Application of theories/models of health education and promotion in Health Literacy research: a systematic review

Document Type : Systematic Review


1 Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.

2 PhD. Student, Department of Health Education & Health Promotion, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Professor, Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.


Background and objective:  Health literacy is one of the biggest and most important determinants of health in the world. The purpose of this study was to investigate studies based on models / theories of health education and health promotion in health literacy research in a systematic way.
Methods:In order to obtain Persian and English related documentation of internal databases (SID, Iranmedex, Magiran, IranDoc), foreign (ProQuest, Scopus, Web of Science, Medlib, PubMed) as well as Google Scholar search engine without restrictions based on PRISMA guideline for systematic reviews study. To avoid bias in the study, the search, selection of studies, qualitative evaluation and data extraction were done independently by two researchers. Any disagreement between the two researchers was examined by the third person and in the end, 14 articles with inclusion criteria were studied.
Results: In this study, three studies were done before and after the semi-experience. The results showed that after the intervention, the mean of health literacy score based on the patterns / theory in the experimental group significantly increased compared to the control group. Another 11 cross-sectional studies examined the predictive power of health literacy in patterns / theories. The results showed that health literacy increases the predictive power of pattern/ theory constructs in predicting the behavior. The studies were conducted in a variety of target groups such as patients, students, nurses, health volunteers and community members, and considered a different range of people. One of the most popular patterns/ theories in the studies was the self-efficacy theory.
Conclusion: The results showed that the use of different patterns/ theories along with health literacy can have a positive effect on health behaviors and depending on the purpose of the study, different patterns/ theories should be used. Based on the results obtained from all the patterns/ theories, one of the constructs and theories that were presented in most studies as the most important and strongest construct was the self-efficacy construct/theory that played an important role in the adoption of human health behavior. Therefore, it is necessary to use this construct in future intervention studies and to use an appropriate and effective strategy to increase the self-efficacy in individuals.
Paper Type:systematic review


