Interventions to Promote Health Literacy in Children, Adolescents and Supporting Adults

An Evidence Map

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SBU Evidence map

systematically evaluates the quality of systematic reviews in a particular field for the purpose of identifying reliable evidence and gaps in scientific knowledge. SBU Evidence Maps are generated with the help of experts in the field. Prior to publication, maps are examined by independent experts, as well as our quality and priority group and SBU’s Scientific Advisory Committees.

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Published: Report no: 401 Registration no: SBU 2025/43 ISBN: 978-91-989734-9-5 https://www.sbu.se/401e

Main message and conclusions

In total 18 systematic reviews (SR) with moderate or low risk of bias, which examined a range of interventions intended to promote health literacy among children, adolescents and supporting adults, were identified. The overall evidence base is constrained by methodological limitations, inconsistent outcome measures and substantial variation in intervention content. Important research gaps remain, particularly concerning younger children, critical health literacy, and digital media and health.

Aim

The aim was to identify, categorise and map systematic reviews evaluating interventions intended to promote health literacy among children, adolescents and supporting adults, and to provide an overview of the areas in which reliable, systematically compiled scientific evidence is available, as well as where evidence is lacking.

Method

A study protocol for this project was made a priori, with number SBU 25/43.

Inclusion criteria

Population: Children and adolescents aged 0–20 years; supporting adults (parents, caregivers, or professionals) when the intervention aimed to promote childrens’ or adolescents’ health literacy.
Intervention: Universal interventions intended to promote health literacy.
Control: Any control group or no control group.
Outcome: Health literacy or closely related constructs, such as health knowledge, health competence. Secondary outcomes, such as behavioural or health-related outcomes were also recorded.
Study design: Systematic reviews of quantitative studies.

Language: English, Swedish, Norwegian or Danish. Search period: 2020 – April 2025. Final search conducted in April 2025.

Databases searched:

APA PsycInfo via EBSCO, Academic Search Premiere (ASP) & Cinahl via EBSCO, ERIC via EBSCO, MEDLINE via OvidSP, PubMed Central via NLM, Scopus via Elsevier, Social Services Abstracts/Sociological Abstracts via Proquest, International HTA-database.
An information specialist conducted a literature search in April 2025 (Appendix 1).

The PICO for this interactive map, and the categories used to classify the content in the map, were discussed and outlined by the project group.
Risk of bias was assessed using the ROBIS tool. Systematic reviews with low to moderate risk of bias were categorized and included in an evidence map. Systematic reviews with high risk of bias were categorized and listed in appendix 4.

Screening of relevance, risk of bias assessment, categorization and data extraction were performed independently by two project members. Results were reported as citations with the reviewers’ comments on the certainty of evidence.
The report was reviewed by an external reviewer.

Results

A total of 72 systematic reviews published between 2020 and April 2025 fulfilled the inclusion criteria. Only 18 reviews had a low or moderate risk of bias, and the results presented in the report and in the evidence map are based on this subset. These systematic reviews examined universal interventions targeting children and adolescents, and in some cases parents, caregivers or professionals. Most interventions were delivered in school settings, and the most frequently studied domains of health literacy were mental health, oral health, dietary behaviours and general health. No eligible reviews were identified in the area of digital media and health, psychomotor development, or communication.

Approximately half of the reviews evaluated outcomes directly related to health literacy; the remainder assessed related constructs such as health knowledge or competence. Intervention content varied considerably and often combined educational components with interactive elements. Few interventions addressed critical health literacy.

Only two SRs provided evidence robust enough to support conclusions about intervention effects, according to the review authors. They reported positive results for school-based interventions to strengthen mental health literacy and for teacher-focused competence-building related to physical activity. For all other intervention types, the scientific evidence was too uncertain to determine whether they influence health literacy.

Link to the evidence map.

Conflicts of Interest

In accordance with SBU’s requirements, the experts and scientific reviewers participating in this project have submitted statements about conflicts of interest. These documents are available at SBU’s secretariat. SBU has determined that the conditions described in the submissions are compatible with SBU’s requirements for objectivity and impartiality.

The full resport in Swedish

Insatser för att främja hälsolitteracitet hos barn, unga och stödjande vuxna

Project group

Experts

  • Anneli Ivarsson, Professor, Epidemiology and Public Health Sciences., Department of Epidemiology and Global Health, Umeå University
  • Karin C Ringsberg, Professor Emerita, Public Health Science, Nordic School of Public Health (NHV), Göteborg

SBU

  • Annika Bring, Project manager
  • Lisa Forsberg, Assistant project manager
  • Fanny Sellberg, Assistant project manager
  • Erik Eriksson, Analyst
  • Jenny Ågren, Analyst
  • Maria Hoppe, Project administrator
  • Emma Wernersson, Project administrator
  • Hanna Olofsson, Information specialist
  • Jenny Odeberg, Head of department

Flow chart

Of 72 articles assessed for eligibility, 4 had low risk, 14 moderate and 54 high risk of bias.

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