Which providers can bridge the health literacy gap in lifestyle risk factor modification education: a systematic review and narrative synthesis

Sarah Dennis, Anna Williams, Jane Taggart, Anthony Newall, Elizabeth Denney-Wilson, Nicholas Zwar, Tim Shortus, Mark F Harris, Sarah Dennis, Anna Williams, Jane Taggart, Anthony Newall, Elizabeth Denney-Wilson, Nicholas Zwar, Tim Shortus, Mark F Harris

Abstract

Background: People with low health literacy may not have the capacity to self-manage their health and prevent the development of chronic disease through lifestyle risk factor modification. The aim of this narrative synthesis is to determine the effectiveness of primary healthcare providers in developing health literacy of patients to make SNAPW (smoking, nutrition, alcohol, physical activity and weight) lifestyle changes.

Methods: Studies were identified by searching Medline, Embase, Cochrane Library, CINAHL, Joanna Briggs Institute, Psychinfo, Web of Science, Scopus, APAIS, Australian Medical Index, Community of Science and Google Scholar from 1 January 1985 to 30 April 2009. Health literacy and related concepts are poorly indexed in the databases so a list of text words were developed and tested for use. Hand searches were also conducted of four key journals. Studies published in English and included males and females aged 18 years and over with at least one SNAPW risk factor for the development of a chronic disease. The interventions had to be implemented within primary health care, with an aim to influence the health literacy of patients to make SNAPW lifestyle changes. The studies had to report an outcome measure associated with health literacy (knowledge, skills, attitudes, self efficacy, stages of change, motivation and patient activation) and SNAPW risk factor.The definition of health literacy in terms of functional, communicative and critical health literacy provided the guiding framework for the review.

Results: 52 papers were included that described interventions to address health literacy and lifestyle risk factor modification provided by different health professionals. Most of the studies (71%, 37/52) demonstrated an improvement in health literacy, in particular interventions of a moderate to high intensity.Non medical health care providers were effective in improving health literacy. However this was confounded by intensity of intervention. Provider barriers impacted on their relationship with patients.

Conclusion: Capacity to provide interventions of sufficient intensity is an important condition for effective health literacy support for lifestyle change. This has implications for workforce development and the organisation of primary health care.

Figures

Figure 1
Figure 1
Review flow chart.

