37 EVIDENCE SYNTHESIS Following the quality assessment, MDB performed an evidence synthesis, which was checked by AFW. The synthesis aimed to determine the strength of evidence regarding an association of LHL with a specific mediating factor or, regarding the effectiveness of targeting a factor in interventions, based on number and quality of studies reporting results. This method of evidence synthesis is based on other publications[31,32]. The synthesis led to three levels of strength of evidence for the existence of an association or effective intervention target: (1) strong: consistent findings in one high-quality study and at least two moderate-quality studies; (2) moderate: consistent findings in at least three studies, of lower quality than (1); and (3) weak: inconsistent findings irrespective of study quality, or less than three studies available. Abstract screened (n=551) Records excluded (n = 449) Records after duplicates removed (n = 551) Full-text articles assessed for eligibility (n = 61) INCLUDED ELIGIBILITY SCREENING IDENTIFICATION Records identified through database searching Medline = 259 Web of Science = 318 Embase = 283 (n = 860) Full-text articles excluded, with reasons (n = 54) No health literacy screener Not about health literacy and mediating factors Publication type Unfinished study Studies included (n = 48) Included after full-text assessment (n = 7) Directly included (n = 41) Figure 2.1 PRISMA flow diagram describing the search and record review process for this study
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