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Table 4 Effective interventions for health literacy

From: A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors

Effective interventions

Participants

Setting

Quality^

RCT

SNAPW#

GROUP EDUCATION

4 to 5 group empowerment sessions over 7 months [22]

Patients with diabetes from 7 primary care centres

Community health

H

RCT

 

*40 hour group education session over 4 weeks with participants following preset dietary goals [23]

Mostly white American

Other (Centre of Excellence)

H

RCT

N, P, W

Church-based program tailored and culturally relevant that included awareness raising activities and exercise and cooking classes over 2 years [24]

Samoan and Tongan

Community

H

 

W

*Language specific self management program of 2.5 hour weekly sessions for 6 weeks with audiocassette and booklet [25]

Greek, Vietnamese, Chinese and Italian

Community

M

RCT

P

Culturally sensitive curriculum in small and large groups and support over 10 months [26]

Mexican American/Latina women of low socio-economic, low education

Community

M

 

P

2.5 day program then weekly group education over 6 months and small group support [27]

Mostly Caucasian

Primary Care clinic

M

RCT

N, P

*Chronic disease self management group program of 15 hours over 6 weeks [28]

Mostly Mexican born, low socio-economic, low education

Community

M

 

N, P

*Small groups that met for an hour one night a week for 16 weeks and then every second week for a further 8 weeks [29]

Mean age 46 yrs

Community

M

RCT

P

Monthly group meetings over 6 months and an additional individual session if requested by patient or needed [30]

Mostly white American

Primary care

M

 

N

Classes and follow-up phone calls over 1 year [31]

Women 20 to 50 yrs

Community

M

  

*10 weekly group education sessions [32]

Mean age around 73

Hospital outpatient

M

RCT

 

*6 × 2 hour classes targeting stage of change and culturally appropriate resources and decision tree with periodic group support meetings after the class series [33]

Mostly Latino then African American, low socio-economic, low education

Community

M

  

3 × 2 hr Prochaska-based stage matched group education sessions [34]

Low socio-economic and education

Primary care

M

RCT

N

WRITTEN MATERIALS

*Computer generated tailored nutrition newsletters & profile feedback related to stage of change [35]

Majority African Americans

General practice

H

RCT

N

3 iterative letters [36]

Educated, mean age 49 yrs

Community

M

RCT

N, P

*3 repeated mailings of self help manuals and motivational messages related to stage of change [37]

Mostly Caucasian

Community

M

 

P

1 tailored or non-tailored letter [38]

Smokers aged 17 to 65 yrs

General practice

M

RCT

S

*12 week mailed lifestyle intervention program [39]

Primarily Caucasian women

Community

L

 

P

3 computer generated reports based on stage of change for each risk factor [40]

Mostly Caucasian

Primary care

M

RCT

S, N

3 computer generated reports based on stage of change for each risk factor [41]

Mostly Caucasian

Community

M

RCT

S, N

INDIVIDUAL COUNSELING

Lifestyle counseling by a doctor with video and written materials [42]

Mean age about 53 yrs

Primary health care

H

  

Exercise prescription provided by GP, 1 counseling session with nurse and materials [43]

Mean age 59 yrs

Primary health care

H

 

P

1–3 individual brief counseling by a nurse [44]

Low socio-economic, low education

Primary health care

M

RCT

P

One individual consultation by a nurse [45]

Practice nurses and their patients

Primary health care

M

  

One individual counseling by a registrar [46]

Mean age 41 yrs

Primary health care

M

  

*One motivational counseling and patient setting targets [47]

Mostly female

Primary health care

M

RCT

P

*Two individual counseling sessions by a physician and two follow-up phone calls [48]

Hypertension and/or hypercholesterolemia and/or non insulin dependent diabetes

General practice

M

RCT

P

*12 to 20 week individual counseling for COPD patients [49]

Scandinavian

Primary health care

L

RCT

S, P

MULTIPLE INTERVENTIONS

6 or 7 × 60min classes and multiple mail/telephone follow-up calls (Stanford Nutrition Action Program) [50]

Mostly Hispanic born in the US, poor, low education and literacy

Community

H

RCT

N

*1 mailing of stage based booklets with provider endorsement and 2 motivational phone counseling sessions [51]

Majority Caucasian

General practice

M

RCT

N

*Interactive computer sessions with feedback from a nurse, a risk factor manual, brief audio tapes, stress management and exercise instructions [52]

Mostly African American

Primary health care

M

 

S

Group education sessions with individual counseling [53]

47% high school education or greater

General practice

M

RCT

W

Various interventions designed by neighbourhood coalitions that have GP representation [54]

Low socio-economic, low education

Community

M

 

N

Stages of change based and counseling and written materials provided by a nurse [55]

Mostly female (70%) mean age 42.4 yrs

General practice

L

 

P

Range of health promotion activities by lay community members [56]

Japanese. Age range 30 to 59 yrs

Community

M

 

N, P

TELEPHONE

Two individual education sessions over the phone plus a mailed brochure [57]

Mostly middle aged, married, Non Hispanic black men

Community

H

RCT

 

6 months telephone counseling and exercise logs [58]

Well educated Caucasian

Community

L

  

COMPUTER

*Self guided interactive program with 2 reminder phone calls [59]

Low socio economic, African and white American women

Community

M

 

N

  1. ^Quality of study H = High, M = Medium, L = Low; # SNAPW significant positive outcome reported, S = Smoking, N = Nutrition, A = Alcohol, P = Physical activity, W = Weight; *Follow-up < 6 months.