Abstract
Health literacy (HL) is an important social determinant of health in inflammatory arthritis (IA). We conducted a systematic literature review (SLR) to i) summarise associations between HL and IA outcomes; ii) inform management in IA; iii) inform further research.
This SLR was registered on PROSPERO (CRD42024511354). Inclusion criteria were adults (≥18 years) with IA; studies assessing HL or interventions targeting HL; observational and qualitative studies, randomised controlled trials; English-language articles. Searches were performed in February 2024, with MeSH headings for HL and IA, in key databases, with no time restriction. HL measures and outcomes were not defined, to ensure capture of all potentially relevant articles. Data were extracted on demographics, HL assessment and relevant clinical and non-clinical outcomes. Outcomes were grouped into themes using vote-counting.
Of 3087 identified articles from the search, 29 met inclusion criteria (22 cross-sectional studies; three cohort studies; two randomised controlled trials; one case-control study; one qualitative study). The total number of participants across all studies was 16402 75% female, with a mean age of 57.5 years (SD 9.6). Ethnicity was reported in 13 studies; 66% of patients were Caucasian. 89% had rheumatoid arthritis, 4% axial spondyloarthritis, 3% psoriatic arthritis and 4% unspecified IA (Table 1). Measures of HL included: Test of Functional Health Literacy in Adults (short and long form; n = 13); Single Item Literacy Screener (n = 10); Rapid Estimate of Adult Literacy in Medicine (n = 6); Health Literacy Questionnaire (n = 2). Meta-analysis was deemed inappropriate due to marked heterogeneity between studies. Associations were determined using vote-counting. Six main associations were identified with lower HL associated with: greater disease activity; greater disability and function; more mental health symptoms (including depression and anxiety); higher healthcare and medication use; lower medication adherence; lower use of the Internet, telehealth and technology.
This is the first SLR to synthesise factors associated with HL in people with IA, including elevated disease activity, greater healthcare utilisation and decreased access to medication and care. Our findings may be used to inform policy and resource allocation, and improve access and quality of care in IA, particularly among those patients with lower HL.
M. Dey: None. S. Budhathoki: None. H. Elwell: None. S. Ramiro: None. K. Michaud: None. S. Norton: None. M.H. Buch: None. A. Cope: None. R. Osborne: None. J. Galloway: None. E. Nikiphorou: None.
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