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Health literacy in type 2 diabetes patients: a systematic review of systematic reviews


Aim To summarize, critically review, and interpret the evidence related to the systematic reviews on health literacy (HL) amongst type 2 diabetes mellitus (T2DM). Methods The methodology for this study consisted of a systematic review of systematic reviews, using the PRISMA statement and flowchart to select studies, and searching on PubMed, CINAHL, Scopus, and Cochrane. The search covered the period between January 2006 and June 2016. Results From the 115 identified record by the queries, only six systematic reviews were included, following a quality evaluation using AMSTAR. The included systematic reviews content was analyzed by the independent work of two authors, using a narrative synthesis approach. The findings of this study (i.e., main themes) are areas of consensus and gaps in knowledge. Areas of consensus are HL definition, HL measurement tools, and the relationship between T2DM patient knowledge (or literacy) and his/her HL. The gaps in knowledge were the assessment of the relations between HL and health outcomes and self-efficacy, the gender differences, the effectiveness of interventions to improve HL, the cost-effectiveness study of interventions to improve HL, and the understanding of the influence of organizational environment on HL. Conclusion This review provides a current state of knowledge to address clinical practice and research proposals. HL could be useful to personalize patients' follow-up and it should be routinely assessed in its three dimensions (i.e. functional, interactive and critical) to enhance patients' ability to cope with clinical recommendations. Future research should be mainly aimed to test the effectiveness of evidence-based interventions to improve HL amongst T2DM patients.

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This study was funded by local research funds of the IRCCS Policlinico San Donato, a Clinical Research Hospital partially funded by the Italian Ministry of Health.

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Correspondence to Davide Ausili.

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Appendix 1. Queries used for the systematic review of systematic reviews search

Appendix 1. Queries used for the systematic review of systematic reviews search

Database Query Date of the search Number of papers
PubMed ((systematic review [ti] OR meta-analysis [pt] OR meta-analysis [ti] OR systematic literature review [ti] OR this systematic review [tw] OR pooling project [tw] OR (systematic review [tiab] AND review [pt]) OR meta synthesis [ti] OR meta synthesis [ti] OR integrative review [tw] OR integrative research review [tw] OR rapid review [tw] OR consensus development conference [pt] OR practice guideline [pt] OR drug class reviews [ti] OR cochrane database syst rev [ta] OR acp journal club [ta] OR health technol assess [ta] OR evid rep technol assess summ [ta] OR jbi database system rev implement rep [ta]) OR (clinical guideline [tw] AND management [tw]) OR ((evidence based[ti] OR evidence-based medicine [mh] OR best practice* [ti] OR evidence synthesis [tiab]) AND (review [pt] OR diseases category[mh] OR behavior and behavior mechanisms [mh] OR therapeutics [mh] OR evaluation studies[pt] OR validation studies[pt] OR guideline [pt] OR pmcbook)) OR ((systematic [tw] OR systematically [tw] OR critical [tiab] OR (study selection [tw]) OR (predetermined [tw] OR inclusion [tw] AND criteri* [tw]) OR exclusion criteri* [tw] OR main outcome measures [tw] OR standard of care [tw] OR standards of care [tw]) AND (survey [tiab] OR surveys [tiab] OR overview* [tw] OR review [tiab] OR reviews [tiab] OR search* [tw] OR handsearch [tw] OR analysis [ti] OR critique [tiab] OR appraisal [tw] OR (reduction [tw]AND (risk [mh] OR risk [tw]) AND (death OR recurrence))) AND (literature [tiab] OR articles [tiab] OR publications [tiab] OR publication [tiab] OR bibliography [tiab] OR bibliographies [tiab] OR published [tiab] OR pooled data [tw] OR unpublished [tw] OR citation [tw] OR citations [tw] OR database [tiab] OR internet [tiab] OR textbooks [tiab] OR references [tw] OR scales [tw] OR papers [tw] OR datasets [tw] OR trials [tiab] OR meta-analy* [tw] OR (clinical [tiab] AND studies [tiab]) OR treatment outcome [mh] OR treatment outcome [tw] OR pmcbook)) NOT (letter [pt] OR newspaper article [pt]))) AND ((((“diabetes mellitus”[MeSH Terms] OR (“diabetes”[All Fields] AND “mellitus”[All Fields]) OR “diabetes mellitus”[All Fields]))) AND ((health[ti] AND literacy[ti]) OR (“health literacy” OR “health literate” OR “medical literacy”) OR (functional[tw] AND health[tw] AND literacy[tw]) OR numeracy OR ((low literate[ti] OR low literacy[ti] OR literacy[ti] OR illiteracy[ti] OR literate[ti] OR illiterate[ti] OR reading[mh] OR comprehension[mh]) AND (health promotion[major] OR health education[major] OR patient education[major] OR Communication Barriers[major] OR communication[major:noexp] OR Health Knowledge, Attitudes, Practice[major] OR attitude to health[major])) OR (comprehension[major] AND educational status[major]) OR (family[ti] AND literacy[ti]) OR ((“drug labeling” OR Prescriptions [mh]) AND (“comprehension” OR “numeracy”)) OR ((cancer[ti] OR diabetes[ti]) AND (literacy[ti] OR comprehension[ti])) OR “adult literacy” OR “limited literacy” OR “patient understanding”[ti] OR (self care [major] AND perception[mh]) OR (comprehension AND food labeling[mh]) OR (comprehension AND informed consent) OR (comprehension AND insurance, health) AND English[la])) 08 June 2016 20
Cinahl (Health literacy) AND (diabetes)—Limiters—Publication Type: Review; Language: English—Search modes—Boolean/Phrase 8 June 2016 5
Scopus TITLE-ABS-KEY-AUTH ((health literacy) AND (diabetes)) AND DOCTYPE (re) AND PUBYEAR > 2005 AND PUBYEAR < 2017 AND (LIMIT-TO (LANGUAGE, “English”)) 8 June 2016 90
Cochrane (Health literacy) AND (diabetes)- Title, Abstract, Keywords—Publication Year from 2006 to 2016 8 June 2016 0

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Caruso, R., Magon, A., Baroni, I. et al. Health literacy in type 2 diabetes patients: a systematic review of systematic reviews. Acta Diabetol 55, 1–12 (2018).

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  • Health literacy
  • Type 2 diabetes mellitus
  • Diabetes mellitus
  • Systematic review
  • Diabetes knowledge
  • Health outcomes