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Table 5 Summary of included studies

From: Which providers can bridge the health literacy gap in lifestyle risk factor modification education: a systematic review and narrative synthesis

Reference Intervention Study type and quality SNAPW outcomes Health literacy outcomes
Authors: Adolfsson ET, Walker-EngstrÃm ML, Smide B, Wikblad K [36] Patient education in type 2 diabetes-A randomized controlled 1-year follow-up study Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: Yes
  Intervention type: Group education Quality rating: High Nutrition: N/A Patient skills: N/A
  Description: Group empowerment sessions Quality score: 2.66 Alcohol: N/A Self efficacy: No
  Intensity: 4–5 sessions over 7 months   Physical activity: N/A Stage of change: N/A
  Intensity score: M   Weight: No  
  Provider: Multi-disciplinary team (GP, educator)    Patient activation: N/A
     Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Aldana SG, Greenlaw RL, Diehl HA, Salberg A, Merrill RM, Ohmine S, et al [37] Effects of an intensive diet and physical activity modification program on the health risks of adults Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: Yes
  Intervention type: Group education Quality rating: High Nutrition: Yes Patient skills: N/A
  Description: Group education with participants following preset dietary goals Quality score: 3.0 Alcohol: N/A Self efficacy: N/A
  Intensity: 40 h over a 4-week period   Physical activity: Yes Stage of change: N/A
  Intensity score: M   Weight: Yes Patient activation: N/A
  Provider: Multi-disciplinary team (GP, educator)    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Brassington GS, Atienza AA, Perczek RE, DiLorenzo TM, King AC [38] Intervention-Related Cognitive Versus Social Study type: Randomised Trial Smoking: N/A Patient knowledge: N/A
  Mediators of Exercise Adherence in the Elderly Quality rating: Low Nutrition: N/A Patient skills: N/A
  Intervention type: Telephone   Alcohol: N/A Self efficacy: Yes
  Description: Telephone Counselling + exercise logs   Physical activity: Yes Stage of change: N/A
  Intensity: exercise prescription, telephone exercise counseling to promote exercise adherence for 12 months, and attended 6- and 12-month assessment visits   Weight: N/A Patient activation: N/A
  Intensity score: H Quality score: 1.83   Shared decision making: N/A
  Provider: Educator    Other health literacy outcome: N/A
Authors: de Vries H, Kremers SP, Smeets T, Brug J, Eijmael K [53] The effectiveness of tailored feedback and action plans in an intervention addressing multiple health behaviors Study type: Randomised Controlled Trial Smoking: No Patient knowledge: N/A
  Intervention type: Written material Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: 3 iterative tailored feedback letters Quality score: 2.0 Alcohol: N/A Self efficacy: Yes
  Intensity: 3 iterative feedback letters   Physical activity: Yes Stage of change: N/A
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Other    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Dunn AL, Marcus BH, Kampert JB, Garcia ME, Kohl HW, Blair SN [39] Reduction in cardiovascular disease risk factors: 6-month results from Project Active Study type: Randomised Clinical Trial Smoking: N/A Patient knowledge: Yes
  Intervention type: Motivational interviewing and counseling Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Cognitive & behavioural strategies + Motivational Interviewing - advised to accumulate at least 30 min of moderate intensity physical activity on most days of the week, tailored to their lifestyle Quality score: 2.33 Alcohol: N/A Self efficacy: Yes
  Intensity: small groups that met for an hour 1 night a week for the first 16 weeks, and then every other week for weeks 17 to 24,   Physical activity: Yes Stage of change: No
  Intensity score: H   Weight: N/A Patient activation: N/A
  Provider: Educator    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Efraimsson EÃ, Hillervik C, Ehrenberg A [40] Effects of COPD self-care management education at a nurse-led primary health care clinic Study type: Randomised Controlled Trial Smoking: Yes Patient knowledge: Yes
  Intervention type: Motivational interviewing and counseling Quality rating: Low Nutrition: N/A Patient skills: N/A
  Description: Disease education (COPD) & counseling on RF Quality score: 1.83 Alcohol: N/A Self efficacy: N/A
  Intensity: 12–20 weeks   Physical activity: Yes Stage of change: N/A
  Intensity score: H   Weight: N/A Patient activation: N/A