1.    Kickbusch I, Nutbeam D. Health promotion glossary. Geneva: World Health Organization. 1998;14.
2.    Khodabandeh M, Avarasin SM, Nikniaz L. The Relationship between Health Literacy, Perceived Self-efficacy and Self-care Performance of Female Senior High School Students in Health Promoting Schools of Miyaneh, 2016-2017. Journal of Health Literacy. 2017;2(3):164-76.
3.    Kutner M, Greenburg E, Jin Y, Paulsen C. The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics. 2006.
4.    Speros C. Health literacy: concept analysis. Journal of advanced nursing. 2005;50(6):633-40.
5.    Paasche-Orlow MK, Wolf MS. The causal pathways linking health literacy to health outcomes. American journal of health behavior. 2007;31(1):S19-S26.
6.    Tavousi M, Haeri MA, Rafiefar S, Solimanian A, Sarbandi F, Ardestani M, et al. Health literacy in Iran: findings from a national study. Payesh. 2016.
7.    Aboumatar HJ, Carson KA, Beach MC, Roter DL, Cooper LA. The impact of health literacy on desire for participation in healthcare, medical visit communication, and patient reported outcomes among patients with hypertension. Journal of general internal medicine. 2013;28(11):1469-76.
8.    Haun JN, Patel NR, French DD, Campbell RR, Bradham DD, Lapcevic WA. Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study. BMC health services research. 2015;15(1):249.
9.    Manganello JA. Health literacy and adolescents: a framework and agenda for future research. Health education research. 2007;23(5):840-7.
10.    Javadzade M, Sharifirad G, Reisi M, Nasr Esfahani M, Mahaki B, Mostafavi F. Applying the theory of planned behavior to predicting nurse’s intention and behavior in using health literacy strategies in patient education. Iran Journal of Nursing. 2015;28(97):23-33.
11.    Tehrani H, Majlessi F, Shojaeizadeh D, Sadeghi R, Kabootarkhani MH. Applying socioecological model to improve women’s physical activity: a randomized control trial. Iranian Red Crescent Medical Journal. 2016;18(3).
12.    Larki A, Tahmasebi R, Reisi M. Factors Predicting Self-Care Behaviors among Low Health Literacy Hypertensive Patients Based on Health Belief Model in Bushehr District, South of Iran. International journal of hypertension. 2018;2018.
13.    Hejazi S, Peyman N, Tajfard M, Esmaily H. The Impact of Education Based on Self-efficacy Theory on Health Literacy, Self-efficacy and Self-care Behaviors in Patients With Type 2 Diabetes. Iranian Journal of Health Education and Health Promotion. 2017;5(4):296-303.
14.    Jahani Eftekhari M, Peyman N, Doosti H. The Effect of Educational Intervention based on the Self Efficacy and Health Literacy Theory on Health Promoting Lifestyles among Female Health Volunteers of Neyshabur, Iran. Journal of Health and Development. 2018;6(4):302-13.
15.    Panahi R, Ramezankhani A, Tavousi M, Niknami S, Elamin EAI, Suliman MA, et al. Adding Health Literacy to the Health Belief Model: Effectiveness of an Educational Intervention on Smoking Preventive Behaviors Among University Students. Iranian Red Crescent Medical Journal. 2018;20(2).
16.    Peyman N, Amani M, Esmaili H. The Relationship between Health Literacy and Constructs of Theory of Planned Behavior and Breast Cancer Screening Tests Performance among Women Referred to Health Care Centers in Roshtkhar, 2015. Iranian Quarterly Journal of Breast Diseases. 2016;9(3):60-9.
17.    Peyman N, Abdollahi M. The relationship between health literacy and self-efficacy physical activity in postpartum women. Journal of Health Literacy. 2016;1(1):5-12.
18.    Panahi R, Ramezankhani A, Tavousi M, HaeriMehrizi A, Niknami S. Reinforcing the performance of health belief model using health literacy in anticipating adoption of smoking preventive behaviors in university students. Journal of Health Literacy. 2018;3(1):39-49.
19.    Náfrádi L, Nakamoto K, Csabai M, Papp-Zipernovszky O, Schulz PJ. An empirical test of the Health Empowerment Model: Does patient empowerment moderate the effect of health literacy on health status? Patient education and counseling. 2018;101(3):511-7.
20.    Tseng H-M, Liao S-F, Wen Y-P, Chuang Y-J. Stages of change concept of the transtheoretical model for healthy eating links health literacy and diabetes knowledge to glycemic control in people with type 2 diabetes. Primary care diabetes. 2017;11(1):29-36.
21.    Lee Y-J, Shin S-J, Wang R-H, Lin K-D, Lee Y-L, Wang Y-H. Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus. Patient education and counseling. 2016;99(2):287-94.
22.    Bohanny W, Wu SFV, Liu CY, Yeh SH, Tsay SL, Wang TJ. Health literacy, self‐efficacy, and self‐care behaviors in patients with type 2 diabetes mellitus. Journal of the American Association of Nurse Practitioners. 2013;25(9):495-502.
23.    Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice: John Wiley & Sons; 2008.
24.    Li K, Kay NS. Correlates of Cigarette Smoking among Male Chinese College Students in China--A Preliminary Study. International Electronic Journal of Health Education. 2009;12:59-71.
25.    Mackert M, Guadagno M. The Health Belief Model and health literacy: The case of perfect knowledge. Health literacy: Developments, issues and outcomes. 2013:225-32.
26.    Ajzen I. The theory of planned behavior. Organizational behavior and human decision processes. 1991;50(2):179-211.
27.    Ajzen I. Perceived behavioral control, self‐efficacy, locus of control, and the theory of planned behavior 1. Journal of applied social psychology. 2002;32(4):665-83.
28.    Ko N-Y, Feng M-C, Chiu D-Y, Wu M-H, Feng J-Y, Pan S-M. Applying theory of planned behavior to predict nurses' intention and volunteering to care for SARS patients in southern Taiwan. The Kaohsiung journal of medical sciences. 2004;20(8):389-98.
29.    Lino S, Marshak HH, Herring RP, Belliard JC, Hilliard C, Campbell D, et al. Using the theory of planned behavior to explore attitudes and beliefs about dietary supplements among HIV-positive Black women. Complementary therapies in medicine. 2014;22(2):400-8.
30.    Allom V, Mullan B, Clifford A, Rebar A. Understanding supplement use: an application of temporal self-regulation theory. Psychology, health & medicine. 2018;23(2):178-88.
31.    Guénette L, Breton M-C, Guillaumie L, Lauzier S, Grégoire J-P, Moisan J. Psychosocial factors associated with adherence to non-insulin antidiabetes treatments. Journal of Diabetes and its Complications. 2016;30(2):335-42.
32.    Jannuzzi FF, Rodrigues RCM, Cornélio ME, São-João TM, Gallani MCBJ. Beliefs related to adherence to oral antidiabetic treatment according to the Theory of Planned Behavior. Revista latino-americana de enfermagem. 2014;22(4):529-37.
33.    Peyman N, Behzad F, Taghipour A, Esmaily H. Assessment of the effect of a health literacy educational program for health personnel on promoting self-efficacy among patients with chronic diseases. Journal of Health System Research. 2016;12(3).
34.    Solhi M, Kazemi SS, Haghni H. Relationship between general health and self-efficacy in women referred to health center No. 2 in Chaloos (2012). Razi Journal of Medical Sciences. 2013;20(109):72-9.
35.    Rifkin SB. Patient Empowerment: Increased Compliance or Total Transformation?  Optimizing health: Improving the value of healthcare delivery: Springer; 2006. p. 66-73.
36.    Porr C, Drummond J, Richter S. Health literacy as an empowerment tool for low-income mothers. Family & Community Health. 2006;29(4):328-35.
37.    Castro EM, Van Regenmortel T, Vanhaecht K, Sermeus W, Van Hecke A. Patient empowerment, patient participation and patient-centeredness in hospital care: a concept analysis based on a literature review. Patient education and counseling. 2016;99(12):1923-39.
38.    Glanz K, Rimer BK, Viswanath K. Health behavior. Theory, Research, and Practice. 2015;5.