandit, A. U., Tang, J. W., Bailey, S. C., Davis, T. C., Bocchini, M. V., Persell, S. D., … Wolf, M. S. (2009). Education, literacy, and health: Mediating effects on hypertension knowledge and control. Patient Education and Counseling, 75, 381–385. https://doi.org/10.1016/j.pec.2009.04.006 First citation in articleCrossrefGoogle Scholar

  • Parker, R. M., Baker, D. W., Williams, M. V. & Nurss, J. R. (1995). The test of functional health literacy in adults. Journal of General Internal Medicine, 10(10), 537–541. First citation in articleCrossrefGoogle Scholar

  • Parker, R. M., Ratzan, S. C. & Lurie, N. (2003). Health literacy: A policy challenge for advancing high-quality health care. Health Affairs, 22, 147–153. https://doi.org/10.1377/hlthaff.22.4.147 First citation in articleCrossrefGoogle Scholar

  • *Pellowski, J. A., Kalichman, S. C. & Grebler, T. (2016). Optimal treatment adherence counseling outcomes for people living with hiv and limited health literacy. Behavioral Medicine (Washington, DC), 4289, 1–9. https://doi.org/10.1080/08964289.2014.963006 First citation in articleGoogle Scholar

  • *Powell, C. K., Hill, E. G. & Clancy, D. E. (2007). The relationship between health literacy and diabetes knowledge and readiness to take health actions. The Diabetes Educator, 33, 144–151. https://doi.org/10.1177/0145721706297452 First citation in articleCrossrefGoogle Scholar

  • *Puente-Maestu, L., Calle, M., Rodríguez-Hermosa, J. L., Campuzano, A., de Miguel Díez, J., Álvarez-Sala, J. L., … Lee, S.-Y. D. (2016). Health literacy and health outcomes in chronic obstructive pulmonary disease. Respiratory Medicine, 115, 78–82. https://doi.org/10.1016/j.rmed.2016.04.016 First citation in articleCrossrefGoogle Scholar

  • *Raehl, C. L., Bond, C., Woods, T. J., Patry, R. A. & Sleeper, R. B. (2006). Screening tests for intended medication adherence among the elderly. The Annals of Pharmacotherapy, 7, 485–503. https://doi.org/1O.1345/aph.1G478 First citation in articleGoogle Scholar

  • Reeve, C. L. & Basalik, D. (2014). Is health literacy an example of construct proliferation? A conceptual and empirical evaluation of its redundancy with general cognitive ability. Intelligence, 44, 93–102. https://doi.org/10.1016/j.intell.2014.03.004 First citation in articleCrossrefGoogle Scholar

  • Rudd, R., Kirsch, I. S. & Yamamoto, K. (2004). Literacy and health in America. Educational testing service. Retrieved from http://www.ets.org/Media/Research/pdf/PICHEATH.pdf First citation in articleGoogle Scholar

  • Sabate, S. E. (2003). Adherence to long-term therapies: Evidence for action. Geneva, Switzerland: World Health Organization. First citation in articleGoogle Scholar

  • *Scarpato, K. R., Kappa, S. F., Goggins, K. M., Chang, S. S., Smith, J. A., Clark, P. E. & Moses, K. A. (2016). The impact of health literacy on surgical outcomes following radical cystectomy. Journal of Health Communication, 21(Suppl 2), 99–104. https://doi.org/10.1080/10810730.2016.1193916 First citation in articleCrossrefGoogle Scholar

  • *Schillinger, D., Barton, L. R., Karter, A. J., Wang, F. & Adler, N. (2006). Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Reports, 121, 245–254. https://doi.org/10.1177/003335490612100305 First citation in articleCrossrefGoogle Scholar

  • *Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., … Bindman, A. B. (2002). Association of health literacy with diabetes outcomes. Journal of American Medical Association, 288, 475–482. https://doi.org/10.1001/jama.288.4.475 First citation in articleCrossrefGoogle Scholar

  • *Scott, T. L., Gazmararian, J. A., Williams, M. V. & Baker, D. W. (2002). Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Medical Care, 40, 395–404. https://doi.org/10.1097/00005650-200205000-00005 First citation in articleCrossrefGoogle Scholar