  Provider: Nurse    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Goldstein MG, Pinto BM, Marcus BH, Lynn H, Jette AM, Rakowski W, et al [32] Physician-based physical activity counseling for middle-aged and older adults: a randomized trial Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Motivational interviewing and counseling Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Individualised motivational counseling, goal setting + PA prescription + mailed monthly materials Quality score: 2.33 Alcohol: N/A Self efficacy: N/A
  Intensity: 5 mins brief counseling with mailed monthly materials   Physical activity: No Stage of change: No
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Doctor    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Hartman TJ, McCarthy PR, Park RJ, Schuster E, Kushi LH [54] Results of a community-based low-literacy nutrition education program Study type: Randomised Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Group education Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: 10 sessions and written information Quality score: 2.5 Alcohol: N/A Self efficacy: No
  Intensity: 10 sessions   Physical activity: N/A Stage of change: N/A
  Intensity score: H   Weight: N/A Patient activation: N/A
  Provider: Lay worker    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Kloek GC, van Lenthe FJ, van Nierop PWM, Koelen MA, Mackenbach JP [55] Impact evaluation of a Dutch community intervention to improve health-related behaviour in deprived neighbourhoods Study type: Quasi experimental Smoking: No Patient knowledge: Yes
  Intervention type: Mixed intervention Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: Group education + community development (one off special events) Quality score: 2.16 Alcohol: No Self efficacy: Yes
  Intensity: 2 year intervention   Physical activity: No Stage of change: Yes
  Intensity score: H   Weight: N/A Patient activation: N/A
  Provider: Other    Shared decision making: N/A
     Other health literacy outcome: No
Authors: Lorig KR, Ritter PL, Jacquez A [56] Outcomes of border health Spanish/English Chronic Disease Self-management Programs Study type: Before and After Study Smoking: N/A Patient knowledge: N/A
  Intervention type: Group education Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: CDSMP Quality score: 2.16 Alcohol: N/A Self efficacy: Yes
  Intensity: 2.5 h sessions over 6 weeks - total 14 h   Physical activity: Yes Stage of change: N/A
  Intensity score: H   Weight: N/A Patient activation: N/A
  Provider: Lay worker    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Nies MA, Artinian NT, Schim SM, Vander Wal JS, Sherrick-Escamilla S [57] Effects of lay health educator interventions on activity, diet, and health risks in an urban Mexican American community Study type: Before and After Study Smoking: N/A Patient knowledge: No
  Intervention type: Group education Quality rating: Low Nutrition: No Patient skills: N/A
  Description: Health promotion train the trainer sessions in the community Quality score: 1.66 Alcohol: N/A Self efficacy: N/A
  Intensity: 2–6 h train the trainer sessions and 3x1h sessions for community   Physical activity: No Stage of change: N/A
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Lay worker    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Norris SL, Grothaus LC, Buchner DM, Pratt M [33] Effectiveness of physician-based assessment and counseling for exercise in a staff model HMO Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Motivational interviewing and counseling Quality rating: High Nutrition: N/A Patient skills: N/A
  Description: One counselling session, written PA prescription and one follow up call. A subset received booster telephone calls at 2, 3 and 4 months and postcard reminders at 2, 3, 4, and 5 months. (no significant difference between groups in PA levels) Quality score: 2.66 Alcohol: N/A Self efficacy: No
  Intensity: One counselling session, written PA prescription and one follow up call   Physical activity: Yes Stage of change: N/A
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Doctor    Shared decision making: N/A
     Other health literacy outcome: No
Authors: Ridgeway NA, Harvill DR, Harvill LM, Falin TM, Forester GM, Gose OD [41] Improved control of type 2 diabetes mellitus: A practical education/behavior modification program in a primary care clinic Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: Yes
  Intervention type: Mixed intervention Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Group education mixed with individual education sessions Quality score: 2.16 Alcohol: N/A Self efficacy: N/A
  Intensity: 12 weekly group sessions, 1 individual session and 6 bi-weekly sessions   Physical activity: N/A Stage of change: N/A
