Diagnóstico de enfermagem letramento em saúde inadequado: revisão sistemática de etiologia e risco e de acurácia diagnóstica

Abstract

This study aimed to review the nursing diagnosis Inadequate Health Literacy in people with chronic conditions. To this end, two systematic reviews were prepared. The first is a systematic review of etiology and risk, with data collection taking place in October 2024, while the second is a systematic review of diagnostic accuracy, with data collection carried out in November 2024. Both followed the criteria proposed by the Joanna Briggs Institute and adopted the mnemonic strategy PEO - Patient, Exposure, and Outcome to formulate the research questions. The first review sought to answer the question: “What are the etiological factors related to the nursing diagnosis Inadequate Health Literacy in people with chronic conditions?”, while the second investigation: “What are the clinical indicators identified based on expert opinion, evaluation panels, or analysis of latent variables that characterize the nursing diagnosis Inadequate Health Literacy in people with chronic conditions?”. The etiology and risk review protocol was registered and approved on the International Prospective Register of Ongoing Systematic Reviews platform, under number CRD42024609074, and the diagnostic accuracy review protocol was approved under number CRD42024619306. The etiology and risk review included 15 studies, most of which were published between 2015 and 2022, with a crosssectional design and predominantly involving patients with diabetes mellitus and cardiovascular diseases. The results indicated that the nursing diagnosis Inadequate Health Literacy is related to predisposing, disabling, precipitating and reinforcing factors that affect the ability of individuals to access, understand and apply health information. Etiological factors of an educational, social, technological, psychological, systemic and population nature were identified, with emphasis on low education, difficulty in understanding medical or nursing guidelines and lack of access to accessible and daily health information. The review of diagnostic accuracy included eight studies, published between 1988 and 2024, with a crosssectional design and a predominance of participants with an unspecified type of chronic noncommunicable disease and multiple diseases. Eighteen defining characteristics of the diagnosis Inadequate Health Literacy were identified, the most prevalent being: difficulty in interpreting medication labels and medical instructions; inability to understand information about disease prevention and management; frequent need for third-party mediation; low knowledge about signs and symptoms of common health conditions; anxiety or frustration with complex information; lack of adherence to self-care recommendations; difficulty accessing health systems; limited understanding of educational materials; failure to monitor health signs; low use of technological tools; reduced frequency of consultations and check-ups; and reports of poor communication with health professionals. This study presents an important contribution to the health and nursing fields, since, through two systematic reviews, it presents relevant scientific reviews on the nursing diagnosis Inadequate Health Literacy. The review allowed not only to confirm factors already present in the current taxonomy, but also to map new components that broaden the understanding of the diagnosis. This combination reinforces the validity of existing elements and highlights the evolution of the concept, contributing to the updating and strengthening of evidence-based clinical practice.