43 Table 2.1 Study characteristics of descriptive quantitative studies and results on study quality and associations and findings within the health literacy – mediators - health outcomes pathway, organized by the Paasche-Orlow derived mechanisms Study Characteristics Study Results Study CKD-pop(N) Country Design Measure (% LHL) Q Mechanism(s) Association of health literacy with mediator within this mechanism(s) or other result related to mechanism Association of health literacy or mediator with health outcome? Studies with results on multiple mechanisms (n=18) Devraj et al., 2018(57) 1-4 (181) USA Crosssectional NVS1 (63%) + Self-care management Utilization of care Yes: CKD awareness with self-management behaviors No: LHL with CKD awareness or duration of participation in clinic. Yes: Worse kidney function associated with higher CKD awareness. No: LHL with severity of CKD Taylor et al. 2016(33) 5 (6842) United Kingdom Crosssectional SILS1 (14.6%) + Self-care management Utilization of care Yes: LHL with current smoking. Other: LHL is more prevalent in non-waitlisted incident dialysis (20%) patients than in waitlisted dialysis patients (15%). Transplant recipients have the lowest prevalence of LHL (12%). Yes: LHL with more comorbidities, long-term disabilities, depression and psychosis. Ricardo et al., 2014(8) 1-3 (2340) USA Crosssectional sTOFHLA1 -16% + Self-care management Utilization of care Yes: LHL with current smoking, perceived health and more frequent visits to the nephrologist No: LHL with medication use. Yes: LHL with lower eGFR, higher urine protein, more cardiovascular disease, more diabetes. Chen et al., 2018(70) 1-5 (410) Taiwan Crosssectional Mandarin HL scale1 (n.a.) +/- Self-care management Social context Yes: LHL with worse self-management behaviors and decreased function of social support. Social support associated with selfmanagement behaviors and treatment adherence. No results reported on health outcomes. Serper et al., 2018(40) 5(T) (98) USA Mixed methods NVS1 (37%) +/- Self-care management Social context Yes: LHL with choosing to spend money on expenses other than medication. These decisions were associated with lower medication adherence and explained by the social context Yes: Choosing to spend money on expenses other than medications with higher rates of hospital admission. Demian et al., 2016(62) 5(T) (96) Canada Crosssectional HL-Q1,2,3 (n.a.) +/- Self-care management Utilization of care P-P interaction Other: Multifaceted HL screener indicates: Actively managing health is the greatest HL challenge for transplant recipients, while navigating the health system, engaging with providers and understanding information are minor HL challenges. Yes: Appraising / understanding information associated with worse kidney health Jain et al. 2015(55) 5(D) (32) USA Crosssectional REALM1 (19%) +/- Self-care management Utilization of care No: LHL with treatment regimens, time on peritoneal dialysis or hospitalization. No: LHL with peritonitis, exit-site infections or dialysis adequacy.
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