  Intensity score: H   Weight: Yes Patient activation: N/A
  Provider: Multi-disciplinary team (Nurse, dietician, GP)    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Sadur CN, Moline N, Costa M, Michalik D, Mendlowitz D, Roller S, et al [42] Diabetes management in a health maintenance organization: Efficacy of care management using cluster visits Study type: Clustered Randomised Controlled Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Group education Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: Group education + 1 additional individual session Quality score: 2.33 Alcohol: N/A Self efficacy: Yes
  Intensity: 10–18 patients/month for 6 months   Physical activity: N/A Stage of change: N/A
  Intensity score: H   Weight: N/A Patient activation: N/A
  Provider: Multi-disciplinary team (Psychologist, educator, dietician, pharmacist)    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Van Sluijs EMF, Van Poppel MNM, Twisk JWR, Van Mechelen W [43] Physical activity measurements affected participants’ behavior in a randomized controlled trial Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: No
  Intervention type: Motivational interviewing and counseling Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Individual physician tailored counseling + 2 phone calls (5–10mins) + follow up consultation Quality score: 2.0 Alcohol: N/A Self efficacy: No
  Intensity: 10 min initial consult, 5–10 min phone call at 2 weeks, 10 min consult at 4 weeks and phone call 8 weeks after 2nd consult   Physical activity: Yes Stage of change: Yes
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Multi-disciplinary team (GP, nurse, counselor)    Shared decision making: N/A
     Other health literacy outcome: No
Authors: Yajima S, Takano T, Nakamura K, Watanabe M [58] Effectiveness of a community leaders’ programme to promote healthy lifestyles in Tokyo, Japan Study type: Quasi experimental Smoking: No Patient knowledge: N/R
  Intervention type: Mixed intervention Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: Range of activities by lay community members to be health promotion leaders Quality score: 2.0 Alcohol: N/A Self efficacy: N/A
  Intensity: 2 year program   Physical activity: Yes Stage of change: N/A
  Intensity score: H   Weight: N/A Patient activation: N/R
  Provider: Lay worker    Shared decision making: N/A
     Other health literacy outcome: Yes
Authors: Boylan MJ, Renier CM, Knuths JS, Haller IV [44] Preventing cardiovascular disease in women: an intervention-control randomized study Study type: Randomised Trial Smoking: No Patient knowledge: N/A
  Intervention type: Group education Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Lifestyle intervention program including individualized review, information, classes and follow up phone calls Quality score: 2.0 Alcohol: N/A Self efficacy: Yes
  Intensity: 12 months   Physical activity: N/A Stage of change: N/A
  Intensity score: H   Weight: N/A Patient activation: N/A
  Provider: Educator    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Jimmy G, Martin BW [59] Implementation and effectiveness of a primary care based physical activity counselling scheme Study type: Randomised Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Mixed intervention Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Individual counseling & feedback on stage of change + take home leaflets + offer of referral to PA specialist (at ¼ of cost) + follow up session computer assisted tool (PA & motivation assessment) + telephone reminders (3) Quality score: 2.33 Alcohol: N/A Self efficacy: N/A
  Intensity: Feedback, information 45 min counselling session   Physical activity: No Stage of change: No
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Doctor    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Kreuter MW, Strecher VJ [60] Do tailored behavior change messages enhance the effectiveness of health risk appraisal? Results from a randomized trial Study type: Randomised Controlled Trial Smoking: No Patient knowledge: N/A
  Intervention type: Written material Quality rating: High Nutrition: No Patient skills: N/A
  Description: individually-tailored behavior change information with health risk assessment mailed Quality score: 2.66 Alcohol: N/A Self efficacy: N/A
  Intensity: 1 off risk information sheet and 1 individually tailored behavior change info   Physical activity: No Stage of change: No
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Computer    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Miller CK, Edwards L, Kissling G, Sanville L [45] Evaluation of a theory-based nutrition intervention for older adults with diabetes mellitus Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: Yes
