Almaleh et al [22]
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To measure HL and to investigate the factors associated with inadequate HL in a sample of outpatient clinics attendees at Ain Shams University Hospitals
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Cross-sectional study and validation: 805 participants, 15 to 85 years, 315 females, 485 males, healthcare setting
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Adaptation of HL instruments to Arabic population. Face-to-face interviews. 81% of participants had limited comprehensive health literacy. 84% had limited functional health literacy, females were more likely to have inadequate functional health literacy.
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Aluh et al [23]
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To assess the knowledge of depression and help-seeking behaviors among adolescent secondary school students in Nigeria by comparing a depression vignette with another vignette of a non-clinically depressed teenager.
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Cross-sectional study: 285 adolescents, 12 to 18 years, 142 females, 143 males, senior secondary schools
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Assesses mental HL. Face-to-face interview. Adolescents with extremely low knowledge of depression in relation to the ability to correctly label depression and to identify the main symptoms. Females demonstrated higher mental HL than males
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Amoah et al [24]
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Assess general health literacy (GHL) and its association with self-perceived health status among street youth in Kumasi, Ghana.
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Cross-sectional study: 290 participants, 12 to 24 years, 139 females, 151 males, urban setting
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Short questionnaire. Face-to-face interviews were required. Limited general HL was higher among females (82%) than males (75%). About 64% of youth perceived their health as poor.
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Atulomah and Atulomah [25]
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To ascertain the level of HL, perceived-health information needs, preventive-health practices of a rural community in Ikenne Local Government area of South-Western Nigeria
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Cross-sectional study: 268 participants, 13 to 32 years, 180 females, 88 males, rural community
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Assess HL in a rural community. Face-to-face interviews. 65% of the respondents designated health information as an important resource for maintaining health. 51% stated that not enough information was given during consultations with caregivers. Levels of HL and perceived information needs are low
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Dowse et al [26]
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To investigate HL in an English second language population using the REALM test, to evaluate its appropriateness and to compare HL between four different education categories.
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Cross-sectional study; 125 participants, aged ]21; 65[ years, 75 females, 50 males, healthcare setting
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The REALM appears to be unsuitable for use in its current form for assessing HL of the study population (Xhosa-speaking). HL level not reported
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Gupta et al [38]
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To examine health literacy on foodborne diseases and the relative effects of HL on self-rated health
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Mixed-method study: 401 participants, 18 to 49 years, 242 females, 159 males, healthcare setting
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Short questionnaire. Face-to-face interviews. Direct positive relationship between HL and health status. Demographic variables were significantly associated with self-rated health status.
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Hunt et al [27]
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The current study focused on the principled relexicalization of the REALM
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Cross-sectional study and validation of REALM: 114 participants, aged 21–65 years, 100 females and 14 males, urban health care setting
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Identification of the health literacy levels of patients in clinics. Face-to-face interviews. Participants struggled to understand the questions and were incapable to complete the test. The tool was more suitable to be applied in South Africa after a relexicalization. HL level not reported
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Mafutha et al [28]
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To identify and determine the literacy level of hypertensive patients attending primary health care clinics in Tshwane, Gauteng Province, South Africa
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Cross-sectional study and validation: 195 participants, aged [18;85] years, 123 females, 72 males, primary health care setting
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The HHLAT was a valid tool to use in busy primary care clinic. Face-to-face interviews. 37 (19%) of the patients with hypertension had poor hypertension HL levels.
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Marimwe and Dowse [29]
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To validate a HL measure and to measure HL in limited literacy multilingual patients in South Africa
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Cross-sectional: 210 first language Xhosa speakers, aged [18;60[ years, 179 females, 31 males, healthcare setting
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Face-to-face interviews were required to ensure that participants were able to understand question content. 18% were found to have adequate HL
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Marimwe and Dowse [30]
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To develop a bank of questions for a population informed by a broader definition of health literacy, which acknowledges both traditional cognitive skills and explores the influence of the collective social environment on HL
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Cross-sectional study: 120 participants, aged [18; 60[ years, 100 females, 20 males, healthcare setting
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MSFHL was considered a valid tool used as comparator of HELT-LL. Face-to-face interviews. Less than 20% reported being able to use the internet to look for health information. 83% were categorized as having inadequate or marginal HL
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McClintok et al [31]
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To examine demographic characteristics associated with HL in Cameroon, Democratic Republic of Congo, Ethiopia, Ghana, Guinea, Ivory Coast, Lesotho, Rwanda, Niger, Namibia, Sierra Leone, Swaziland, Togo and Zambia
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Population-based, cross-sectional study: 259,684 participants, 15 to 49 years, 88,293 females, 101,277 males
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Prevalence of high HL of 36%; 34% in females and 39% in males. High HL varied from 9% in Niger to 64% in Namibia.
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Mojoyinola [32]
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To determine whether maternal HL enhances or impedes healthy pregnancy and pregnancy outcomes.
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Cross-sectional study and validation study: 231 pregnant women, aged [20;51[ years, healthcare setting
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The MHLAPQ was specially designed for low–and-middle income countries. Face-to-face interviews. Significant relationship between maternal HL and antenatal care, healthy pregnancy and pregnancy outcomes. Majority of the respondents are highly literate
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Reid et al [39]
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To develop an appropriate HL test for use among South African public health service users with Sesotho as their first language
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Mixed methods: delphi session, 17 HL tests remained, healthcare setting
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Tool culturally appropriate and context-specific test of HL in Sesotho-speaking populations that use primarily public health services. Suitable for people with limited literacy and non-English speaking minorities in Africa.
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Schrauben and Wiebe [33][22]
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To derive a measure of HL in data from the Demographic and Health Surveys Program
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Cross-sectional study: 13,646 participants, 15 to 49 years, 7,096 females, 6,550 males
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Construction of a health literacy measure in an African country using demographic health survey data from DHS. 47% of males and 25% of females had high literacy.
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Shabi and Oyewusi [34]
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To determine the health literacy experience of in school adolescents in Osun State, Nigeria.
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Cross-sectional study: 1,186 adolescents, 14 to 16 years, 616 females, 570 males, senior secondary schools
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Face-to-face interviews. 38% of participants with adequate HL skills, 63% used the internet to search for health information weekly.
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Tenibiaje [35]
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To examine the level of communication skills, literacy and health literacy of inmates in South-West Prisons in Nigeria.
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Cross-sectional study: 504 male participants, 14 to 16 years, prisons
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Research about a hard-to-reach population. Face-to-face interviews. Literacy levels of inmates were very low. 97% poor HL. Poor HL was common among elderly inmates.
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Tique et al [36]
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To develop and rigorously test the psychometric properties of the HIV Literacy Test (HIV-LT)
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Cross-sectional study: 319 participants, 18 to 49 years, 227 females, 92 males, healthcare setting
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Face-to-face interview. Participants had difficulty interpreting commonly used prescription cards, understanding the correct time and number of pills to take daily, and routinely discussed disease-related concepts. The majority had low HL.
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Tutu et al [37]
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To assess HL on cholera and the association between HL competency and health outcome
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Cross-sectional study: 401 participants, aged 18 or more, 241 female, 160 male, Urban setting
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Short questionnaire. Face-to-face interview required. Respondents reveal substantial knowledge gaps about environmental risk factors for cholera.
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HL – health literacy
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