Darren A. DeWalt|Nancy D Berkman|Stacey Sheridan|Kathleen N Lohr|Michael Pignone
Literacy and health outcomes
RTI International|RTI International|RTI International|RTI International|University of North Carolina at Chapel Hill
review relationship literacy health outcomeswe searched medline cumulative index nursing allied health cinahl educational resources information center eric public affairs information service pais industrial labor relations review illr psychinfo ageline 1980 2003we included observational studies reported original data measured literacy valid instrument measured one health outcomes two abstractors reviewed study inclusion resolved disagreements discussionone reviewer abstracted data article evidence table second reviewer checked entry whole study team reconciled disagreements information evidence tables data extractors independently completed 11item quality scale article scores averaged give final measure article qualitywe reviewed 3015 titles abstracts pulled 684 articles full review 73 articles met inclusion criteria 44 addressed questions report patients low literacy poorer health outcomes including knowledge intermediate disease markers measures morbidity general health status use health resources patients low literacy generally 15 3 times likely experience given poor outcome average quality articles fair good studies crosssectional design many failed address adequately confounding use multiple comparisonslow literacy associated several adverse health outcomes future research using rigorous methods better define relationships guide developers new interventions