Health literacy-sensitive self-management interventions for chronic obstructive pulmonary disease: a systematic...

Chronic obstructive pulmonary disease (COPD) requires sustained self-management, and health literacy may play an important role in patients' ability to understand, implement, and maintain disease-management behaviors. However, the effectiveness of self-management interventions incorporating health literacy-sensitive components in COPD remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials evaluating health literacy-sensitive self-management interventions for adults with COPD. Health literacy-sensitive self-management interventions were defined as self-management programs incorporating explicitly identifiable strategies intended to reduce literacy-related barriers or to support patients in obtaining, understanding, appraising, or applying COPD-related health information in daily self-management. Nine databases were searched from inception to August 30, 2025. Thirty-one randomized controlled trials involving 4759 participants were included. Outcomes included 6 min walk distance (6MWD), forced expiratory volume in 1 s as a percentage of predicted value (FEV₁% predicted), St George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnea score, COPD Assessment Test (CAT), and self-management-related outcomes. Risk of bias was assessed using the Cochrane Risk of Bias tool, and pooled effects were calculated using fixed- or random-effects models according to heterogeneity. Compared with usual care, self-management interventions with health literacy-sensitive components were associated with improvements in 6MWD (MD = 44.81 m, 95% CI 17.48-72.14; p = 0.001), FEV₁% predicted (MD = 7.43, 95% CI 6.31-8.55; p < 0.00001), SGRQ total score (MD = -6.80, 95% CI -9.80--3.80; p < 0.00001), mMRC score (MD = -0.40, 95% CI -0.61--0.19; p = 0.0002), CAT score (MD = -3.78, 95% CI -5.49--2.07; p < 0.0001), and self-management-related outcomes (SMD = 1.50, 95% CI 1.34-1.67; p < 0.00001). Substantial heterogeneity was observed for several outcomes, particularly 6MWD, SGRQ, mMRC, CAT, and self-management-related outcomes. Health literacy-sensitive self-management interventions were associated with improvements in exercise capacity, pulmonary function, symptom burden, dyspnea, health-related quality of life, and self-management-related outcomes in patients with COPD. However, the evidence should be interpreted with caution because eligible interventions were defined by the presence of explicitly identifiable health literacy-sensitive strategies embedded within self-management programs, rather than by isolated health-literacy enhancement alone, and substantial heterogeneity and variable methodological quality were present across studies. More rigorously designed and standardized trials are needed to clarify the specific contribution of health literacy-sensitive strategies and their long-term effectiveness in COPD care.