References

    1. Commonwealth of Australia. Building a 21st Century Primary Health Care System Australia’s First National Primary Health Care Strategy. Commonwealth of Australia, Canberra; 2010.
    1. World Health Organization. Preventing Chronic Disease: a Vital Investment. WHO Press; 2007.
    1. Australian Institute of Health and Welfare. The Burden of Disease and Injury in Australia. 2000.
    1. Joint WHO/FAO Expert Consultation on Diet NatPo Diseases C. Diet, Nutrition and The Prevention of Chronic Diseases: Report of a Joint Who/Fao Expert Consultation. , Geneva, Switzerland; 2002.
    1. Nutbeam D, Kickbusch I. Advancing health literacy: a global challenge for the 21st century. Heal Promot Int. 2000;15(3):183–184. doi: 10.1093/heapro/15.3.183.
    1. Australian Bureau of Statistics. Health Literacy, Australia. Australian Bureau of Statistics, Canberra; 2006.
    1. Australian Bureau of Statistics. Adult Literacy and Life Skills Survey: User Guide. Australian Bureau of Statistics, Canberra; 2006.
    1. Adams RJ AS, Hill CL, Dodd M, Finlay C, Wilson DH. Risks associoated with low functional health literacy in an Australian Population. Med J Aus. 2009;191:530–534.
    1. Neilsen-Bohlman L, Panzer A, Kindig D, editor. Institute of Medicine: Health Literacy. A Prescription to End Confusion. National Academies Press, Washington, DC; 2004.
    1. Williams J, Clemens S, Oleinikova K, Tarvin K. The Skills for Life Survey. A National Needs and Impact Survey of Literacy, Numeracy and ICT Skills. Department for Education and Skills, London; 2003.
    1. Sheida White. Assessing the Nation’s Health Literacy. Key Concepts and Findings of the National Assessment of Adult Literacy (NAAL) American Medical Association Foundation, ; 2008.
    1. Nutbeam D. Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Heal Promot Int. 2000;15(3):259–267. doi: 10.1093/heapro/15.3.259.
    1. DeWalt DA, Berkman ND, Sheridan S, Lohr KN, Pignone MP. Literacy and health outcomes a systematic review of the literature. J Gen Intern Med. 2004;19:1228–1239. doi: 10.1111/j.1525-1497.2004.40153.x.
    1. Berkman ND, DA D, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Evidence Report/Technology Assessment. Agency for Healthcare Research and Quality, Rockville; 2004. Literacy and Health Outcomes.
    1. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients’ knowledge of their chronic disease. a study of patients with hypertension and diabetes. Arch Intern Med. 1998;158:166–172. doi: 10.1001/archinte.158.2.166.
    1. Schillinger D, Bindman A, Wang F, Stewart A, Piette J. Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Edu Counseling. 2004;52(3):315–323. doi: 10.1016/S0738-3991(03)00107-1.
    1. National Preventative Health Taskforce. Australia: The Healthiest Country by 2020 - National Preventative Health Strategy - the roadmap for action. Australian Government Department of Health and Ageing, Canberra; 2009.
    1. Britt H, Miller G, Charles J, General Practice Activity in Australia 2008–09. AIHW, Canberra; 2009.
    1. Slama K, Karsenty S, Hirsch A. French general practitioners’ attitudes and reported practices in relation to their participation and effectiveness in a minimal smoking cessation programme for patients. Addiction. 1999;94(1):125–132. doi: 10.1046/j.1360-0443.1999.9411259.x.
    1. Bodenheimer T. Helping patients improve their health-related behaviors: what system changes do we need? Dis Manag. 2005;8(5):319–330. doi: 10.1089/dis.2005.8.319.
    1. Calnan M. Examining the general practitioner’s role in health education: A critical review. Fam Pract. 1988;5(3):217–223. doi: 10.1093/fampra/5.3.217.
    1. Crebolder HFJM, Van Der Horst FG. Anticipatory care and the role of Dutch general practice in health promotion - A critical reflection. Patient Edu Counseling. 1996;28(1):51–55. doi: 10.1016/0738-3991(96)00869-5.