  Intervention type: Group education Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: 10 group education sessions Quality score: 2.33 Alcohol: N/A Self efficacy: Yes
  Intensity: 10 weekly group sessions   Physical activity: N/A Stage of change: N/A
  Intensity score: H   Weight: N/A Patient activation: N/A
  Provider: Dietician    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Oenema A, Brug J, Dijkstra A, de Weerdt I, de Vries H [61] Efficacy and use of an internet-delivered computer-tailored lifestyle intervention, targeting saturated fat intake, physical activity and smoking cessation: a randomized controlled trial Study type: Randomised Controlled Trial Smoking: No Patient knowledge: N/A
  Intervention type: Computer Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: Internet-delivered, computer-tailored lifestyle intervention Quality score: 2.5 Alcohol: N/A Self efficacy: N/A
  Intensity: 1 month   Physical activity: Yes Stage of change: No
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider:    Shared decision making: N/A
  Computer    Other health literacy outcome: N/A
Authors: Ogden J, Hoppe R [62] The relative effectiveness of two styles of educational package to change practice nurses’ management of obesity Study type: Before and After Study Smoking: N/A Patient knowledge: N/A
  Intervention type: Motivational interviewing and counseling Quality rating: Medium Nutrition: N/A Patient skills: Yes
  Description: Individual consultation + advice by nurse Quality score: 2.0 Alcohol: N/A Self efficacy: N/A
  Intensity: One consultation   Physical activity: N/A Stage of change: N/A
  Intensity score: L   Weight: No Patient activation: N/A
  Provider: Nurse    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Simmons D, Voyle JA, Fout F, Feot S, Leakehe L [63] Tale of two churches: Differential impact of a church-based diabetes control programme among Pacific Islands people in New Zealand Study type: Non-Randomised Controlled Trial Smoking: N/A Patient knowledge: Yes
  Intervention type: Group education Quality rating: High Nutrition: N/A Patient skills: N/A
  Description: Tailored activities by language & culture relevance & cooking classes Quality score: 2.66 Alcohol: N/A Self efficacy: N/A
  Intensity: NR   Physical activity: No Stage of change: Yes
  Intensity score: NR   Weight: Yes Patient activation: N/A
  Provider: Lay worker    Shared decision making: N/A
     Other health literacy outcome: No
Authors: Ryan A, Smith C [64] Change for Life/Cambia tu vida: a health promotion program based on the stages of change model for African descendent and Latino adults in New Hampshire Study type: Before and After Study Smoking: N/A Patient knowledge: N/A
  Intervention type: Group education Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Group education targeting participants stage of change + culturally appropriate written resources + decision tree Quality score: 2.33 Alcohol: N/A Self efficacy: N/A
  Intensity: six 2-h classes held weekly, followed by periodic group support meetings after the series of classes is completed   Physical activity: N/A Stage of change: Yes
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Multi-disciplinary team (Researcher, lay worker)    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Steptoe A, Rink E, Kerry S [65] Psychosocial predictors of changes in physical activity in overweight sedentary adults following counseling in primary care Study type: Randomised Controlled Trial Smoking: No Patient knowledge: N/A
  Intervention type: Motivational interviewing and counseling Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Individual brief counseling by a nurse (1–3 sessions) Quality score: 2.33 Alcohol: N/A Self efficacy: Yes
  Intensity: 1–3 sessions   Physical activity: Yes Stage of change: Yes
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Nurse    Shared decision making: N/A
     Other health literacy outcome: No
Authors: Toobert DJ, Glasgow RE, Strycker LA, Barrera M, Ritzwoller DP, Weidner G [46] Long-term effects of the Mediterranean lifestyle program: a randomized clinical trial for postmenopausal women with type 2 diabetes (Provisional abstract) Study type: Randomised Controlled Trial Smoking: No Patient knowledge: N/A
  Intervention type: Group education Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: 2.5 day non residential education + weekly meetings for 6 months with small group support Quality score: 2.33 Alcohol: N/A Self efficacy: Yes
