Community-based health literacy programs: a comparative narrative review of policy and implementation approaches

Despise the existence of numerous community-based health literacy interventions worldwide, our understanding of their impact on equity and the influence of national policy frameworks and implementation considerations remains limited. This narrative review aims to conduct a comparative analysis of community-based health literacy programs and national policy frameworks post-2020, with a focus on implementation characteristics, system-level integration, and implications for equitable public health initiatives. Effective interventions across various countries exhibited three key action-relevant features: integration into national prevention and broader primary care strategies; utilization of hybrid delivery models combining digital technology with in-person contact; and active targeting of socioeconomically disadvantaged groups. Government-led models demonstrated superior scalability and sustainability, whereas community-based models enhanced outreach to marginalized populations. However, the majority of programs rely on short-term or output-based indicators to assess success, with insufficient evidence regarding their long-term impact on equity. Although digitalization increased accessibility on a large scale, there is a risk of reinforcing existing inequalities in the absence of inclusive design and digital support. This study provides a policy-focused synthesis that positions community-based health literacy as a viable public health intervention rather than merely an educational endeavor. This review provides practical guidance for integrating health literacy into national preventive efforts by identifying transferable implementation characteristics and governance requirements.