A Scoping Review and Practical Approach to Measuring Health Literacy in Solid Organ Transplantation

Introduction: Solid organ transplant recipients have extensive self-care responsibilities. Limited health literacy (HL) can hinder effective self-management and long-term outcomes. Objective: A scoping review of HL instruments is needed to summarize their use in solid organ transplant. Methods: A systematic search was conducted using Medline, Embase, and CINAHL databases to identify studies that measured HL in the context of solid organ transplant. Search results were uploaded into Mendeley, and duplicates were removed. Two reviewers screened the abstracts and full texts for eligibility and discrepancies were resolved by the research team. Data extraction included publication details, study features, and HL instruments. Results: Of 721 articles identified for title and abstract assessment, 94 articles were further reviewed for full-text eligibility, and 50 were included in the review. HL instruments included: the Brief HL Screen (BHLS) and iterations (with 16 studies), Newest Vital Sign (NVS) (15 studies), Rapid Estimate of Adult Literacy in Medicine (REALM) (8 studies), Test of Functional HL in Adults (TOFHLA) (7 studies), HL Questionnaire (HLQ) (6 studies), eHL Scale (eHEALS) (4 studies), Brief Medical Numbers Test (BMNT) (3 studies), Decision-Making Capacity Assessment Tool (DMCAT) (2 studies), Short Assessment of HL (SAHL) (1 study). Discussion: Seven studies used multiple HL instruments in their analysis. Some instruments had multiple versions, such as the original TOFHLA and its shortened form (S-TOFHLA), and the original REALM and its transplant-specific version (REALMT). Conclusion: This review provides an overview of HL instruments for transplant healthcare providers who may want to incorporate HL measurement into practice.