A systematic review of health literacy interventions in health promotion contexts

Background

Health literacy is recognised as a critical determinant of health, and policy frameworks increasingly recommend strengthening it across populations and settings. However, evidence on the effectiveness and characteristics of health literacy interventions remains scarce. Thus, this review s to synthesize interventions designed to improve the ability to deal with health information.

Methods

A systematic literature search identified health literacy intervention studies published between January 2010 and April 2025 across eight databases: Scopus, PubMed, Web of Science, PSYNDEX, ERIC, APA PsycArticles, Teacher Reference Center, and Education Source. Eligibility criteria were predefined and registered in PROSPERO. Following intercoder reliability testing, three reviewers independently screened titles, abstracts, and full texts.

Results

10,086 records were screened, leading to the inclusion of 111 health literacy interventions. Various outcomes were measured, such as specific literacies (digital, sexual, nutrition, and media literacy, etc.), as well as general health literacy. Considerable heterogeneity was identified in both intervention design and evaluation, including a lack of validated measurement tools. Delivery modalities ranged from classical educational instruction and the teach-back approach to participatory formats such as problem-based learning. A considerable number of interventions adapted content to the needs of populations vulnerable to low HL, including older adults, migrants, and people with low socioeconomic status.

Conclusions

Health literacy interventions have been developed for various contexts and use a broad range of delivery modalities. Both targeted approaches for populations at greater risk of low health literacy and universal interventions may contribute to strengthening population health literacy. However, the heterogeneity in outcome measures limits comparability across studies and constrains conclusions regarding effectiveness.

Key messages

• Refinement and implementation of tailored health literacy interventions for high-risk groups, such as older adults, migrants, and disadvantaged populations, may reduce health inequities.

• There is a need for greater standardisation of outcome measures to improve comparability and establish evidence on effectiveness.