  Intensity: 2.5 day non residential education + weekly meetings for 6 months with small group support   Physical activity: Yes Stage of change: N/A
  Intensity score: H   Weight: N/A Patient activation: N/A
  Provider: Multi-disciplinary team (Dietician, exercise physiologist, educator, lay worker)    Shared decision making: N/A
     Other health literacy outcome: Yes
Authors: Hoffman AM, Redding CA, Goldberg D, Añel D, Prochaska JO, Meyer PM, et al [66] Computer expert systems for African-American smokers in physicians offices: A feasibility study Study type: Randomised Trial Smoking: Yes Patient knowledge: N/A
  Intervention type: Mixed intervention Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Computer feedback with nurse + stage based RF manual + 3–6 min audio-tapes + stress management exercise instructions Quality score: 2.0 Alcohol: N/A Self efficacy: N/A
  Intensity: Interactive computer sessions (number uncertain) and brief audiotapes   Physical activity: N/A Stage of change: Yes
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Computer    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Wolf RL, Lepore SJ, Vandergrift JL, Basch CE, Yaroch AL [67] Tailored telephone education to promote awareness and adoption of fruit and vegetable recommendations among urban and mostly Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: Yes
  Intervention type: Telephone Quality rating: High Nutrition: N/A Patient skills: N/A
  Description: Telephone individual education & mailed brochure Quality score: 2.66 Alcohol: N/A Self efficacy: N/A
  Intensity: 2 calls and mailed brochure   Physical activity: N/A Stage of change: Yes
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Other    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Swerissen H, Belfrage J, Weeks A, Jordan L, Walker C, Furler J, et al [68] A Randomized Controlled Trial of Financial Incentives for Smoking Cessation Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Group education Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Language specific SM Program + audiocassette + program booklet Quality score: 2.0 Alcohol: N/A Self efficacy: Yes
  Intensity: 6 weekly 2.5 h sessions. 20 h training for peer leaders   Physical activity: Yes Stage of change: N/A
  Intensity score: H   Weight: N/A Patient activation: N/A
  Provider: Lay worker    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Campbell J, Aday RH [69] Improving dietary behavior: the effectiveness of tailored messages in primary care settings Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Written material Quality rating: High Nutrition: Yes Patient skills: N/A
  Description: Computer generated tailored nutrition newsletters & profile feedback related to stage of change Quality score: 3.0 Alcohol: N/A Self efficacy: N/A
  Intensity: one-time, mailed nutrition information packet   Physical activity: N/A Stage of change: Yes
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Computer    Shared decision making: N/A
     Other health literacy outcome: Yes
Authors: Collins R, Lee RE, Albright CL, King AC [47] Ready to be Physically Active? The Effects of a Course Preparing Low-Income Multiethnic Women to be more Physically Active Study type: Before and After Study Smoking: N/A Patient knowledge: Yes
  Intervention type: Group education Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Group Education + culturally sensitive curriculum Quality score: 2.16 Alcohol: N/A Self efficacy: No
  Intensity: 10 mth intervention   Physical activity: Yes Stage of change: Yes
  Intensity score: H   Weight: N/A Patient activation: N/A
  Provider: Educator    Shared decision making: N/A
     Other health literacy outcome: Yes
Authors: Gladys Block PW, Rochelle Mandel, Diane Metz, Mary L Fujii, Nancy Feldman, and Barbara Sutherland [70] A Randomized Trial of the Little by Little CD-ROM: Demonstrated Effectiveness in Increasing Fruit and Vegetable Intake in a Low-income Population Study type: Randomised Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Computer Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: Self Guided interactive computer program + goal setting + handouts Quality score: 2.33 Alcohol: N/A Self efficacy: N/A
  Intensity: CD ROM and 2 reminder phone calls   Physical activity: N/A Stage of change: Yes
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Computer    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Koffman DM BT, Mosca L, Redberg R, Schmid T, Wattigney WA [71] An evaluation of Choose to Move 1999: an American Heart Association physical activity program for women. Study type: Before and After Study Smoking: N/A Patient knowledge: Yes
