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Chronic diseases are a major global health burden, contributing to morbidity, mortality and healthcare costs. Self-care is essential for effective disease management, with health literacy (HL) and digital health literacy (eHL) playing a role in enabling individuals to engage in health-promoting behaviours. However, the relationship between HL and self-care remains inconclusive, necessitating further investigation to clarify its impact.
To synthesise evidence on the association between HL and self-care in chronic diseases and identify mediating and moderating factors influencing this relationship.
A systematic search was conducted across PubMed, CINAHL, PsycINFO, Embase, Web of Science and Cochrane CENTRAL, supplemented by manual reference checks and author correspondence.
This systematic review and meta-analysis followed PRISMA guidelines, including observational studies and RCTs assessing HL and self-care. Meta-analyses were performed using Fisher's Z transformation. Risk of bias was assessed using ROBINS-E and certainty of evidence was evaluated through GRADE.
A total of 138 studies were included, with 52 meta-analysed. Higher HL was associated with improved self-care behaviours, including medication adherence, disease monitoring and lifestyle modifications across chronic diseases, including type 2 diabetes, heart failure, hypertension, chronic kidney disease, asthma, coronary artery disease, arthritis and COPD. Psychological (self-efficacy, empowerment), cognitive (disease knowledge, decision-making) and social (healthcare communication, social support) factors mediated this relationship, while distress and depression moderated it. Meta-analysis revealed a moderate positive association between HL and self-care (r = 0.29, 95% CI: 0.26–0.31, p < 0.001). Subgroup analyses showed consistent positive effects across conditions. No significant publication bias was detected (Egger's test, p = 0.294). Risk of bias was high in 62 studies, while certainty of evidence ranged from very low to moderate.
HL positively influences self-care in chronic diseases, with its impact shaped by multiple mediators and moderators. Future interventions should integrate tailored education, digital tools and mental health support to enhance HL effectiveness.
PROSPERO (CRD42024488061, registered 20.01.2024).
Long covid affects over 36 million individuals in the European region, but its clinical profile is still poorly defined, particularly in the general population with less severe acute disease. This study aimed to assess the prevalence of a broad spectrum of symptoms potentially linked to long covid in the general population of Tuscany, Italy.
A cross-sectional study was conducted in January–February 2024 using Computer-Assisted Telephone Interviews in a representative population sample of Tuscany. Based on the WHO questionnaire long covid symptom list, data on 33 symptoms experienced in the past 6 months were collected, along with demographic and clinical characteristics. After excluding patients with COVID-19 within the past 6 months and those failing a screening cognitive test, symptom prevalence and ORs adjusted for sex, time since infection, smoking and concurrent diseases (aOR) were calculated according to COVID-19 history.
After excluding 129 failing the cognitive test (6.4%) and 123 recent COVID cases (6.1%), among 1753 participants interviewed, 1013 (57.8%) had a history of COVID-19. The symptoms significantly more prevalent in individuals with previous COVID-19 were fatigue (12.8% vs 8.9%, aOR 1.6 (95% CI 1.2 to 2.2)), concentration impairment (5.5% vs 2.4%, aOR 2.2 (95% CI 1.3 to 3.8)) and skin rashes (4.5% vs 2.4%, aOR 1.9 (95% CI 1.1 to 3.3)). Prevalences and ORs were higher in more recent COVID-19 cases, particularly females and individuals with concurrent diseases.
We identified in a population-based study some symptoms significantly more common in individuals with previous COVID-19. This approach complements data collected in clinical settings and in patients selected by greater disease severity. The findings may help future surveillance efforts and targeted public health interventions directed at optimising care pathways and mitigating long-term consequences.
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