    1. Dennis S, May J, Perkins D, Zwar N, Sibbald B, Hasan I. What evidence is there to support skill mix changes between GPs, pharmacists and practice nurses in the care of elderly people living in the community? Aust New Zealand Health Policy. 2009;6(1):23. doi: 10.1186/1743-8462-6-23.
    1. Zwar N, Dennis S, Griffiths R, Perkins D, May J, Sibbald B, Caplan G, Harris M. APHCRI Stream 6 Reports. Australian Primary Health Care Research Institute (APHCRI), Canberra; 2007. Optimising skill mix in the primary health care workforce for the care of older Australians: A systematic review.
    1. Institute for Healthcare Improvement. 90-day research and development process
    1. Prochaska JOD, Carlo C. Theoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Res & Pract. 1982;19(3):276–288.
    1. Effective Public Health Practice Project. Quality Assessment Tool For Quantitative Studies. Retrieved October 2008 from above web address. Corresponding article of interest: Thomas, B.H., Ciliska, D., Dobbins, M., & Micucci, S. (2004). A process for systematically reviewing the literature: Providing the research evidence for public health nursing interventions. Worldviews on Evidence-Based Nursing. 1998;1(3):176–184.
    1. Dennis S, Zwar N, Griffiths R, Roland M, Hasan I, Powell DG, Harris M. Chronic disease management in primary care: from evidence to policy. Med JAust. 2008;188(8 Suppl):S53–S56.
    1. Weingarten SR, Henning JM, Badamgarav E, Knight K, Hasselblad V, Gano A, Ofman JJ. Interventions used in disease management programmes for patients with chronic illness---which ones work? Meta-analysis of published reports. BMJ. 2002;325(7370):925. doi: 10.1136/bmj.325.7370.925.
    1. Harris M, Taggart J, Williams A, Dennis S, Newall AT, Shortus T, Denney-Wilson E, Zwar N. APHCRI Stream 13 reports. Australian Primary Health Care Institute, Canberra; 2010. Effective determinants for supporting lifestyle health literacy and self management skills in primary health care.
    1. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339(jul21_1):b2700.
    1. Goldstein MG, Pinto BM, Marcus BH, Lynn H, Jette AM, Rakowski W, McDermott S, DePue JD, Milan FB, Dube C. et al.Physician-based physical activity counseling for middle-aged and older adults: a randomized trial. Ann Behavioral Med. 1999;21(1):40–47. doi: 10.1007/BF02895032.
    1. Norris SL, Grothaus LC, Buchner DM, Pratt M. Effectiveness of physician-based assessment and counseling for exercise in a staff model HMO. Preventive Med. 2000;30(6):513–523. doi: 10.1006/pmed.2000.0673.
    1. Beresford SASJC, Kristal AR, Lazovich D, Feng Z, Wagner EH. A dietary intervention in primary care practice: the Eating Patterns Study. Am J Public Health. 1997;87(4):610–616. doi: 10.2105/AJPH.87.4.610.
    1. Calfas K, Sallis J, Oldenburg B. et al.Mediators of change in physical activity following an intervention in primary care: PACE. Prev Med. 1997;26:297–304. doi: 10.1006/pmed.1997.0141.
    1. Adolfsson ET, Walker-Engström ML, Smide B, Wikblad K. Patient education in type 2 diabetes-A randomized controlled 1-year follow-up study. Diabetes ResClin Practice. 2007;76(3):341–350. doi: 10.1016/j.diabres.2006.09.018.
    1. Aldana SG, Greenlaw RL, Diehl HA, Salberg A, Merrill RM, Ohmine S, Thomas C. Effects of an intensive diet and physical activity modification program on the health risks of adults. J Am Diet Assoc. 2005. pp. 371–381.
    1. Brassington GS, Atienza AA, Perczek RE, DiLorenzo TM, King AC. Intervention-related cognitive versus social mediators of exercise adherence in the elderly. Am J Preventive Med. 2002;23(2 Suppl):80–86.
    1. Dunn AL, Marcus BH, Kampert JB, Garcia ME, Kohl HW, Blair SN. Reduction in cardiovascular disease risk factors: 6-month results from Project Active. Preventive Med. 1997. pp. 883–892.
    1. Efraimsson EÃ, Hillervik C, Ehrenberg A. Effects of COPD self-care management education at a nurse-led primary health care clinic. Scand J Caring Sci. 2008;22(2):178–185. doi: 10.1111/j.1471-6712.2007.00510.x.
