Table 62Health outcome study results (KQ1): summary and comparison of 2004 and 2010 systematic reviews

OutcomeStudy designNumber of articles: 2004 (Number controlling for confounding)Number of articles: 2010 (Number controlling for confounding)Low Health Literacy Related Results: 2004Low Health Literacy Related Results: 2010Strength of Evidence: 2010
HospitalizationCohort2 (2)4 (3)IncreaseIncreaseModerate
Cross-sectional02 (2)
Emergency care visitsCohort04 (3)NA: no studiesIncreaseModerate
Cross-sectional03 (3)
Colon screeningCross-sectional05(5)NA: no studiesDecreaseInsufficient
Pap testsCross-sectional1(1)3(3)DecreaseDecreaseLow
STI (testing)Cross-sectional1(1)1(1)IncreaseIncreaseLow
Immunization: InfluenzaCohort01(1)DecreaseDecreaseModerate
Immunization: PneumococcalCohort01(1)DecreaseMixedInsufficient
Access to careCohort04(4)No differenceMixedInsufficient
Access to insuranceCross-sectional01(1)NA: no studiesDecreaseLow
KnowledgeCohort1 (0)NADecreaseNA: analysis not repeatedNot re-evaluated
Cross-sectional9 (7)
AdherenceCohort2 (0)6 (6)MixedMixedInsufficient
Cross-sectional2 (1)9 (9)
Self-efficacyCross-sectional05 (4)NA: no studiesMixedInsufficient
SmokingCross-sectional3 (1)2 (2)MixedMixedInsufficient
Alcohol and drug useCross-sectional1 (1)2 (2)No differenceMixedInsufficient
Healthy lifestyle (physical activity, eating habits, and seat belt use)Cross-sectional03 (3-for some outcomes)NA: no studiesMixedInsufficient
Obesity and weightCohort01 (0)NA: no studiesMixedInsufficient
Cross-sectional04 (1)
Review of prescription informationCross-sectional01 (1)NA: no studiesDecreaseLow
HIV risk and sexual behaviorCohort01 (1)NA: no studiesMixedInsufficient
Cross-sectional01 (1)
Taking medications appropriatelyCohort01 (1)NA: no studiesDecreaseModerate
Cross-sectional04 (4)
Interpreting labels and health messagesCross-sectional05 (4)NA: no studiesDecreaseModerate
Asthma self careCross-sectional1 (1)1 (1)DecreaseDecreaseLow
Mental health symptomatologyCohort1 (0)2 (1)DecreaseGreater in 8 studiesLow
Cross-sectional4 (2)8 (4)
Chronic diseaseCohort1 (1)2 (0)No differenceMixedInsufficient
Cross-sectional5 (3)
HIV severity and symptomsCohort1 (1)MixedNo difference in 4 studiesLow
Cross-sectional3 (0)4 (3)
Asthma severity and controlCross-sectional02 (1)NA: no studiesMixedInsufficient
Diabetes control and related symptomsCross-sectional3 (2)6 (5)MixedMixedInsufficient
Hypertension controlCross-sectional1 (1)2 (2)No differenceMixedInsufficient
Prostate cancer controlCross-sectional1 (1)1 (1)No differenceDecreaseLow
Health status: all adultsCross-sectional2 (2)1 (1)DecreaseNo differenceLow
Health status and QoL seniors: Mental & physical functioning: seniorsCohort01 (1)DecreaseDecreaseModerate
Cross-sectional1 (0)5 (4)
Cohort3 (2)NA: no studiesMixedInsufficient
Cross-sectional02 (2)
Health status and QoL: specific diseasesCross-sectional2 (0)5 (5)No differenceMixedInsufficient
Mortality: seniorsCohort03 (3)NA: no studiesGreaterHigh
CostsCohort1 (1)2(2)No differenceMixedInsufficient
DisparitiesCohort01 (1)HL mediates racial disparity in 1 studyHL partially mediates: racial disparities in some outcomes, no differences in Hispanic ethnicity, sex differences for 1 outcomeRace: Low
Hispanic ethnicity: Low
Sex: Low
Cross-sectional1 (1)5 (5)

HL=health literacy; NA=not applicable; QoL=quality of life; STI=sexually transmitted infection

From: Conclusions

Cover of Health Literacy Interventions and Outcomes: An Updated Systematic Review
Health Literacy Interventions and Outcomes: An Updated Systematic Review.
Evidence Reports/Technology Assessments, No. 199.
Berkman ND, Sheridan SL, Donahue KE, et al.

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