Health literacy level in Turkey: A meta-analysis

Over the past decade, the body of literature on health literacy in Turkey has expanded significantly particularly through the measurement of comprehensive health literacy across various Turkish populations. This growing body of research has now reached a level of maturity that enables it to make meaningful contributions to both the Ministry of Health and the broader international health literacy literature. The aim of the present systematic review and meta-analysis was to determine the prevalence of inadequate-problematic and sufficient-excellent health literacy levels in the Turkish population, while also identifying sociodemographic and methodological factors associated with the inadequate-limited health literacy at the study-level. A systematic search was conducted across seven different databases (Web of Science, PubMed, Scopus, EBSCO, DergiPark, TRDizin, and the Council of Higher Education Thesis Center) to identify relevant descriptive or analytical cross-sectional studies. A total of 187 studies that met the inclusion criteria, conducted on literate Turkish citizens aged 15 and older who were not healthcare professionals or students and reporting necessary data for meta-analysis, were included. If required data were missing, they were obtained from the responsible researchers. The analyses were conducted using MetaXL 5.3 and StataMP 17.0 software. The pooled effect sizes was represented by the "pooled prevalences", and heterogeneity was assessed using the "I²" index. Given the expectation of high heterogeneity, the random-effects model was applied. Publication bias was assessed using the Luis-Furuya-Kanamori Asymmetry Index. Subgroup analyses, sensitivity analyses, and meta-regression analyses were conducted to address significant heterogeneity. The reliability and generalizability of the multivariable meta-regression models were ensured. The meta-analysis based on 187 studies (65,544 individuals) revealed that the prevalence of inadequate-problematic health literacy in Türkiye was 63.7% (CI: 61%-66%), while the prevalence of sufficient-excellent health literacy was 36.3% (CI: 34%-39%). These findings supported the improvement identified by the Ministry of Health in its most recent survey, published in 2024. On the other hand, the sociodemographic and methodological variables explaining approximately half of the variations (Adj. R² = 47.4%) in the inadequate-problematic health literacy prevalence were education, sample size, gender, age, and the education-age interaction. It is strongly recommended that the Ministry of Health and health literacy researchers give due consideration to the current meta-analytic findings and their implications in health literacy measurement and interventions aimed at enhancing it.