Health literacy and health outcomes in hypertension: An integrative review.
Shaoying Du, Yi Zhou, Cong Fu and 3 others
PMID 31406840WHAT IT FOUND
Low health literacy in adults with hypertension was consistently linked to poorer knowledge of the condition.
Blood pressure control and medication adherence findings were inconsistent, so health literacy alone is not a reliable marker of these outcomes.
Key findings
01Lower health literacy was associated with poorer hypertension knowledge across the included studies.
02Blood pressure control findings were inconsistent, with studies linking low literacy to uncontrolled blood pressure, a study linking higher literacy to less controlled blood pressure, and a study finding no association.
03Higher health literacy was associated with better ability to name antihypertensive medications.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
All included studies were cross-sectional, so they cannot show that health literacy caused poor outcomes. The studies used different health literacy tools and different cut-offs, which makes results hard to compare. Most tools measured reading and numeracy skills, not interactive or critical communication skills. Some studies included patients with other conditions, such as diabetes, so blood pressure targets may not have been the same. Few studies examined self-efficacy, patient trust, or shared decision making. Adjusting for too many factors may have hidden the pathway from health literacy to outcomes. Most studies were from developed countries, so findings may not apply everywhere.
Declared interests
The work was supported by the Health and Family Planning Commission of Hebei in China. The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that improving health literacy will improve blood pressure control. The review included only cross-sectional studies, and the blood pressure control findings were inconsistent.