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Health literacy research in primary healthcare services - A scoping review
Christine Råheim Borge1, Hedda Eik2, Astrid Klopstad Wahl3
1Department of Public Health and Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway; Department of Research, Lovisenberg Diaconal Hospital, Oslo, Norway.
Objective:
To systematically map existing evidence on health literacy among people with non-communicable diseases (NCDs) in primary healthcare.
Methods:
An interdisciplinary research group conducted a scoping review following the Arksey and O'Malley framework, refined by Levac and Peters, and reported according to PRISMA-ScR. The review was registered in OSF and applied the Population-Concept-Context framework to define inclusion criteria. Searches were conducted in Medline, APA PsycInfo, Scopus, and Cochrane for studies published between 2000-2025. Peer-reviewed studies were screened in Rayyan, and data were charted and thematically analyzed through team-based consensus.
Results:
The search identified 7952 studies, of which 106 studies met the inclusion criteria. Participants' mean age was 59 years; 56% were female. Studies originated from 29 countries, mainly the USA, China, and Canada, with an increase after 2013. Three main themes were identified: (1) health literacy, social status, and ethnicity, (2) health literacy, disease, and health outcomes, and (3) health literacy, NCD knowledge, and self-management. Many studies reported associations between health literacy, and self-management, quality of life, and some clinical outcomes, but findings across designs and outcomes were heterogeneous and not consistently positive.
Conclusions:
Improved communication, greater cultural competence, and tailored health literacy interventions are associated with better self-management and disease outcomes in non-communicable diseases, but most evidence is associative rather than causal, intervention effects are mixed, and research on health literacy experiences remains limited.
Practice Implications:
More rigorously designed intervention studies and broader conceptualization and measurement of health literacy with multidimensional instruments are needed to strengthen the evidence and clarify how health literacy relates to social status, disease outcomes, and self-management in primary healthcare. Training healthcare professionals to assess and address health literacy is essential to promote equity and effective patient engagement.
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