title: Effective intervention strategies to improve health outcomes for cardiovascular disease patients with low health literacy skills: a systematic review.
abstract: OBJECTIVE
  Systematic studies on the relationship between health literacy and health outcomes demonstrate that as health literacy declines, patients engage in fewer preventive health and self-care behaviors and have worse disease-related knowledge. The purpose of this study was to identify effective intervention strategies to improve health outcomes in patients with cardiovascular disease and low literacy skills.
  
  
  METHODS
  This study employs the following criteria recommended by Khan Kunz, Keijnen, and Antes (2003) for systematic review: framing question, identifying relevant literature, assessing quality of the literature, summarizing the evidence, and interpreting the finding. A total of 235 articles were reviewed by the research team, and 9 articles met inclusion criteria. Although nine studies were reviewed for their health outcomes, only six studies, which had a positive quality grade evaluation were used to recommend effective intervention strategies.
  
  
  RESULTS
  Interventions were categorized into three groups: tailored counseling, self-monitoring, and periodic reminder. The main strategies used to improve health outcomes of low literacy patients included tailored counseling, improved provider-patient interactions, organizing information by patient preference, self-care algorithms, and self-directed learning. Specific strategies included written materials tailored to appropriate reading levels, materials using plain language, emphasizing key points with large font size, and using visual items such as icons or color codes.
  
  
  CONCLUSIONS
  With evidence-driven strategies, health care professionals can use tailored interventions to provide better health education and counseling that meets patient needs and improves health outcomes.
authors.affiliation: Department of Nursing Environment Systems, Yonsei University, Seoul, South Korea.
authors.forename: Tae Wha
authors.initials: TW
authors.lastname: Lee
authors.affiliation: Heath Technology Assessment Department, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea.
authors.forename: Seon Heui
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Nursing, Armed Forces Nursing Academy, Daejeon, South Korea.
authors.forename: Hye Hyun
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Nursing, Daegu University, Daegu, South Korea. Electronic address: kangsj@daegu.ac.kr.
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Kang