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<p>Chronic obstructive pulmonary disease (COPD) requires sustained self-management, and health literacy may play an important role in patients’ ability to understand, implement, and maintain disease-management behaviors. However, the effectiveness of self-management interventions incorporating health literacy–sensitive components in COPD remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials evaluating health literacy–sensitive self-management interventions for adults with COPD. Health literacy–sensitive self-management interventions were defined as self-management programs incorporating explicitly identifiable strategies intended to reduce literacy-related barriers or to support patients in obtaining, understanding, appraising, or applying COPD-related health information in daily self-management. Nine databases were searched from inception to August 30, 2025. Thirty-one randomized controlled trials involving 4759 participants were included. Outcomes included 6 min walk distance (6MWD), forced expiratory volume in 1 s as a percentage of predicted value (FEV₁% predicted), St George’s Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnea score, COPD Assessment Test (CAT), and self-management-related outcomes. Risk of bias was assessed using the Cochrane Risk of Bias tool, and pooled effects were calculated using fixed- or random-effects models according to heterogeneity. Compared with usual care, self-management interventions with health literacy–sensitive components were associated with improvements in 6MWD (MD = 44.81 m, 95% CI 17.48–72.14; <i>p</i> = 0.001), FEV₁% predicted (MD = 7.43, 95% CI 6.31–8.55; p &lt; 0.00001), SGRQ total score (MD = −6.80, 95% CI −9.80–−3.80; p &lt; 0.00001), mMRC score (MD = −0.40, 95% CI −0.61–−0.19; <i>p</i> = 0.0002), CAT score (MD = −3.78, 95% CI −5.49–−2.07; p &lt; 0.0001), and self-management-related outcomes (SMD = 1.50, 95% CI 1.34–1.67; p &lt; 0.00001). Substantial heterogeneity was observed for several outcomes, particularly 6MWD, SGRQ, mMRC, CAT, and self-management-related outcomes. Health literacy–sensitive self-management interventions were associated with improvements in exercise capacity, pulmonary function, symptom burden, dyspnea, health-related quality of life, and self-management-related outcomes in patients with COPD. However, the evidence should be interpreted with caution because eligible interventions were defined by the presence of explicitly identifiable health literacy–sensitive strategies embedded within self-management programs, rather than by isolated health-literacy enhancement alone, and substantial heterogeneity and variable methodological quality were present across studies. More rigorously designed and standardized trials are needed to clarify the specific contribution of health literacy–sensitive strategies and their long-term effectiveness in COPD care.</p>

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Health literacy–sensitive self-management interventions for chronic obstructive pulmonary disease: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月13日

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  • Changfu Chen,
  • Miao Zhan,
  • Hongying Zhang

摘要

Chronic obstructive pulmonary disease (COPD) requires sustained self-management, and health literacy may play an important role in patients’ ability to understand, implement, and maintain disease-management behaviors. However, the effectiveness of self-management interventions incorporating health literacy–sensitive components in COPD remains unclear. We conducted a systematic review and meta-analysis of randomized controlled trials evaluating health literacy–sensitive self-management interventions for adults with COPD. Health literacy–sensitive self-management interventions were defined as self-management programs incorporating explicitly identifiable strategies intended to reduce literacy-related barriers or to support patients in obtaining, understanding, appraising, or applying COPD-related health information in daily self-management. Nine databases were searched from inception to August 30, 2025. Thirty-one randomized controlled trials involving 4759 participants were included. Outcomes included 6 min walk distance (6MWD), forced expiratory volume in 1 s as a percentage of predicted value (FEV₁% predicted), St George’s Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnea score, COPD Assessment Test (CAT), and self-management-related outcomes. Risk of bias was assessed using the Cochrane Risk of Bias tool, and pooled effects were calculated using fixed- or random-effects models according to heterogeneity. Compared with usual care, self-management interventions with health literacy–sensitive components were associated with improvements in 6MWD (MD = 44.81 m, 95% CI 17.48–72.14; p = 0.001), FEV₁% predicted (MD = 7.43, 95% CI 6.31–8.55; p < 0.00001), SGRQ total score (MD = −6.80, 95% CI −9.80–−3.80; p < 0.00001), mMRC score (MD = −0.40, 95% CI −0.61–−0.19; p = 0.0002), CAT score (MD = −3.78, 95% CI −5.49–−2.07; p < 0.0001), and self-management-related outcomes (SMD = 1.50, 95% CI 1.34–1.67; p < 0.00001). Substantial heterogeneity was observed for several outcomes, particularly 6MWD, SGRQ, mMRC, CAT, and self-management-related outcomes. Health literacy–sensitive self-management interventions were associated with improvements in exercise capacity, pulmonary function, symptom burden, dyspnea, health-related quality of life, and self-management-related outcomes in patients with COPD. However, the evidence should be interpreted with caution because eligible interventions were defined by the presence of explicitly identifiable health literacy–sensitive strategies embedded within self-management programs, rather than by isolated health-literacy enhancement alone, and substantial heterogeneity and variable methodological quality were present across studies. More rigorously designed and standardized trials are needed to clarify the specific contribution of health literacy–sensitive strategies and their long-term effectiveness in COPD care.