  Intervention type: Written material Quality rating: Low Nutrition: Yes Patient skills: N/A
  Description: written materials + Postcards + Email + Newsletter Quality score: 1.5 Alcohol: N/A Self efficacy: N/A
  Intensity: 12-week, mail-mediated lifestyle intervention program   Physical activity: Yes Stage of change: N/A
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Other    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Marcus BH BB, Pinto BM, Forsyth LH, Roberts MB, Traficante RM [72] Efficacy of an individualized, motivationally-tailored physical activity intervention Study type: Randomised Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Written material Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Tailored counseling messages using “computer expert system” + motivationally matched manuals + feedback on progress were mailed to subjects Quality score: 2.16 Alcohol: N/A Self efficacy: Yes
  Intensity: NR   Physical activity: Yes Stage of change: Yes
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Other    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Prochaska JO, Velicer WF, Redding C, Rossi JS, Goldstein M, DePue J, et al [73] Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms Study type: Randomised Controlled Trial Smoking: Yes Patient knowledge: N/A
  Intervention type: Written material Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: Mailed computer generated profile reports (stage of change, use of change processes, pros & cons of changing) + self help manual + strategies on how to progress stages Quality score: 2.33 Alcohol: N/A Self efficacy: N/A
  Intensity: 3 reports mailed for each risk factor   Physical activity: N/A Stage of change: Yes
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Computer    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Prochaska JO, Velicer WF, Rossi JS, Redding CA, Greene GW, Rossi SR, et al [74] Multiple Risk Expert Systems Interventions: Impact of Simultaneous Stage-Matched Expert System Interventions for Smoking, High-Fat Diet, and Sun Exposure in a Population of Parents Study type: Randomised Controlled Trial Smoking: Yes Patient knowledge: N/A
  Intervention type: Written material Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: Mailed computer generated profile reports (stage of change, use of change processes, pros & cons of changing) + self help manual + strategies on how to progress stages Quality score: 2.16 Alcohol: N/A Self efficacy: N/A
  reports for each of their relevant behaviors at 0, 6, and 12 months as well as a multiple behavior manual.   Physical activity: N/A Stage of change: Yes
  Intensity: Received 3 reports per year   Weight: N/A Patient activation: N/A
  Intensity score: L    Shared decision making: N/A
  Provider: Computer    Other health literacy outcome: N/A
Authors: Beresford SA SJC, A R Kristal, D Lazovich, Z Feng and E H Wagner [34] A dietary intervention in primary care practice: the Eating Patterns Study. Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Written material Quality rating: High Nutrition: Yes Patient skills: No
  Description: Self help materials Quality score: 2.66 Alcohol: N/A Self efficacy: N/A
  Intensity: Low intensity – time not stated   Physical activity: N/A Stage of change: No
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Doctor    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Marcus B H Emmons KM, Simkin-Silverman L R, Linnan L A, Taylor E R, Bock B C, Roberts M B, Rossi J S, Abrams D B [75] Evaluation of motivationally tailored vs standard self-help physical activity interventions at the workplace Study type: Randomised Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Written material Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Repeated mailing (3 times) Self-help manuals + motivational messages related to stage of change Quality score: 2.0 Alcohol: N/A Self efficacy: N/A
  Intensity: 3 lots of written material   Physical activity: No Stage of change: Yes
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Other    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Graham-Clarke P, Oldenburg B [76] The effectiveness of a general-practice-based physical activity intervention on patient physical activity status Study type: Randomised Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Motivational interviewing and counseling Quality rating: High Nutrition: N/A Patient skills: N/A
  Description: Lifestyle counseling - Fresh Start Program by Heart Foundation Quality score: 2.66 Alcohol: N/A Self efficacy: N/A
  Intensity: NR   Physical activity: No Stage of change: Yes
  Intensity score: NR   Weight: N/A Patient activation: N/A
