Health literacy in rural and urban populations: A systematic review. Issue 10 (October 2020)

• Record Type: Journal Article
• Authors: Aljassim, Noor; Ostini, Remo
• Is Part Of: Patient education and counseling. Volume 103:Issue 10(2020)
• Page Start: 2142
• Page End: 2154
• Publication Date: 2020-10
• Subjects: Health literacy -- Rural -- Urban -- Health disparities -- Social determinants of health; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2020.06.007
• Languages: English
• ISSNs: 0738-3991

Abstract

Highlights: Urban populations tend to have higher health literacy than rural populations. Health literacy differences are more likely in developing countries. Differences are more likely when knowledge measures rather than direct measures of health literacy are used. Rurality is typically not a specific determinant of health literacy. Education, age, gender, SES and race/ethnicity have the strongest associations with health literacy in rural and urban areas. Abstract: Objective: This review assessed whether health literacy differences exist between rural and urban populations and whether rurality is a determinant. Methods: Eight online databases were searched using the keywords "health literacy", "rural" and "urban", and related terms. Peer-reviewed original research comparing health literacy levels between rural and urban populations were evaluated for strength of evidence. A narrative synthesis summarised the results of included studies. Results: Nineteen articles met inclusion criteria and were of sufficient methodological quality for data extraction. The majority of studies found that urban populations had higher health literacy than rural populations. Differences were more likely to be found in developing than developed countries. Studies that performed covariate analysis indicated that rurality may not be a significant determinant of health literacy. Conclusion: Evidence suggests that rurality alone does not explain rural-urban health literacy differences and that sociodemographic factors play important roles. Practice implications: These findings could be used to help inform the development of evidence-based interventions specifically for rural populations, at both health policy and clinical levels; for example, by tackling healthcare access challenges. The findings also provide a lens through which to consider efforts to reduce rural-urban health outcome disparities.