    1. Ridgeway NA, Harvill DR, Harvill LM, Falin TM, Forester GM, Gose OD. Improved control of type 2 diabetes mellitus: A practical education/behavior modification program in a primary care clinic. Southern Medl J. 1999;92(7):667–672. doi: 10.1097/00007611-199907000-00004.
    1. Sadur CN, Moline N, Costa M, Michalik D, Mendlowitz D, Roller S, Watson R, Swain BE, Selby JV, Javorski WC. Diabetes management in a health maintenance organization. Efficacy of care management using cluster visits. Diabetes Care. 1999;22(12):2011–2017. doi: 10.2337/diacare.22.12.2011.
    1. Van Sluijs EMF, Van Poppel MNM, Twisk JWR, Van Mechelen W. Physical activity measurements affected participants’ behavior in a randomized controlled trial. J Clin Epidemiol. 2006;59(4):404–411. doi: 10.1016/j.jclinepi.2005.08.016.
    1. Boylan MJ, Renier CM, Knuths JS, Haller IV. Preventing cardiovascular disease in women: an intervention-control randomized study. Minnesota Med. 2003;86(5):52–56.
    1. Miller CK, Edwards L, Kissling G, Sanville L. Evaluation of a theory-based nutrition intervention for older adults with diabetes mellitus. J Am Diet Assoc. 2002;102(8):1069–1081.
    1. Toobert DJ, Glasgow RE, Strycker LA, Barrera M, Ritzwoller DP, Weidner G. Long-term effects of the Mediterranean lifestyle program: a randomized clinical trial for postmenopausal women with type 2 diabetes (Provisional abstract) Int J Behav Nutr Phys Act. 2007.
    1. Collins R, Lee RE, Albright CL, King AC. Ready to be physically active? the effects of a course preparing low-income multiethnic women to be more physically active. Health Educ Behav. 2004;31(1):47–64. doi: 10.1177/1090198103255529.
    1. Winkleby MA, Howard-Pitney B, Albright CA, Bruce B, Kraemer HC, Fortmann SP. Predicting achievement of a low-fat diet: a nutrition intervention for adults with low literacy skills. Preventive Med. 1997;26(6):874–882. doi: 10.1006/pmed.1997.0231.
    1. Agurs-Collins T, Kumanyika S, Ten Have T, Adams-Campbell L. A randomised controlled trial of weight reduction and exercise for diabetes management in older African-American subjects. Diabetes Care. 1997;20(10):1503–1511. doi: 10.2337/diacare.20.10.1503.
    1. Delichatsios H, Hunt M, Lobb R. et al.EatSmart: efficacy of a multifaceted preventive nutrition intervention in clinical practice. Prev Med. 2001;33:91–98.
    1. Lancaster T, Dobbie W, Vos K, al e. Randomized trial of nurse-assisted strategies for smoking cessation in primary care. Br J Gen Pract. 1999;49:191–194.
    1. Siero F, Broer J, Bemelmans WJ, Meyboom-de Jong BM. Impact of group nutrition education and surplus value of Prochaska-based stage-matched information on health-related cognitions and on Mediterranean nutrition behavior. Health Educ Res. 2000;15:635–647. doi: 10.1093/her/15.5.635.
    1. de Vries H, Kremers SP, Smeets T, Brug J, Eijmael K. The effectiveness of tailored feedback and action plans in an intervention addressing multiple health behaviors. Am J Health Promotion : AJHP. 2008. pp. 417–425.
    1. Hartman TJ, McCarthy PR, Park RJ, Schuster E, Kushi LH. Results of a community-based low-literacy nutrition education program. J Community Health. 1997;22(5):325–341. doi: 10.1023/A:1025123519974.
    1. Kloek GC, van Lenthe FJ, van Nierop PWM, Koelen MA, Mackenbach JP. Impact evaluation of a Dutch community intervention to improve health-related behaviour in deprived neighbourhoods. Health and Place. 2006;12(4):665–677. doi: 10.1016/j.healthplace.2005.09.002.
    1. Lorig KR, Ritter PL, Jacquez A. Outcomes of border health Spanish/English Chronic Disease Self-management Programs. Diabetes Educator. 2005;31(3):401–409. doi: 10.1177/0145721705276574.
    1. Nies MA, Artinian NT, Schim SM, Vander Wal JS, Sherrick-Escamilla S. Effects of lay health educator interventions on activity, diet, and health risks in an urban Mexican American community. J Prim Prev. 2004;25(4):441–455.