  Provider: Doctor    Shared decision making: N/A
     Other health literacy outcome: No
Authors: O’Loughlin, Jennifer Paradis, Gilles Meshefedjian, Garbis Kishchuk, Natalie [77] Evaluation of an 8-Week Mailed Healthy-Weight Intervention Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: Unsure
  Intervention type: Written material Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: 8-Week Mailed Healthy-Weight Intervention Quality score: 2.33 Alcohol: N/A Self efficacy: No
  Intensity: 18 pamphlets mailed over 8 weeks   Physical activity: Unsure Stage of change: No
  Intensity score: M   Weight: No Patient activation: No
  Provider: Other    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Winkleby MA, Howard-Pitney B, Albright CA, Bruce B, Kraemer HC, Fortmann SP [48] Predicting achievement of a low-fat diet: a nutrition intervention for adults with low literacy skills Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: Yes
  Intervention type: Mixed intervention Quality rating: High Nutrition: Yes Patient skills: N/A
  Description: Group education (Stanford Nutrition Action Program) + multiple mail/telephone follow up calls Quality score: 2.66 Alcohol: N/A Self efficacy: Yes
  Intensity: six or seven 60-min sessions classes   Physical activity: N/A Stage of change: N/A
  Intensity score: H   Weight: No Patient activation: N/A
  Provider: Educator    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Agurs-Collins, TD, Kumanyika, SK, Ten Have, TR, Adams-Campbell, LL [49] A randomised controlled trial of weight reduction and exercise for diabetes management in older African-American subjects. Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: Unsure
  Intervention type: Mixed intervention Quality rating: Medium Nutrition: No Patient skills: N/A
  Description: 6 group sessions, 1 individualised counseling + diary Quality score: 2.16 Alcohol: N/A Self efficacy: N/A
  Intensity: 12 weekly group sessions, 1 individual session and 6 bi-weekly group sessions   Physical activity: No Stage of change: Unsure Not reported
  Intensity score: H   Weight: Yes Patient activation: N/A
  Provider: Multi-disciplinary team (Dietician, exercise physiologist)    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Butler, CC, Rollnick, S, Cohen, D et al, [78] Motivational consulting versus brief advice for smokers in general practice: a randomized trial Study type: Randomised Trial Smoking: Yes Patient knowledge: N/A
  Intervention type: Motivational interviewing and counseling Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Motivational Counselling + patient setting targets Quality score: 2.0 Alcohol: N/A Self efficacy: N/A
  Intensity: NR   Physical activity: N/A Stage of change: Yes
  Intensity score: NR   Weight: N/A Patient activation: N/A
  Provider: Doctor    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Calfas, KJ, Sallis, JF, Oldenburg, B et al, [35] Mediators of change in physical activity following an intervention in primary care: PACE Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Motivational interviewing and counseling Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Motivational counseling + patient setting goals + activity log + examples of activities Quality score: 2.33 Alcohol: N/A Self efficacy: No
  Intensity: Brief intervention   Physical activity: Yes Stage of change: Yes
  \Intensity score: L   Weight: N/A Patient activation: N/A
  Provider:    Shared decision making: N/A
  Doctor    Other health literacy outcome: No
Authors: Delichatsios, HK, Hunt, MK, Lobb, R et al, [50] EatSmart: efficacy of a multifaceted preventive nutrition intervention in clinical practice Study type: Clustered Smoking: N/A Patient knowledge: N/A
  Intervention type: Mixed intervention Randomised Controlled Trial Nutrition: Yes Patient skills: N/A
  Description: Tailored recommendations & stage matched booklets by mail + Motivational Counseling + personalized letter + physician endorsement + option of referral to counselor Quality rating: Medium Alcohol: N/A Self efficacy: N/A
  Intensity: 1 mailed information, verbal endorsement by provider and 2 motivational sessions with phone counsellor. Dietitian consult offered Quality score: 2.33 Physical activity: N/A Stage of change: Yes
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Multi-disciplinary team (GP, counselor)    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Fries,E, Edinboro, P, McClish, D, Manion, L, Bowen, D, Beresford, SAA, Ripley, J [79] Randomized trial of a low-intensity dietary intervention in rural residents: the Rural Physician Cancer Prevention Project. Study type: Randomised Trial Smoking: N/A Patient knowledge: No
