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Health literacy is moderately associated with improved self-care behaviors in patients with multiple chronic diseasesBetter health literacy helps people manage chronic diseases more effectively

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Key Takeaway
Note that health literacy is moderately associated with improved self-care behaviors in patients with chronic diseases.

This meta-analysis synthesized data from 138 studies (52 of which were meta-analyzed) to examine the relationship between health literacy (HL) and self-care behaviors in patients with chronic conditions, including Type 2 Diabetes, Heart Failure, Hypertension, and COPD. The analysis focused on how HL impacts behaviors such as medication adherence, disease monitoring, and lifestyle modifications.

The primary finding is a moderate positive association between health literacy and self-care (r = 0.29; 95% CI: 0.26-0.31; p < 0.001). The authors note that the impact of HL on self-care is influenced by various mediators and moderators, including psychological factors like self-efficacy, cognitive factors such as disease knowledge, and social factors like healthcare communication.

Several limitations affect the strength of these findings. Risk of bias was high in 62 studies, and the overall certainty of evidence ranged from very low to moderate. Because the results are reported as correlations rather than causal links, the impact of HL on self-care should be interpreted with caution. Clinicians may consider how addressing patient health literacy could potentially support better management of chronic conditions.

How this fits prior evidence

This meta-analysis addresses a gap in understanding how patient education and communication impact management of chronic diseases like Type 2 Diabetes and Heart Failure. While previous coverage noted that lipid metabolism disorders drive podocyte injury in diabetic kidney disease, this finding highlights the role of health literacy as a behavioral factor in managing such conditions. The moderate positive association (r = 0.29) provides a quantified link between patient knowledge and self-care behaviors.

Living with a chronic condition like asthma, heart failure, or arthritis is often a full-time job. It requires constant decision-making, tracking symptoms, and following complex medication schedules. For many patients, the biggest hurdle isn't just the illness itself, but the ability to understand and act on the information provided by doctors.

A large review of 138 studies looked at how health literacy—the ability to find and understand health info—impacts daily self-care. The researchers found a moderate positive link between these skills and how well patients manage their conditions. This includes better medication habits, more consistent monitoring, and improved lifestyle choices for people with various long-term illnesses.

While the results are promising, it is important to note that the evidence quality varies. Some studies had a high risk of bias, and the overall certainty of the data ranges from low to moderate. The findings show a clear connection between knowing your stuff and taking care of yourself, but they do not prove that literacy alone causes these improvements.

What this means for you:
Better health literacy is linked to better self-care for people managing chronic conditions like diabetes or heart failure.

Common questions

What is health literacy and how does it help?

Health literacy is your ability to find, understand, and use information to make decisions about your health. This includes digital health literacy, which involves using online tools. The study found that better skills in these areas are linked to better self-care behaviors, such as taking medication correctly and making healthier lifestyle choices for chronic conditions.

Which conditions does this finding apply to?

The findings relate to several common chronic conditions. These include Type 2 Diabetes, Heart Failure, Hypertension, Chronic Kidney Disease, Asthma, Coronary Artery Disease, Arthritis, and COPD. For all these conditions, having a better grasp of health information was linked to improved daily management.

How strong is the evidence for this link?

The study found a moderate positive association between health literacy and self-care. However, it is important to note that the certainty of the evidence ranges from very low to moderate. Additionally, 62 of the 138 studies reviewed had a high risk of bias, so the results should be viewed with some caution.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
BACKGROUND: Chronic diseases are a major global health burden, contributing to morbidity, mortality and healthcare costs. Self-care is essential for effective disease management, with health literacy (HL) and digital health literacy (eHL) playing a role in enabling individuals to engage in health-promoting behaviours. However, the relationship between HL and self-care remains inconclusive, necessitating further investigation to clarify its impact. OBJECTIVE: To synthesise evidence on the association between HL and self-care in chronic diseases and identify mediating and moderating factors influencing this relationship. INFORMATION SOURCES: A systematic search was conducted across PubMed, CINAHL, PsycINFO, Embase, Web of Science and Cochrane CENTRAL, supplemented by manual reference checks and author correspondence. METHODS: This systematic review and meta-analysis followed PRISMA guidelines, including observational studies and RCTs assessing HL and self-care. Meta-analyses were performed using Fisher's Z transformation. Risk of bias was assessed using ROBINS-E and certainty of evidence was evaluated through GRADE. RESULTS: A total of 138 studies were included, with 52 meta-analysed. Higher HL was associated with improved self-care behaviours, including medication adherence, disease monitoring and lifestyle modifications across chronic diseases, including type 2 diabetes, heart failure, hypertension, chronic kidney disease, asthma, coronary artery disease, arthritis and COPD. Psychological (self-efficacy, empowerment), cognitive (disease knowledge, decision-making) and social (healthcare communication, social support) factors mediated this relationship, while distress and depression moderated it. Meta-analysis revealed a moderate positive association between HL and self-care (r = 0.29, 95% CI: 0.26-0.31, p < 0.001). Subgroup analyses showed consistent positive effects across conditions. No significant publication bias was detected (Egger's test, p = 0.294). Risk of bias was high in 62 studies, while certainty of evidence ranged from very low to moderate. CONCLUSIONS: HL positively influences self-care in chronic diseases, with its impact shaped by multiple mediators and moderators. Future interventions should integrate tailored education, digital tools and mental health support to enhance HL effectiveness. REGISTRATION: PROSPERO (CRD42024488061, registered 20.01.2024).
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