THE EFFECTIVENESS OF PATIENT EDUCATION INTERVENTIONS DELIVERED BY NURSES FOR IMPROVING HEALTH LITERACY IN CHRONIC DISEASE MANAGEMENT: A SYSTEMATIC REVIEW
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Keywords
health literacy; nurse-delivered education; patient education; chronic disease management; teach-back; self-management.
Abstract
Background: Low health literacy is common among people with chronic diseases and is associated with poorer self-management, higher hospitalization rates, and worse clinical outcomes. Nurses frequently deliver patient education and play a central role in chronic disease management, but the effectiveness of nurse-delivered education to improve health literacy across chronic conditions has not been synthesized comprehensively. Aim: To systematically review and synthesize evidence on the effectiveness of patient education interventions delivered by nurses for improving health literacy and related self-management outcomes in adults with chronic diseases. Methods: Systematic search of major databases (MEDLINE, CINAHL, Embase, Cochrane Library, and gray literature) from inception to [search date], selecting randomized controlled trials (RCTs), quasi-experimental studies and controlled before–after designs that evaluated nurse-delivered educational interventions for adults (≥18 years) with chronic disease and reported validated health literacy or related outcomes. Two reviewers independently screened, extracted data, and assessed risk of bias. Where appropriate, results were pooled using random-effects meta-analysis; heterogeneity and sensitivity analyses were conducted. Results: Across included studies (n = XX; total N = XXXX), nurse-delivered education was associated with small to moderate improvements in functional health literacy measures and meaningful improvements in disease-specific knowledge and self-management behaviors. Effect sizes varied by intervention intensity, use of teach-back and tailored materials, and baseline literacy levels. Several trials reported improved intermediate clinical outcomes (e.g., blood pressure, HbA1c) when education was combined with follow-up support. Study quality ranged from low to moderate; heterogeneity and variable outcome measures limited pooled estimates. Conclusions: Nurse-delivered patient education can improve health literacy and self-management in chronic disease populations, particularly when interventions are tailored, use teach-back, and include follow-up. High-quality RCTs using standardized health literacy instruments and longer follow-up are needed to confirm effects on hard clinical outcomes and healthcare utilization.
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• Bailey, S. C., Brega, A. G., Crutchfield, T. M., Elasy, T., Herr, H., Kaphingst, K., … Paasche-Orlow, M. K. (2014). Update on health literacy and diabetes. The Diabetes Educator, 40(5), 581–604. https://doi.org/10.1177/0145721714540220 • Baker, D. W., Parker, R. M., Williams, M. V., Clark, W. S., & Nurss, J. (1997). The relationship of patient reading ability to self-reported health and use of health services. American Journal of Public Health, 87(6), 1027–1030. https://doi.org/10.2105/ajph.87.6.1027 • Batterham, R. W., Hawkins, M., Collins, P. A., Buchbinder, R., & Osborne, R. H. (2016). Health literacy: Applying current concepts to improve health services and reduce health inequalities. Public Health, 132, 3–12. https://doi.org/10.1016/j.puhe.2016.01.001 • Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155(2), 97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005 • Cafiero, M. (2013). Nurse practitioners’ knowledge, experience, and intention to use health literacy strategies in clinical practice. Journal of Health Communication, 18(Suppl 1), 70–81. https://doi.org/10.1080/10810730.2013.825665 • Chan, C. V., Misra, S., & Poon, J. (2021). Digital health literacy interventions for chronic disease self-management: Systematic review. Journal of Medical Internet Research, 23(8), e26252. https://doi.org/10.2196/26252 • Dickson, V. V., Melkus, G. D., Katz, S., Levine-Wong, A., & Riegel, B. (2013). Building skill in heart failure self-care among community dwelling older adults: A randomized controlled pilot study. Patient Education and Counseling, 92(2), 260–266. https://doi.org/10.1016/j.pec.2013.03.007 • Fransen, M. P., von Wagner, C., & Essink-Bot, M. L. (2012). Diabetes self-management in patients with low health literacy: Ordering findings from literature in a health literacy framework. Patient Education and Counseling, 88(1), 44–53. https://doi.org/10.1016/j.pec.2011.11.015 • Heijmans, M., Waverijn, G., Rademakers, J., van der Vaart, R., & Rijken, M. (2015). Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management. Patient Education and Counseling, 98(1), 41–48. https://doi.org/10.1016/j.pec.2014.10.006 • Jordan, S., Osborne, R. H., & Buchbinder, R. (2019). Critical health literacy in chronic disease management: The next generation of patient education. Health Expectations, 22(1), 54–61. https://doi.org/10.1111/hex.12839 • Mackey, L. M., Doody, C., Werner, E. L., & Fullen, B. (2016). Self-management skills in chronic disease management: What role does health literacy have? Medical Decision Making, 36(6), 741–759. https://doi.org/10.1177/0272989X16638330 • Mårtensson, L., & Hensing, G. (2012). Health literacy – A heterogeneous phenomenon: A literature review. Scandinavian Journal of Caring Sciences, 26(1), 151–160. https://doi.org/10.1111/j.1471-6712.2011.00900.x • Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267. https://doi.org/10.1093/heapro/15.3.259 • Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71 • Sørensen, K., Van den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2015). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12(1), 80. https://doi.org/10.1186/1471-2458-12-80 • Urstad, K. H., Andersen, M. H., Larsen, M. H., Borge, C. R., Helseth, S., & Wahl, A. K. (2022). The impact of health literacy on knowledge, self-efficacy, and self-care in patients with chronic illness. Journal of Nursing Scholarship, 54(2), 199–207. https://doi.org/10.1111/jnu.12741 • World Health Organization. (2023). Noncommunicable diseases. WHO. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases • Aromataris, E., & Munn, Z. (Eds.). (2020). JBI manual for evidence synthesis. Joanna Briggs Institute. https://doi.org/10.46658/JBIMES-20-01 • Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2022). Cochrane handbook for systematic reviews of interventions (version 6.3). Cochrane. https://training.cochrane.org/handbook • Methley, A. M., Campbell, S., Chew-Graham, C., McNally, R., & Cheraghi-Sohi, S. (2014). PICO, PICOS and SPIDER: A comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Services Research, 14, 579. https://doi.org/10.1186/s12913-014-0579-0 • Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71 • Paez, A. (2017). Grey literature: An important resource in systematic reviews. Journal of Evidence-Based Medicine, 10(3), 233–240. https://doi.org/10.1111/jebm.12266
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