Interventions to promote health literacy among working-age populations experiencing socioeconomic disadvantage: systematic review

Background

Experiencing financial insecurity and being underserved is often associated with low health literacy, i.e., the ability to identify, obtain, interpret and act upon health information, which may result in poor health outcomes. Little is known about effective interventions for promoting health literacy among underserved populations. The objective of this systematic review is to summarize the literature on such interventions and identify characteristics that differentiate more effective interventions.

Methods

Following PRISMA guidelines we searched the databases SCOPUS, Pubmed, Web of Science core collection and CINAHL. We included primary studies with a quantitative study design and control groups testing interventions to increase health literacy or health knowledge in underserved populations between 18 and 65 years. Where possible, we converted effect sizes into Cohen's d and compared mean differences of intervention and control groups. Albatross plots were created to summarize the results according to different health literacy and health knowledge outcomes.

Results

We screened 3,696 titles and abstracts and 206 full texts. In total, 86 articles were analyzed, of which 55 were summarized in seven albatross plots. The majority of the studies (n = 55) were conducted in the United States and had a randomized controlled study design (n = 44). More effective intervention approaches assessed needs of participants through focus group discussions prior to conducting the intervention, used bilingual educational materials, and included professionals fluent in the first languages of the study population as intervention deliverers. Additionally, the use of educational materials in video and text form, fotonovelas and interactive group education sessions with role playing exercises were observed to be effective.

Discussion

Although the outcomes addressed in the included studies were heterogeneous, effective intervention approaches were often culturally sensitive and developed tailored educational materials. Interventions aiming to promote health literacy in underserved populations should hence consider applying similar approaches.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323801, PROSPERO registration ID: CRD42022323801.

Bilingualism and Development of Literacy in Children: A Systematic Review

Background

The importance of biliteracy in bilingual children's development has been widely investigated and discussed for the last several decades, suggesting beneficial effects of writing and reading in two languages for bilingual children as well as for adult second language learners.

Objective

To analyze research on the link between bilingualism and literacy development in two or more languages and the factors that may influence a successful or problematic biliteracy acquisition. RQ (1): What is the relationship between bilingualism and literacy of bilingual children? RQ (2): What strategies are used to develop biliteracy?

Design

The review analyzes 50 studies of literacy development in bilingual children. The selected articles have been separated based on their methodology: 25 articles gave a critical analysis of more than 1,100 studies on the topic, strengthening the theoretical basis of existing research, and 25 other articles were empirical research articles demonstrating practical evidence for the former.

Results

Our analysis revealed that literacy in bilinguals, or biliteracy, can be seen as a necessary condition for fluent development of bilingualism, though it is not a necessary condition (which is explained by the difference between structures of specific languages and writing systems, instruction in literacy, and cognitive baggage invoked by the task used to measure the skill) (Bialystok, 2002). Research suggests that bilingualism impacts children's ultimate acquisition of literacy via the beneficial effects of bilingualism overall: advanced biliteracy boosts the development of phonological and phonemic awareness and metacognitive abilities. Thus, biliteracy can be considered as an advantage in terms of maintaining bilingual acquisition in general and developing writing skills in particular.

Conclusion

There is a lack of studies on the development of writing skills in different educational contexts, across countries and cultures, which must be addressed and complemented by new empirical research. Research will enable policymakers to improve educational programs in accordance with the needs of bilingual children, who are the majority in the current global population.