Health literacy and polypharmacy; a scoping review of international literature

Introduction Polypharmacy, commonly understood as the concurrent use of multiple medications, has been consistently linked to a range of adverse outcomes. Shared decision-making supports personalized care for patients with multiple medicines and multiple long-term conditions. However, effective shared decision-making relies on adequate health literacy (HL) which is often lower among individuals with chronic illness. This scoping review examines how HL is reported within the context of polypharmacy. Methods A scoping review was undertaken using Arksey and O’Malley’s (Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32.) methodological framework. The review explored how HL was assessed within populations experiencing polypharmacy. Searches were conducted in Embase, MEDLINE, PsycINFO, Web of Science, and CINAHL to ensure comprehensive coverage of the literature. An author-designed extraction tool was used to collate information on study characteristics, participant demographics, HL assessment methods, and any reported relationships between HL and polypharmacy. Results The literature search yielded 606 citations after duplicate removal, from which 14 studies were identified for inclusion. Thirteen studies used quantitative methods, and one used a mixed-method approach, spanning six countries. HL assessments comprised seven functional, one communicative, and six critical domains. Fourteen studies assessed patients, of which two also included information provided by doctors and carers. Conclusions This scoping review highlights significant gaps in the literature relating to HL and polypharmacy, especially around geographic coverage, HL domains, and diverse patient groups. Further investigation is needed to characterize these relationships and inform the development of interventions that enhance patient care and healthcare system efficiency.