The Prevalence and Risk Factors of Limited Health Literacy in Iran: A Systematic Review and Meta-Regression Analysis

There is a requisite need to document the health literacy status and its determinants for making recommendations for public health promotions. The aim of this study was to determine the prevalence of limited health literacy and its associated factors in Iranian studies. Search queries were made in PubMed, SCOPUS, SID, Irandoc, IranMedex, and Magiran from 2000 to 1 April 2016. The quality of the selected studies was assessed using the Critical Appraisal Skills Program checklists. Thirty one original papers were incorporated into the systematic review. We conducted a meta-analysis using a random effects model. All analysis were performed using comprehensive meta-analysis [CMA] V.2 statistical software. Thirty-one papers were reviewed including data on 28,138 subjects and reporting a prevalence of low health literacy between 4.8% and 79.9%. Pooled analysis of these data showed that the weighted prevalence of low health literacy was 37.01% (95% confidence interval [CI]: 36.97%, 37.04%) and of marginal health, literacy was 30.76% (95% CI: 30.72%, 30.79%). Low educational levels, old age, poor employment situation, and low economic status were the most important determinants of limited health literacy. In the multivariate meta-regression model, the years of the studies were significantly associated with health literacy prevalence rates. Only a third of the population had adequate health literacy and health literacy was poor among vulnerable groups such as the unemployed, older and less educated people. So, considering appropriate strategies for each of these groups could have a significant role in improving community health literacy.