Effectiveness of health literacy interventions on anxious and depressive symptomatology in primary health care: A systematic review and meta-analysis

Rosa Magallón-Botaya; Fátima Méndez-López; Bárbara Oliván-Blázquez; Luis Carlos Silva-Aycaguer; David Lerma-Irureta; Cruz Bartolomé-Moreno

doi:10.3389/fpubh.2023.1007238

Effectiveness of health literacy interventions on anxious and depressive symptomatology in primary health care: A systematic review and meta-analysis

Front Public Health. 2023 Feb 9:11:1007238. doi: 10.3389/fpubh.2023.1007238. eCollection 2023.

Authors

Rosa Magallón-Botaya^{1

2

3}, Fátima Méndez-López^{2

3}, Bárbara Oliván-Blázquez^{2

3

4}, Luis Carlos Silva-Aycaguer⁵, David Lerma-Irureta¹, Cruz Bartolomé-Moreno^{2

3

6

7}

Affiliations

¹ Department of Medicine, Psychiatry and Dermatology, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain.
² Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain.
³ Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) RD21/0016/0001, Zaragoza, Spain.
⁴ Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain.
⁵ National School of Public Health (ENSAP), University of Medical Sciences of Havana, Havana, Cuba.
⁶ Aragonese Healthcare Service (SALUD), Zaragoza, Spain.
⁷ Department of Family and Community Care Teaching - Sector I, Aragonese Healthcare Service, Zaragoza, Spain.

Abstract

Background: Affective disorders are a debilitating and very prevalent problem throughout the world. Often these are associated with the onset of comorbidities or a consequence of chronic diseases. Anxiety and depression are associated with poor social and personal relationships, compromised health. We aimed to synthesize evidence from studies measuring the impact of a health literacy (HL) intervention on the improvement of affective disorders.

Methods: For this systematic review and meta-analysis, we searched PubMed/MEDLINE, Embase, Web of Science, Ibecs, Cuiden, Scielo, Science Direct and Dialnet for exclusively randomized controlled trial studies (RCTs) published between 1 Jan 2011, and 31 May 2022. The search terms employed were "health literacy," "health knowledge," "anxiety," "anxiety disorder," "depression," "depressive disorder," and "adult." The risk of bias assessment was performed using the Cochrane Collaboration Revised Risk of Bias tool (RoB2). We conducted random-effects meta-analyses and explored heterogeneity using meta-regression and a stratified survey.

Results: Of 2,863 citations found through the initial screening, 350 records were screened by the title and abstract for their themes and relevance. Finally, nine studies complied with the inclusion criteria for the meta-analysis. 66.66% of studies (n = 6) were rated as having a low risk of bias and 33.33% (n = 3) were judged to raise some concerns. The health literacy interventions were associated with -1.378 reduction in depression and anxiety questionnaires scores [95% CI (-1.850, -0.906)]. Low mood disorder scores are associated with better mental health and wellbeing.

Conclusion: Our findings demonstrate that an HL intervention in relation to the symptoms associated with affective disorders improves the emotional state of patients in PHC, with a moderately positive effect in reducing depression and anxiety.

Keywords: affective disorders; effectiveness; health literacy; mental health; meta-analysis; primary health care.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anxiety / therapy
Anxiety Disorders / therapy
Comorbidity
Health Literacy*
Humans
Primary Health Care
Randomized Controlled Trials as Topic

Grants and funding

This study has been funded by Health Institute Carlos III (ISCIII) through the project grant number PI19/01076, Feder Funds Another way to make Europe. The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation. The trial will be audited once a year by the funding organization.