Health literacy in African countries: a scoping review

Abstract Background Despite its relevance, health literacy and its impact on health-seeking behaviour and health outcomes tends to be poorly understood, and usually not assessed or integrated with health policies, especially in African countries. Objective To map existing evidence on the health literacy of adolescents and adults in African countries and provide an overview of the instruments used. Methods We conducted a scoping review and applied the Population, Concept, and Context (PCC) framework recommended by Joanna Briggs Institute. Population - adolescents and adults; Concept - health literacy and health literacy scales; Context - African countries. We searched PubMed, Scopus, Taylor and Francis Online, and Web of Science for articles published in Portuguese, French, or English, between January 2000 to January 2020, using a composite search term, combining search terms with Boolean operators. Qualitative synthesis of results. Results Eighteen studies were included, and 12 health literacy instruments were identified: 7 were generic, 3 assessed health literacy regarding HIV, hypertension, and maternal care and 2 derived from Demographic Health Surveys. Health literacy levels tended to be poor and vary across countries, contexts, and groups. Conclusion Research on health literacy in Africa is limited and several authors have tried to adapt health literacy tools to local context and languages. Certain constraints like poor ability to understand questionnaire response items, and low levels of health literacy outcomes for both adolescents and adults are more marked in rural contexts and hard-to-reach populations. Our study confirmed that there is a lack of health literacy measurement instruments adapted to African contexts.