WHO Bulletin: Health literacy and tuberculosis control

4 June, 2024

CITATION: Health literacy and tuberculosis control: systematic review and meta-analysis

Arohi Chauhan et al.

Bull World Health Organ. 2024 Jun 1; 102(6): 421–431.

Published online 2024 Mar 27. doi: 10.2471/BLT.23.290396

PMCID: PMC11132163


Objective: To identify literature on health literacy levels and examine its association with tuberculosis treatment adherence and treatment outcomes.

Methods: Two authors independently searched Pubmed®, Embase, CINAHL, PsycINFO, Scopus, LILACS, Global Health Medicus and ScienceDirect for articles reporting on health literacy levels and tuberculosis that were published between January 2000 and September 2023. We defined limited health literacy as a person's inability to understand, process, and make decisions from information obtained concerning their own health. Methodological quality and the risk of bias was assessed using the JBI critical appraisal tools. We used a random effects model to assess the pooled proportion of limited health literacy, the association between health literacy and treatment adherence, and the relationship between health literacy and tuberculosis-related knowledge.

Findings: Among 5813 records reviewed, 22 studies met the inclusion criteria. The meta-analysis revealed that 51.2% (95% confidence interval, CI: 48.0–54.3) of tuberculosis patients exhibit limited health literacy. Based on four studies, patients with lower health literacy levels were less likely to adhere to tuberculosis treatment regimens (pooled odds ratio: 1.95; 95% CI: 1.37–2.78). Three studies showed a significant relationship between low health literacy and inadequate knowledge about tuberculosis (pooled correlation coefficient: 0.79; 95% CI: 0.32–0.94).

Conclusion: Health literacy is associated with tuberculosis treatment adherence and care quality. Lower health literacy might hamper patients' ability to follow treatment protocols. Improving health literacy is crucial for enhancing treatment outcomes and is a key strategy in the fight against tuberculosis.


This review highlights that health literacy is associated with treatment adherence and disease understanding. Health literacy-focused interventions tailored to different contexts are needed to foster patient empowerment and improve health outcomes... Improved health literacy supports individuals in taking charge of their health, and aids providers in delivering inclusive care. Literacy also stands to lessen health inequities and bolster public health. Well-informed tuberculosis patients can contribute significantly to elimination efforts, benefiting the wider community.

COMMENT (NPW): In addition to improving individual health literacy, there is a need for organisational literacy among providers of information, to ensure that people with different levels of health literacy have access to healthcare information in a format, language and technical level that they can understand.

HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org