The promotion of health literacy is critical to active and informed participation in health and healthcare  and is
identified as a key action to reduce health inequalities within the European Union . Health literacy may be
defined as a multi-level concept encompassing basic/functional literacy, communication/iterative literacy and
critical literacy . This paper reports on a rapid review of the evidence on the effectiveness of interventions to
improve health literacy with a specific focus on communicable diseases and interventions for disadvantaged
populations within the European region.
This review of reviews seeks to: identify and synthesise review-level evidence on effective strategies for improving
health literacy, highlight gaps in the evidence and provide recommendations.
Five evidence reviews, published between the years 2000 and 2010, were identified. The vast majority of the
intervention studies concerned written health information and/or use of other formats such as audiovisual material.
The studies reviewed were predominantly located in North America and encompassed a very broad range of health
concerns. No studies fell within the categories of low-literacy initiatives or targeted mass media campaigns. The
only studies included in the reviews that referred to communicable diseases concerned HIV, and all three of these
had medication adherence as an outcome of the intervention. The review exposed a paucity of research
concerning disadvantaged or hard-to-reach groups.
Most interventions identified in the reviews focus on the functional level of health literacy and work at the
traditional health education level. There is little evidence of interventions targeted at the interactive or critical
levels of health literacy. Not all reviews identified whether the study results were stratified across literacy levels,
but from those that did, it is clear that few of the studies provided this analysis. Without such information it is
impossible to measure impacts on people with varying levels of health literacy and to effectively target
interventions to reduce disparities and inequalities. Two of the five reviews reported on the quality assessment of
the included studies. In one, only half the studies achieved the ‘good’ benchmark, while four of five did so in the
other review. The lack of information from the other reviews leaves the issue of quality of evidence subject to
There are considerable gaps in the evidence reviewed concerning which interventions are most effective in
improving health literacy, particularly with regard to communicable diseases and studies conducted in Europe.
Further research is needed on the impact of health literacy interventions in the public health field, paying particular
attention to evaluating communication about communicable diseases, and determining the most effective
strategies for meeting the needs of population groups with low literacy levels, and those who are vulnerable,
disadvantaged and hard to reach.