title: Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have?
abstract: Self-management-based interventions can lead to improved health outcomes in people with chronic diseases, and multiple patient characteristics are associated with the development of self-management behaviors. Low health literacy (HL) has been implicated in poorer self-management behaviors and increased costs to health services. However, the mechanisms behind this relationship remain unclear. Therefore, the aim of the current review is to assess the association between HL and patient characteristics related to self-management behaviors (i.e., disease-related knowledge, beliefs, and self-efficacy).
  
  
  
  The review comprised 3 phases: 1) database searches, 2) eligibility screening, and 3) study quality assessment and strength of evidence. Inclusion criteria specified that a valid HL screening tool was used, that at least one self-management behavior was assessed, and that patients had a chronic condition.
  
  
  
  An initial search generated a total of 712 articles, of which 31 studies fulfilled the eligibility criteria. A consistent association was found between low HL and poorer disease-related knowledge in respiratory diseases, diabetes, and multiple disease categories. A significant association between low HL and poorer self-efficacy was reported in cardiovascular diseases, diabetes, human immunodeficiency virus, and multiple disease categories. HL was significantly associated with poorer beliefs in respiratory, musculoskeletal, and cardiovascular diseases.
  
  
  
  The findings from the current review suggest that low HL may affect behaviors necessary for the development of self-management skills. Given that self-management strategies are core components for effective treatment of a range of chronic diseases, low HL poses a considerable health concern. Further research is needed to understand the mediating influence of HL on disease-related knowledge, self-efficacy, and beliefs. From this, HL-sensitive, self-management interventions ought to be devised and implemented.
authors.affiliation: University College Dublin, Belfield, Dublin, Ireland (LMM, CD, BMF)
authors.forename: Laura M
authors.initials: LM
authors.lastname: Mackey
authors.affiliation: University College Dublin, Belfield, Dublin, Ireland (LMM, CD, BMF)
authors.forename: Catherine
authors.initials: C
authors.lastname: Doody
authors.affiliation: Department of General Practice, Institute of Health and Society, University of Oslo, Norway (ELW)|Research Unit for General Practice, Uni Health, Bergen, Norway (ELW)
authors.forename: Erik L
authors.initials: EL
authors.lastname: Werner
authors.affiliation: University College Dublin, Belfield, Dublin, Ireland (LMM, CD, BMF)|UCD Centre for Translational Pain Research, Dublin, Ireland (BMF)
authors.forename: Brona
authors.initials: B
authors.lastname: Fullen
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D019468:Disease Management; D057220:Health Literacy; D006801:Humans; D012648:Self Care; D020377:Self Efficacy
keywords: beliefs; chronic disease; health literacy; self-efficacy; self-management