  Intervention type: Mixed intervention Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: A series of tailored feedback, brief telephone counseling + booklets Quality score: 2.16 Alcohol: N/A Self efficacy: No
  Intensity: Feedback, 1 phone call and 4 booklets mailed weekly   Physical activity: N/A Stage of change: N/A
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Doctor    Shared decision making: N/A
     Other health literacy outcome: No
Authors: Lancaster, T, Dobbie, W, Vos, K et al [51] Randomized trial of nurse-assisted strategies for smoking cessation in primary care Study type: Randomised Trial Smoking: No Patient knowledge: N/A
  Intervention type: Motivational interviewing and counseling Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Brief advice by a doctor followed by extended counseling from a nurse Quality score: 2.16 Alcohol: N/A Self efficacy: N/A
  Intensity: 6 weeks   Physical activity: N/A Stage of change: No
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Nurse    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Little, P, Dorward, M, Gralton, S, Hammerton, L, Pillinger, J, White, P et al. [80] A randomised controlled trial of three pragmatic approaches to initiate increased physical activity in sedentary patients with risk factors for cardiovascular disease. Study type: Randomised Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Mixed intervention Quality rating: High Nutrition: N/A Patient skills: N/A
  Description: Exercise Prescription provide by GP + counseling by practice nurses and booklet Quality score: 2.83 Alcohol: N/A Self efficacy: N/A
  Intensity: Brief intervention with GP, 1 counseling session with nurse and material   Physical activity: Yes Stage of change: Yes
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Multi-disciplinary team (GP, nurse)    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Naylor, PJ, Simmonds, G, Riddoch, C et al. [81] Comparison of stage-matched and unmatched interventions to promote exercise behaviour in the primary care setting Study type: Randomised Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Mixed intervention Quality rating: Low Nutrition: N/A Patient skills: N/A
  Description: General advice and written materials or counseling and 4 staged booklets or 4 staged booklets and action planner for all groups Quality score: 1.66 Alcohol: N/A Self efficacy: No
  Intensity: Single contact interventions   Physical activity: No Stage of change: Yes
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Nurse    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Siero, FW, Broer, J, Bemelmans, WJ, Meyboom-de Jong, BM [52] Impact of group nutrition education and surplus value of Prochaska-based stage-matched information on health-related cognitions and on Mediterranean nutrition behavior. Study type: Randomised Controlled Trial Smoking: N/A Patient knowledge: N/A
  Intervention type: Group education Quality rating: Medium Nutrition: Yes Patient skills: N/A
  Description: Group education + booklets (core information) Quality score: 2.16 Alcohol: N/A Self efficacy: No
  Intensity: 3 sessions of 2 h each   Physical activity: N/A Stage of change: Yes
  Intensity score: M   Weight: N/A Patient activation: N/A
  Provider: Educator    Shared decision making: N/A
     Other health literacy outcome: Yes
Authors: Slama K, Redman S, Perkins J et al [82] The effectiveness of two smoking cessation programmes for use in general practice: a randomised controlled trial. Study type: Randomised Controlled Trial Smoking: Yes Patient knowledge: N/A
  Intervention type: Written material Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Asked if a smoker and given a brochure Quality score: 2.0 Alcohol: N/A Self efficacy: N/A
  Intensity: Brief   Physical activity: N/A Stage of change: N/A
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Doctor    Shared decision making: N/A
     Other health literacy outcome: N/A
Authors: Lennox AS, Osman LM, Reiter E, Robertson R, Friend J, McCann I, Skatun D, Donnan PT [83] Cost effectiveness of computer tailored and non-tailored smoking cessation letters in general practice: randomised controlled. Study type: Randomised Controlled Trial Smoking: Yes Patient knowledge: N/A
  Intervention type: Written material Quality rating: Medium Nutrition: N/A Patient skills: N/A
  Description: Tailored letter Quality score: 2.16 Alcohol: N/A Self efficacy: N/A
  Intensity: Brief   Physical activity: N/A Stage of change: Yes
  Intensity score: L   Weight: N/A Patient activation: N/A
  Provider: Computer    Shared decision making: N/A
     Other health literacy outcome: N/A