Morris Gellisch, Gabriela Morosan-Puopolo, Beate Brand-Saberi, Thorsten Schäfer
Adapting to new challenges in medical education: a three-step digitization approach for blended learning
BMC medical education
health literacy hl determinant health important autonomous decisionmaking migrants high risk limited hl improving hl important equitable promotion migrants health assess effectiveness interventions improving hl migrants assess whether female male migrants respond differently identified interventions ran electronic searches 2 february 2022 central medline embase psycinfo cinahl also searched trial registries used study filter randomised controlled trials rcts rct classifier included rcts clusterrcts addressing hl either concept components access understand appraise apply health information used methodological procedures recommended cochrane followed prismae guidelines outcome categories hl b quality life qol c knowledge health outcomes e health behaviour f selfefficacy g health service use h adverse events conducted metaanalysis possible reported remaining results narrative synthesis included 28 rcts six clusterrcts 8249 participants conducted highincome countries participants migrants wide range conditions interventions adapted culture language literacy find evidence hl interventions cause harm two studies assessed adverse events eg anxiety many studies reported results shortterm assessments less six weeks total programme completion reported several comparisons also findings later time points presented review text compared hl intervention standard careno intervention unrelated hl intervention similar intervention different information topic selfmanagement programmes smp probably improve selfefficacy slightly standardised mean difference smd 028 95 confidence interval ci 006 050 2 studies 333 participants moderate certainty smp may improve hivrelated hl understanding mean difference md 425 95 ci 132 718 recognition hiv terms md 332 95 ci 128 536 1 study 69 participants smp may slightly improve health behaviours 3 studies 514 participants may little effect knowledge 2 studies 321 participants subjective health status md 038 95 ci 013 089 1 study 69 participants low certainty uncertain effects smp qol health service use adverse events due lack evidence hl skills building courses hlsbc may improve knowledge md 1087 95 ci 569 1606 2 studies 111 participants generic hl smd 048 95 ci 020 075 2 studies 229 participants may little effect depression literacy md 017 95 ci 128 162 health behaviour 2 studies 229 participants low certainty uncertain hlsbc improve qol health outcomes health service use selfefficacy adverse events due lowcertainty lack evidence audiovisual education without personal feedback ave probably improves depression literacy md 862 95 ci 751 973 1 study 202 participants health service use md 059 95 ci 111 007 1 study 157 participants probably little effect health behaviour risk ratio rr 107 95 ci 091 125 1 study 135 participants moderate certainty ave may improve selfefficacy md 351 95 ci 253 449 1 study 133 participants may slightly improve knowledge md 844 95 ci 256 1944 2 studies 293 participants intention seek depression treatment md 18 95 ci 043 317 little effect depression smd 015 95 ci 040 010 low certainty evidence found qol adverse events adapted medical instruction may improve understanding health information 3 studies 478 participants little effect medication adherence md 05 95 ci 01 11 1 study 200 participants low certainty evidence found qol health outcomes knowledge health service use selfefficacy adverse events compared written information topic smp probably improves health numeracy slightly md 07 95 ci 015 125 probably improves print literacy md 9 95 ci 29 151 1 study 209 participants selfefficacy smd 047 95 ci 03 064 4 studies 552 participants moderate certainty smp may improve diseasespecific hl smd 067 95 ci 027 107 4 studies 955 participants knowledge md 1145 95 ci 475 1815 6 studies 1101 participants health behaviours 4 studies 797 participants little effect health information appraisal md 115 95 ci 023 253 1 study 329 participants low certainty uncertain whether smp improves qol health outcomes health service use adverse events due lack evidence lowvery lowcertainty evidence ave probably little effect diabetes hl md 2 95 ci 015 415 1 study 240 participants probably improves information appraisal md 988 95 ci 1287 689 application rr 151 95 ci 129 177 1 study 608 participants moderate certainty ave may slightly improve knowledge md 835 95 ci 032 1702 low certainty shortterm evidence found qol depression health behaviour selfefficacy health service use adverse events ave compared another ave uncertain whether narrative videos superior factual knowledge videos evidence low certainty gender differences female migrants diabetes hl may improve slightly males receiving ave md 500 95 ci 062 938 1 study 118 participants know whether female male migrants benefit differently interventions due lowcertainty lack evidence adequately powered studies measuring longterm effects six months hl interventions female male migrants needed using wellvalidated tools representing various healthcare systems