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Table 4 Effective interventions for health literacy

From: A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors

Effective interventions Participants Setting Quality^ RCT SNAPW#
GROUP EDUCATION
4 to 5 group empowerment sessions over 7 months [22] Patients with diabetes from 7 primary care centres Community health H RCT  
*40 hour group education session over 4 weeks with participants following preset dietary goals [23] Mostly white American Other (Centre of Excellence) H RCT N, P, W
Church-based program tailored and culturally relevant that included awareness raising activities and exercise and cooking classes over 2 years [24] Samoan and Tongan Community H   W
*Language specific self management program of 2.5 hour weekly sessions for 6 weeks with audiocassette and booklet [25] Greek, Vietnamese, Chinese and Italian Community M RCT P
Culturally sensitive curriculum in small and large groups and support over 10 months [26] Mexican American/Latina women of low socio-economic, low education Community M   P
2.5 day program then weekly group education over 6 months and small group support [27] Mostly Caucasian Primary Care clinic M RCT N, P
*Chronic disease self management group program of 15 hours over 6 weeks [28] Mostly Mexican born, low socio-economic, low education Community M   N, P
*Small groups that met for an hour one night a week for 16 weeks and then every second week for a further 8 weeks [29] Mean age 46 yrs Community M RCT P
Monthly group meetings over 6 months and an additional individual session if requested by patient or needed [30] Mostly white American Primary care M   N
Classes and follow-up phone calls over 1 year [31] Women 20 to 50 yrs Community M   
*10 weekly group education sessions [32] Mean age around 73 Hospital outpatient M RCT  
*6 × 2 hour classes targeting stage of change and culturally appropriate resources and decision tree with periodic group support meetings after the class series [33] Mostly Latino then African American, low socio-economic, low education Community M   
3 × 2 hr Prochaska-based stage matched group education sessions [34] Low socio-economic and education Primary care M RCT N
WRITTEN MATERIALS
*Computer generated tailored nutrition newsletters & profile feedback related to stage of change [35] Majority African Americans General practice H RCT N
3 iterative letters [36] Educated, mean age 49 yrs Community M RCT N, P
*3 repeated mailings of self help manuals and motivational messages related to stage of change [37] Mostly Caucasian Community M   P
1 tailored or non-tailored letter [38] Smokers aged 17 to 65 yrs General practice M RCT S
*12 week mailed lifestyle intervention program [39] Primarily Caucasian women Community L   P
3 computer generated reports based on stage of change for each risk factor [40] Mostly Caucasian Primary care M RCT S, N
3 computer generated reports based on stage of change for each risk factor [41] Mostly Caucasian Community M RCT S, N
INDIVIDUAL COUNSELING
Lifestyle counseling by a doctor with video and written materials [42] Mean age about 53 yrs Primary health care H   
Exercise prescription provided by GP, 1 counseling session with nurse and materials [43] Mean age 59 yrs Primary health care H   P
1–3 individual brief counseling by a nurse [44] Low socio-economic, low education Primary health care M RCT P
One individual consultation by a nurse [45] Practice nurses and their patients Primary health care M   
One individual counseling by a registrar [46] Mean age 41 yrs Primary health care M   
*One motivational counseling and patient setting targets [47] Mostly female Primary health care M RCT P
*Two individual counseling sessions by a physician and two follow-up phone calls [48] Hypertension and/or hypercholesterolemia and/or non insulin dependent diabetes General practice M RCT P
*12 to 20 week individual counseling for COPD patients [49] Scandinavian Primary health care L RCT S, P
MULTIPLE INTERVENTIONS
6 or 7 × 60min classes and multiple mail/telephone follow-up calls (Stanford Nutrition Action Program) [50] Mostly Hispanic born in the US, poor, low education and literacy Community H RCT N
*1 mailing of stage based booklets with provider endorsement and 2 motivational phone counseling sessions [51] Majority Caucasian General practice M RCT N
*Interactive computer sessions with feedback from a nurse, a risk factor manual, brief audio tapes, stress management and exercise instructions [52] Mostly African American Primary health care M   S
Group education sessions with individual counseling [53] 47% high school education or greater General practice M RCT W
Various interventions designed by neighbourhood coalitions that have GP representation [54] Low socio-economic, low education Community M   N
Stages of change based and counseling and written materials provided by a nurse [55] Mostly female (70%) mean age 42.4 yrs General practice L   P
Range of health promotion activities by lay community members [56] Japanese. Age range 30 to 59 yrs Community M   N, P
TELEPHONE
Two individual education sessions over the phone plus a mailed brochure [57] Mostly middle aged, married, Non Hispanic black men Community H RCT  
6 months telephone counseling and exercise logs [58] Well educated Caucasian Community L   
COMPUTER
*Self guided interactive program with 2 reminder phone calls [59] Low socio economic, African and white American women Community M   N
  1. ^Quality of study H = High, M = Medium, L = Low; # SNAPW significant positive outcome reported, S = Smoking, N = Nutrition, A = Alcohol, P = Physical activity, W = Weight; *Follow-up < 6 months.