    1. Yajima S, Takano T, Nakamura K, Watanabe M. Effectiveness of a community leaders' programme to promote healthy lifestyles in Tokyo, Japan. Heal Promot Int. 2001;16(3):235–243. doi: 10.1093/heapro/16.3.235.
    1. Jimmy G, Martin BW. Implementation and effectiveness of a primary care based physical activity counselling scheme. Patient Edu Counseling. 2005;56(3):323–331. doi: 10.1016/j.pec.2004.03.006.
    1. Kreuter MW, Strecher VJ. Do tailored behavior change messages enhance the effectiveness of health risk appraisal? Results from a randomized trial. Heal Educ Res. 1996;11(1):97–105. doi: 10.1093/her/11.1.97.
    1. Oenema A, Brug J, Dijkstra A, de Weerdt I, de Vries H. Efficacy and use of an internet-delivered computer-tailored lifestyle intervention, targeting saturated fat intake, physical activity and smoking cessation: a randomized controlled trial. Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine. 2008. pp. 125–135.
    1. Ogden J, Hoppe R. The relative effectiveness of two styles of educational package to change practice nurses' management of obesity. Int J Obes. 1997;21(11):963–971. doi: 10.1038/sj.ijo.0800503.
    1. Simmons D, Voyle JA, Fout F, Feot S, Leakehe L. Tale of two churches: Differential impact of a church-based diabetes control programme among Pacific Islands people in New Zealand. Diabet Med. 2004;21(2):122–128. doi: 10.1111/j.1464-5491.2004.01020.x.
    1. Smith C, Ryan A. Change for Life/Cambia tu vida: a health promotion program based on the stages of change model for African descendent and Latino adults in New Hampshire. Preventing Chronic Disease. 2006;3(3):1–11.
    1. Steptoe A, Rink E, Kerry S. Psychosocial predictors of changes in physical activity in overweight sedentary adults following counseling in primary care. Preventive Med. 2000;31(2 I):183–194.
    1. Hoffman AM, Redding CA, Goldberg D, Añel D, Prochaska JO, Meyer PM, Pandey D. Computer expert systems for African-American smokers in physicians offices: A feasibility study. Preventive Med. 2006;43(3):204–211. doi: 10.1016/j.ypmed.2006.03.025.
    1. Wolf RL, Lepore SJ, Vandergrift JL, Basch CE, Yaroch AL. Tailored telephone education to promote awareness and adoption of fruit and vegetable recommendations among urban and mostly immigrant black men: A randomized controlled trial. Preventive Med. 2009;48(1):32–38. doi: 10.1016/j.ypmed.2008.10.015.
    1. Swerissen H, Belfrage J, Weeks A, Jordan L, Walker C, Furler J, McAvoy B, Carter M, Peterson C. A randomised control trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds. Patient Edu Counseling. 2006;64(1–3):360–368.
    1. Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF, Sandler RS. Improving dietary behavior: the effectiveness of tailored messages in primary care settings. Am J Public Health. 1994;84(5):783–787. doi: 10.2105/AJPH.84.5.783.
    1. Block G, Wakimoto P, Mandel R, Metz D, Fujii ML, Feldman N, Sutherland B. A randomized trial of the little by little cd-rom: demonstrated effectiveness in increasing fruit and vegetable intake in a low-income population. Preventing Chronic Disease. 2004;1(3):1–12.
    1. Koffman DMBT, Mosca L, Redberg R, Schmid T, Wattigney WA. An evaluation of Choose to Move 1999: an American Heart Association physical activity program for women. Arch Intern Med. 2001;161(18):2193–2199. doi: 10.1001/archinte.161.18.2193.
    1. Marcus BHBB, Pinto BM, Roberts LH, Forsyth MB, Traficante RM. Efficacy of an individualized, motivationally-tailored physical activity intervention. Ann Behav Med. 1998;20(3):174–180. doi: 10.1007/BF02884958.
    1. Prochaska JO, Velicer WF, Redding C, Rossi JS, Goldstein M, DePue J, Greene GW, Rossi SR, Sun X, Fava JL. et al.Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms. Preventive Med. 2005;41(2):406–416. doi: 10.1016/j.ypmed.2004.09.050.