  • *Serper, M., Patzer, R. E., Curtis, L. M., Smith, S. G., O’Conor, R., Baker, D. W. & Wolf, M. S. (2014). Health literacy, cognitive ability, and functional health status among older adults. Health Services Research, 49, 1249–1267. https://doi.org/10.1111/1475-6773.12154 First citation in articleCrossrefGoogle Scholar

  • *Smith, S. G., Curtis, L. M., Wardle, J., von Wagner, C. & Wolf, M. S. (2013). Skill set or mind set? Associations between health literacy, patient activation and health. PLoS One, 8, e74373. https://doi.org/10.1371/journal.pone.0074373 First citation in articleCrossrefGoogle Scholar

  • Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z. & Brand, H. (2012). Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health, 12(1), 80. First citation in articleCrossrefGoogle Scholar

  • *Sperber, N. R., Bosworth, H. B., Coffman, C. J., Lindquist, J. H., Oddone, E. Z., Weinberger, M. & Allen, K. D. (2013). Differences in osteoarthritis self-management support intervention outcomes according to race and health literacy. Health Education Research, 28, 502–511. https://doi.org/10.1093/her/cyt043 First citation in articleCrossrefGoogle Scholar

  • *Sudore, R. L., Mehta, K. M., Simonsick, E. M., Harris, T. B., Newman, A. B., Satterfield, S., … Yaffe, K. (2006). Limited literacy in older people and disparities in health and healthcare access. Journal of the American Geriatrics Society, 54, 770–776. https://doi.org/10.1111/j.1532-5415.2006.00691.x First citation in articleCrossrefGoogle Scholar

  • *Sudore, R. L., Yaffe, K., Satterfield, S., Harris, T. B., Mehta, K. M., Simonsick, E. M., … Schillinger, D. (2006). Limited literacy and mortality in the elderly: The health, aging, and body composition study. Journal of General Internal Medicine, 21, 806–812. https://doi.org/10.1111/j.1525-1497.2006.00539.x First citation in articleCrossrefGoogle Scholar

  • Taggart, J., Williams, A., Dennis, S., Newall, A., Shortus, T., Zwar, N. & Harris, M. F. (2012). A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Family Practice, 13, 49. https://doi.org/10.1186/1471-2296-13-49 First citation in articleCrossrefGoogle Scholar

  • *Tang, Y. H., Pang, S. M. C., Chan, M. F., Yeung, G. S. P. & Yeung, V. T. F. (2008). Health literacy, complication awareness, and diabetic control in patients with type 2 diabetes mellitus. Journal of Advanced Nursing, 62, 74–83. https://doi.org/10.1111/j.1365-2648.2007.04526.x First citation in articleCrossrefGoogle Scholar

  • Van der Vaart, R. & Drossaert, C. H. C. C. (2017). Development of the digital health literacy instrument; measuring a broad spectrum of Health 1.0 and Health 2.0 skills. Journal of Medical Internet Research, 19, 1–13. https://doi.org/10.2196/jmir.6709 First citation in articleCrossrefGoogle Scholar

  • Van der Vaart, R., Van Deursen, A. J. A. M., Drossaert, C. H. C., Taal, E., van Dijk, J. A. & Van De Laar, M. A. (2011). Does the eHealth literacy scale (eHEALS) measure what it intends to measure? Validation of a Dutch version of the eHEALS in two adult populations. Journal of Medical Internet Research, 13, e86. https://doi.org/10.2196/jmir.1840 First citation in articleCrossrefGoogle Scholar

  • *Waite, K. R., Paasche-Orlow, M., Rintamaki, L. S., Davis, T. C. & Wolf, M. S. (2008). Literacy, social stigma, and HIV medication adherence. Journal of General Internal Medicine, 23, 1367–1372. https://doi.org/10.1007/s11606-008-0662-5 First citation in articleCrossrefGoogle Scholar

  • *Waldrop-Valverde, D., Jones, D. L., Jayaweera, D., Gonzalez, P., Romero, J. & Ownby, R. L. (2009). Gender differences in medication management capacity in HIV infection: The role of health literacy and numeracy. AIDS and Behavior, 13, 46–52. https://doi.org/10.1007/s10461-008-9425-x First citation in articleCrossrefGoogle Scholar

  • *Walker, D., Adebajo, A., Heslop, P., Hill, J., Firth, J., Bishop, P. & Helliwell, P. S. (2007). Patient education in rheumatoid arthritis: The effectiveness of the ARC booklet and the mind map. Rheumatology, 46, 1593–1596. https://doi.org/10.1093/rheumatology/kem171 First citation in articleCrossrefGoogle Scholar

  • Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P., … Hale, F. A. (2005). Quick assessment of literacy in primary care: The newest vital sign. The Annals of Family Medicine, 3(6), 514–522. First citation in articleCrossrefGoogle Scholar

  • *White, S., Chen, J. & Atchison, R. (2008). Relationship of preventive health practices and health literacy: A national study. American Journal of Health Behavior, 32, 227–242. https://doi.org/10.5555/ajhb.2008.32.3.227 First citation in articleCrossrefGoogle Scholar

  • *Williams, M. V., Baker, D. W., Honig, E. G., Lee, T. M. & Nowlan, A. (1998). Inadequate literacy is a barrier to asthma knowledge and self-care. Chest, 114, 1008–1015. https://doi.org/10.1378/chest.114.4.1008 First citation in articleCrossrefGoogle Scholar

  • Williams, M. V., Baker, D. W., Parker, R. M. & Nurss, J. R. (1998). Relationship of functional health literacy to patients’ knowledge of their chronic disease. Archives of Internal Medicine, 158, 166–172. https://doi.org/10.1001/archinte.158.2.166 First citation in articleCrossrefGoogle Scholar

  • *Wolf, M. S., Davis, T. C., Osborn, C. Y., Skripkauskas, S., Bennett, C. L. & Makoul, G. (2007). Literacy, self-efficacy, and HIV medication adherence. Patient Education and Counseling, 65, 253–260. https://doi.org/10.1016/j.pec.2006.08.006 First citation in articleCrossrefGoogle Scholar

  • *Wolf, M. S., Gazmararian, J. A. & Baker, D. W. (2005). Health literacy and functional health status among older adults. Archives of Internal Medicine, 165, 1946–1952. https://doi.org/10.1001/archinte.165.17.1946 First citation in articleCrossrefGoogle Scholar

  • *Wolf, M. S., Gazmararian, J. A. & Baker, D. W. (2007). Health literacy and health risk behaviors among older adults. American Journal of Preventive Medicine, 32, 19–24. https://doi.org/10.1016/j.amepre.2006.08.024 First citation in articleCrossrefGoogle Scholar

  • World Health Organization. (1998). Health promotion. Geneva, Switzerland: World Health Organization. First citation in articleGoogle Scholar

  • *Xie, B. (2011). Effects of an eHealth literacy intervention for older adults. Journal of Medical Internet Research, 13, e90. https://doi.org/10.2196/jmir.1880 First citation in articleCrossrefGoogle Scholar

  • Yin, H. S., Dreyer, B. P., Foltin, G., van Schaick, L. & Mendelsohn, A. L. (2007). Association of low caregiver health literacy with reported use of nonstandardized dosing instruments and lack of knowledge of weight-based dosing. Ambulatory Pediatrics, 7, 292–298. https://doi.org/10.1016/j.ambp.2007.04.004 First citation in articleCrossrefGoogle Scholar

  • Yuen, E. Y. N., Knight, T., Ricciardelli, L. A. & Burney, S. (2016). Health literacy of caregivers of adult care recipients: A systematic scoping review. Health and Social Care in the Community, 26(2), e191–e206. https://doi.org/10.1111/hsc.12368 First citation in articleCrossrefGoogle Scholar

  • Zamora, H. & Clingerman, E. M. (2011). Health literacy among older adults: A systematic literature review. Journal of Gerontological Nursing, 37, 41–51. https://doi.org/10.1093/her/cys067 First citation in articleGoogle Scholar

  • *Zhang, X.-H., Li, S.-C., Fong, K.-Y. & Thumboo, J. (2009). The impact of health literacy on health-related quality of life (HRQoL) and utility assessment among patients with rheumatic diseases. Value in Health, 12(Suppl 3), S106–S109. https://doi.org/10.1111/j.1524-4733.2009.00640.x First citation in articleCrossrefGoogle Scholar

  • Zikmund-Fisher, B. J., Exe, N. L. & Witteman, H. O. (2014). Numeracy and literacy independently predict patients’ ability to identify out-of-range test results. Journal of Medical Internet Research, 16, e187. https://doi.org/10.2196/jmir.3241 First citation in articleCrossrefGoogle Scholar