{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:13:26Z","timestamp":1791893606695,"version":"4.3.4"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2017,11,20]],"date-time":"2017-11-20T00:00:00Z","timestamp":1511136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006662","name":"NIHR","doi-asserted-by":"publisher","award":["RP-PG-0109-10116"],"award-info":[{"award-number":["RP-PG-0109-10116"]}],"id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Health Service"},{"name":"NHS"},{"DOI":"10.13039\/100006662","name":"NIHR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Access to Transplant and Transplant Outcome Measures"},{"name":"ATTOM"},{"DOI":"10.13039\/100006662","name":"NIHR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Limited health literacy affects 25% of people with chronic kidney disease (CKD), and may reduce self-management skills resulting in poorer clinical outcomes. By disproportionately affecting people with low socio-economic status and non-white ethnicity, limited health literacy may promote health inequity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review of quantitative studies of health literacy and clinical outcomes among adults with CKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 29 studies (13 articles; 16 conference abstracts) were included. One included non-USA patients. Of the 29 studies, 5 were cohort studies and 24 were cross-sectional. In all, 18\u2009300 patients were studied: 4367 non-dialysis CKD; 13\u2009202 dialysis; 390 transplant; 341 unspecified. Median study size was 127 [interquartile range (IQR) 92\u2013238)], but 480 (IQR 260\u20132392) for cohort studies. Median proportion of non-white participants was 48% (IQR 17\u201370%). Six health literacy measures were used. Outcomes included patient attributes, care processes, clinical\/laboratory parameters and \u2018hard\u2019 clinical outcomes. Limited health literacy was significantly, independently associated with hospitalizations, emergency department use, missed dialysis sessions, cardiovascular events and mortality (in cohort studies). Study quality was high (1 study), moderate (3 studies) and poor (25 studies), limited by sampling methods, variable adjustment for confounders and reduced methodological detail given in conference abstracts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>There is limited robust evidence of the causal effects of health literacy on patient outcomes in CKD. Available evidence suggests associations with adverse clinical events, increased healthcare use and mortality. Prospective studies are required to determine the causal effects of health literacy on outcomes in CKD patients, and examine the relationships between socio-economic status, comorbidity, health literacy and CKD outcomes. Intervention development and evaluation will determine whether health literacy is a modifiable determinant of poor outcomes in CKD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfx293","type":"journal-article","created":{"date-parts":[[2017,9,19]],"date-time":"2017-09-19T07:36:30Z","timestamp":1505806590000},"page":"1545-1558","source":"Crossref","is-referenced-by-count":123,"title":["Health literacy and patient outcomes in chronic kidney disease: a systematic review"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1362-2146","authenticated-orcid":false,"given":"Dominic M","family":"Taylor","sequence":"first","affiliation":[{"name":"Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK"},{"name":"Richard Bright Renal Service, North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Fraser","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Dudley","sequence":"additional","affiliation":[{"name":"Richard Bright Renal Service, North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel C","family":"Oniscu","sequence":"additional","affiliation":[{"name":"Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Tomson","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Freeman Hospital, Newcastle-upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rommel","family":"Ravanan","sequence":"additional","affiliation":[{"name":"Richard Bright Renal Service, North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Roderick","sequence":"additional","affiliation":[{"name":"Richard Bright Renal Service, North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the ATTOM investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,11,20]]},"reference":[{"key":"2025102312504442800_gfx293-B1","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1016\/j.socscimed.2008.09.050","article-title":"The evolving concept of health literacy","volume":"67","author":"Nutbeam","year":"2008","journal-title":"Soc Sci Med"},{"key":"2025102312504442800_gfx293-B2","doi-asserted-by":"crossref","first-page":"e009627","DOI":"10.1136\/bmjopen-2015-009627","article-title":"Gaps in understanding health and engagement with healthcare providers across common long-term conditions: a population survey of health literacy in 29,473 Danish citizens","volume":"6","author":"Friis","year":"2016","journal-title":"BMJ Open"},{"key":"2025102312504442800_gfx293-B3","doi-asserted-by":"crossref","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","article-title":"Low health literacy and health outcomes: an updated systematic review","volume":"155","author":"Berkman","year":"2011","journal-title":"Ann Intern Med"},{"key":"2025102312504442800_gfx293-B4","doi-asserted-by":"crossref","first-page":"e1602","DOI":"10.1136\/bmj.e1602","article-title":"Association between low functional health literacy and mortality in older adults: longitudinal cohort study","volume":"344","author":"Bostock","year":"2012","journal-title":"BMJ"},{"key":"2025102312504442800_gfx293-B5","doi-asserted-by":"crossref","first-page":"e74373","DOI":"10.1371\/journal.pone.0074373","article-title":"Skill set or mind set? 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