Health literacy in rural and urban populations: A systematic review

Abstract

Objective: This review assessed whether health literacy differences exist between rural and urban populations and whether rurality is a determinant.

Methods: Eight online databases were searched using the keywords "health literacy", "rural" and "urban", and related terms. Peer-reviewed original research comparing health literacy levels between rural and urban populations were evaluated for strength of evidence. A narrative synthesis summarised the results of included studies.

Results: Nineteen articles met inclusion criteria and were of sufficient methodological quality for data extraction. The majority of studies found that urban populations had higher health literacy than rural populations. Differences were more likely to be found in developing than developed countries. Studies that performed covariate analysis indicated that rurality may not be a significant determinant of health literacy.

Conclusion: Evidence suggests that rurality alone does not explain rural-urban health literacy differences and that sociodemographic factors play important roles.

Practice implications: These findings could be used to help inform the development of evidence-based interventions specifically for rural populations, at both health policy and clinical levels; for example, by tackling healthcare access challenges. The findings also provide a lens through which to consider efforts to reduce rural-urban health outcome disparities.

Keywords: Health disparities; Health literacy; Rural; Social determinants of health; Urban.