    1. Prochaska JO, Velicer WF, Rossi JS, Redding CA, Greene GW, Rossi SR, Sun X, Fava JL, Laforge R, Plummer BA. Multiple risk expert systems interventions: impact of simultaneous stage-matched expert system interventions for smoking, high-fat diet, and sun exposure in a population of parents. Heal Psychol. 2004;23(5):503–516.
    1. Marcus BHEKM, Simkin-Silverman LR, Linnan LA, Taylor ER, Bock BC, Roberts MB, Rossi JS, Abrams DB. Evaluation of motivationally tailored vs. standard self-help physical activity interventions at the workplace. Am J Heal Promot. 1998;12(4):246–253. doi: 10.4278/0890-1171-12.4.246.
    1. Graham-Clarke P, Oldenburg B. The effectiveness of a general-practice-based physical activity intervention on patient physical activity status. Behav Chang. 1994;11(3):132–144.
    1. O'Loughlin J, Paradis G, Meshefedjian G, Kishchuk N. Evaluation of an 8-Week mailed healthy-weight intervention. Preventive Med. 1998;27(2):288–295. doi: 10.1006/pmed.1998.0265.
    1. Butler C, Rollnick S, Cohen D. et al.Motivational consulting versus brief advice for smokers in general practice: a randomized trial. Br J Gen Pract. 1999;49:611–616.
    1. Fries E, Edinboro P, McClish D, Manion L, Bowen D, Beresford S, Ripley J. Randomized trial of a low-intensity dietary intervention in rural residents: the Rural Physician Cancer Prevention Project. Am J Prev Med. 2005;28:162–168. doi: 10.1016/j.amepre.2004.10.017.
    1. Little P, Dorward M, Gralton S, Hammerton L, Pillinger J, White P. et al.A randomised controlled trial of three pragmatic approaches to initiate increased physical activity in sedentary patients with risk factors for cardiovascular disease. Br J Gen Pract. 2004;54(500):189–195.
    1. Naylor P, Simmonds G, Riddoch C. et al.Comparison of stage-matched and unmatched interventions to promote exercise behaviour in the primary care setting. Health Educ Res. 1999;14:653–666. doi: 10.1093/her/14.5.653.
    1. Slama K, Redman S, Perkins J, al E. The effectiveness of two smoking cessation programmes for use in general practice: a randomised controlled trial. BMJ. 1999;300:1707–1709.
    1. Lennox AS, Osman LM, Reiter E, Robertson R, Friend J, McCann I, Skatun D, Donnan PT. Cost effectiveness of computer tailored and non-tailored smoking cessation letters in general practice: randomised controlled. BMJ. 2001;322(7299):1396. doi: 10.1136/bmj.322.7299.1396.
    1. Légaré F, Ratté S, Gravel K, G ID. Barriers and facilitators to implementing shared decision-making in clinical practice: Update of a systematic review of health professionals perceptions. Patient Edu Counseling. 2008;73(3):526–535. doi: 10.1016/j.pec.2008.07.018.
    1. Amoroso C, Harris M, Ampt M, Laws R, McKenzie S, Williams A, Jayasinghe U, Zwar N, Powell Davies G. Health check for 45–49 year old patients in general practice: feasibility and impact on practices and patient behaviour. Aust Family Physician. 2009;38:358–362.
    1. Harris M, Hobbs C, Powell Davies G. et al.Implementation of a SNAP intervention in two divisions of general practice: a feasibility study. Med J Aust. 2005;183:s54–s58.
    1. Miller David P, Brownlee Caroline D, McCoy Thomas P, Pignone MP. The effect of health literacy on knowledge and receipt of colorectal cancer screening: a survey study. BMC Fam Pract. 2007;8:16. doi: 10.1186/1471-2296-8-16.
    1. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.
    1. Bowler I, Gooding S. Health promotion in primary health care: The situation in England. Patient Edu Counseling. 1995;25(3):293–299. doi: 10.1016/0738-3991(95)00803-8.
    1. Rootman I, Gordon-El-Bihbety D. A Vision for a Health Literate Canada Report of the Expert Panel on Health Literacy. Canadian Public Health Association, Ottawa; 2008.
    1. Parker RM, Ratzan SC, Lurie N. Health literacy: a policy challenge for advancing high-quality health care. Health Aff. 2003;22(4):147–153. doi: 10.1377/hlthaff.22.4.147.

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