The health literacy status and its role in interventions in Iran: a systematic and meta-analysis

Seyedeh Belin Tavakoly Sany, Hassan Doosti, Mehrsadat Mahdizadeh, Arezoo Orooji, Nooshin Peyman*

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    11 Citations (Scopus)
    17 Downloads (Pure)


    There are increasing calls for public health policies to realize the visions of a health literate society and health literacy on a global scale. However, there are still more gaps in what researchers recognize and what steps they should take to improve health literacy (HL) skills. This review aimed to measure the HL status of the Iranian population and the effect size of the underlying association between HL and other health outcomes, and to examine the effectiveness of HL interventions on improving the functional dimension of HL, self-efficacy, and health-promoting behaviors. All full text published articles written in English and Persian language were included from inception until January 2019, but the type of study is not limited. A total of 52 potentially relevant articles with data on 36,523 participants were included in this review. In the population with health conditions, the average HL score was 62.51 (95% CI: 59.95–65.08), while in the patient population, the HL score was 64.04 (95% CI: 60.64–67.45). Health literacy was positively and significantly correlated with self-care behaviors 0.42 (95% CI; 0.35–0.49), self-efficacy 0.35 (95% CI; 0.26–0.43), knowledge 0.50 (95% CI; 0.44–0.55), communication skills 0.33 (95% CI; 0.25–0.41), and health promotion behaviors 0.39 (95% CI; 0.35–0.44). The meta-analyses showed that overall, HL interventions significantly improved HL status, self-efficacy, and health promotion behaviors. Results indicate that HL status was in the range of marginal HL level in the Iranian population. Our finding highlights the beneficial impact of HL intervention on health-promoting behaviors and self-efficacy, particularly in low literacy/socioeconomic status people.

    Original languageEnglish
    Article number4260
    Pages (from-to)1-23
    Number of pages23
    JournalInternational Journal of Environmental Research and Public Health
    Issue number8
    Publication statusPublished - 2 Apr 2021

    Bibliographical note

    Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


    • health literacy
    • health literacy interventions
    • health-promoting behaviors
    • meta-analysis
    • self-efficacy
    • systematic review


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