The Effect of Health Literacy Interventions on Self-management in Chronic Diseases: A Systematic Review

Abstract

BACKGROUND: Patients need cognitive and social skills in order to be able to make informed healthcare decisions. Health literacy (HL) encompasses these skills, enabling individuals to manage their conditions and adapt to challenges. HL interventions in patients could be a powerful way of optimizing self-management (SM) in individuals with chronic diseases. PURPOSE: To examine the efficacy of HL interventions on the medical, emotional, and role management domains of SM, theoretical foundations, conceptualizations of HL and SM, and intervention components. METHODS: Health literacy interventions aimed at increasing SM in adults (≥18 years) with chronic diseases were considered. A database search was conducted in PubMed, Scopus, SciELO (Scientific Electronic Library Online), and Web of Science from 2014 to 2024. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Risk of bias was assessed using the Joanna Briggs Institute Checklist. RESULTS: Fourteen studies were included. Interventions improved 3 components of medical management: medication adherence, disease knowledge, and self-efficacy. However, the effects on adherence to diet and exercise regimens, also part of medical management, were inconclusive. Emotional and role management received limited attention. There was inconsistency between HL definitions and instruments. Most interventions were delivered through in-person sessions. Overall, studies showed moderate risk of bias, which may have influenced the results. CONCLUSIONS: Theory-based interventions, methodological consistency, and comprehensive HL and SM measures are needed to understand interventions' effectiveness. To support behavioral change, HL interventions must address emotional and role management. Future high-quality research is required to determine optimal strategies for strengthening SM through HL interventions.