The objective of this paper is to synthesize and update findings from systematic review on health literacy and health outcomes among patients with long-term conditions, and extend the review to the digital domain. Health outcomes include clinical outcomes, processes of care, and health service use. Data sources are the following: (1) studies which appeared in two previous systematic reviews in 2004 and 2011 whose participants were people with long-term conditions or elderly (n = 54); (2) articles on health literacy and health outcomes identified in an updated 2011–2016 search (n = 26); (3) articles on eHealth literacy and its association with health outcomes (n = 8). Strength of evidence was determined by a qualitative assessment of risk of bias, consistency, and directness. There was a lack of consistent evidence on the relationship between health literacy and clinical outcomes despite the consistent evidence on the association with mortality. There was low to insufficient evidence on the association between health literacy and self-rated health/function and emotional states of anxiety and depression, alongside high evidence on lack of association with quality of life. There was insufficient to low evidence on the association between health literacy and behavioral outcomes (medication adherence, other health behaviors) and finally also low to moderate evidence on the association between health literacy and use of health services such as hospitalization and emergency department. In the eHealth literacy domain, there were few studies reporting association with health behaviors and self-rated health with inconsistent results. In conclusion, it is advocated to examine performed heath literacy and eHealth literacy in large longitudinal studies.

中文翻译：

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长期病患者的健康素养，电子健康素养和健康状况之间的关联

本文的目的是综合和更新对长期病患健康素养和健康结局进行系统评价的结果，并将该评价扩展到数字领域。健康结果包括临床结果，护理过程和卫生服务使用。数据来源如下：（1）在2004年和2011年的前两次系统评价中出现的研究，受试者均为患有长期疾病或老年人（n = 54）；（2）在最新的2011-2016年搜索中确定的有关健康素养和健康成果的文章（n = 26）；（3）关于电子卫生保健素养及其与健康结果的关系的文章（n = 8）。证据的强度是通过对偏差，一致性和直接性风险的定性评估来确定的。尽管有与死亡率相关的一致证据，但缺乏关于健康素养与临床结果之间关系的一致证据。关于健康素养和自我评估的健康/功能与焦虑和抑郁情绪状态之间的关联的证据不足至不足，而缺乏与生活质量关联的证据也很高。关于健康素养与行为结果（依从性，药物依从性，其他健康行为）之间的关联的证据不足，证据不足，最后，关于健康素养与使用医疗服务（如住院和急诊室）之间的关联的证据也很少至中等。在eHealth素养领域，很少有研究报告与健康行为和自我评估的健康有关联，但结果不一致。总之，提倡在大型纵向研究中检查已执行的健康知识和eHealth素养。