The research topics included in health literacy review covers, in order of prevalence, preventive cancer screenings, chronic disease, healthy living (including exercise, diet, and risk reduction), health management, and accessing health care services. The preventive cancer screenings included breast cancer and colorectal cancer. Most of preventive literature examined the comparison of trained providers, either a patient navigator (typically a nurse or social worker) or a clinician and sort of written material, such as a letter or a brochure. The other preventive literature focused on targeting specific ethnic groups (African American women and Hmong men and women) and comparing different modes and level of tailoring, for example, comparing video, print, interactive computer, and group learning sessions. These interventions had several limitations, the most common being small sample-sizes which decreased the precision of the study. Similar to financial literacy, self-selection into some of the studies posed a bias: self-selected participants may be more interested in self-care and health management and could be different from the general population. Other limitations included patient attrition from the study; differences between treatment and control group potentially confounding the findings; and a lack of control groups.
Health literacy has also been examined in the context of improving chronic conditions such as diabetes, heart failure, asthma, and hypertension. The modes of delivery for these studies were one-on-one education or counseling and group sessions. Where there was a control group, the control group typically received a pamphlet. These studies also had their own limitations, again the most common being small sample size. Lack of a random controlled design also limited findings for a few studies. Not all studies examined clinical outcomes which would have been valuable to ascertain the achievement of the initiative. Finally, two studies relied on self-selection into the study and self-report of behavior, increasing the likelihood of positive results.
Five health literacy studies examined health management, including patient-specific health improvement/risk reduction activities (e.g., fall prevention and medication management), diets, and general health improvement/risk reduction activities (e.g., smoking cessation, diet improvement, exercise), and drug allergy awareness. All but one of these studies, the drug allergy awareness study, examined a health educator and individual interaction, including counseling, phone support, and classes. The drug allergy awareness used a form only. The most common limitations to these studies included conducting the studies at a single health site decreasing generalizability; a lack of control group for comparison; self-selection into the study; and self-reporting behavior. Other limitations include participant attrition and poor recall for self-reported behaviors.
Similar to the financial literacy research, most of the studies focused on interventions involved interactions between a health educator and a patient. Of the health educator-patient interaction studies, less than half involved a clinical provider such as a physician, nurse, or social worker. The others used a trained educator, but it was unclear whether these educators had degrees related to the activity; in one case, it appeared they were trained graduate students. Several of the studies also examined the use of materials, whether as a usual source of information as part of the control group, or as a key source of providing or collecting information, such as collecting data on allergies. In only one case were alternate methods examined, such as the use of a video, interactive computer, and a pamphlet.
Unlike the financial literacy, there were no articles studying the same intervention, although in at least one case, such as Montz & Seshamanis article on WISEWOMAN, there are several publications on the program, but all were published prior to 2005.
Appendix C presents details of the studies and results in financial literacy and health literacy.