The effectiveness of musculoskeletal patient education provided to people with lower levels of literacy: a systematic review

Purpose: To evaluate the effectiveness of patient education provided to people with arthritis and lower levels of literacy. Method A systematic review was conducted. Electronic databases were searched from 1946 to 2012. Randomised controlled trials with primary interventions designed for individuals with arthritis and lower levels of literacy were included. Results 2440 studies were identified. Three community studies and three rheumatology clinic studies met the inclusion criteria. Trial outcomes included patient knowledge, self-efficacy, arthritis related illness, general health and anxiety. The community based studies recruited a higher proportion of people with lower levels of literacy. There was a moderate level of support for the effectiveness of patient education interventions in increasing knowledge (ES: 1.00-2.8) and self-efficacy (ES 0.1- 0.2) and decreasing self-reported arthritis illness. Conclusions Only a small number of trials were sufficiently robust to be included in this systematic review. Patient education interventions for people with arthritis who also have lower levels of literacy appear to be moderately effective in the short term at increasing knowledge although this is not equal across all literacy groups. The effectiveness of interventions on self-efficacy, arthritis and general health have lower effect. Trials also included people with adequate literacy. Many studies that offer valuable information had to be excluded as they were not methodologically robust enough to include in a systematic review. Future trials need to be robustly designed and reported and assess interventions with the specific target population. Contribution to the conceptual/practice/evidence base of health literacy This systematic review reports both community and clinical trials in the same analysis. Whilst different approaches to health literacy may be evident (risk vs asset) both aim for an improvement in patient outcome and provide useful evidence for application within patient education. Our results show minimal to moderate short term evidence for targeted patient education interventions for people with arthritis and lower levels of literacy.