Objective To examine existing literature regarding health literacy levels and their association with multimorbidity and the potential underlying mechanisms behind the said association. Design Systematic review and meta-analysis. Data sources The databases MEDLINE, EMBASE, CINAHL and Science Direct were searched for articles published between 1 January 2000 and 31 October 2023 using a systematic search strategy. Eligibility criteria Included were all primary studies conducted in people over 18 years old with data on health literacy levels and the presence of multimorbidity. No language restrictions were used. Data extraction and synthesis Two authors independently extracted data and assessed the bias using the Joanna Briggs Institute critical appraisal tools. Results We included a total of 39 studies (36 quantitative, two qualitative and one mixed-method), representing 154 337 participants. We found a 32% proportion of limited health literacy among individuals with multimorbidity. Analysis of three articles using the Health Literacy Questionnaire tool (n=31 228) (Pooled OR 2.88 (95% CI 1.92 to 4.31)) and three articles using the Health Literacy Survey Questionnaire–European Union tool (n=35 358) (OR 1.16 (95% CI 1.07 to 1.25)) indicated that people with limited health literacy were likely to have multiple conditions. One of three articles studying underlying mechanisms reported that self-efficacy mediates the association between health literacy and multimorbidity. Additionally, substantial literature identified education and income as the most consistent determinants of health literacy among individuals with multimorbidity. Of the only two articles studying the effectiveness of health literacy-related interventions, both reported an improvement in clinical outcomes after the intervention. Conclusions Our review demonstrated a consistent association between health literacy and multimorbidity, indicating that people with lower health literacy levels are more likely to have multimorbidity. More evidence is needed regarding the effect of health literacy interventions on multimorbidity. PROSPERO registration number CRD42022301369.

Background: Multimorbidity, the concurrent presence of two or more chronic conditions is an emerging public health challenge. Till date, most of the research have focused on the presence and interaction of selected co-morbidities in tuberculosis (TB). There exist a critical knowledge gap on the magnitude of multimorbidity among TB patients and its impact on health outcomes. Methods: We undertook a cross-sectional study to assess the prevalence and patterns of multimorbidity among newly diagnosed TB patients in two states of India. A total of 323 patients were interviewed using a structured multimorbidity assessment questionnaire for primary care (MAQ-PC). MAQ-PC is already validated for Indian population and elicits 22 chronic conditions. We defined TB multimorbidity as the co-existence of TB with one or more chronic conditions and identified commonly occurring dyads (TB + single condition) and triads (TB + two conditions). Results: More than half (52%) of TB patients reported multimorbidity. Among dyads, depression, diabetes mellitus (DM), acid peptic disease (APD), hypertension, chronic alcoholism, arthritis and chronic back ache (CBA) were the most common co-occurring conditions while ‘DM + arthritis’, ‘depression + APD’, ‘depression + DM’ were the most commonly occurring triads among TB patients. Factors such as increasing age, low levels of education, alcohol abusers, drug-resistant TB and having health insurance were significantly associated with multimorbidity among TB patients. Conclusions: Our findings suggest high prevalence of multimorbidity among newly diagnosed TB patients in India. The presence of concordant and discordant conditions with TB may increase the health complexity, thus necessitating appropriate care protocols. Given, the current situation, wherein TB and non-communicable diseases (NCD) services are delivered through collaborative framework between programmes, there is a need for addressing multimorbidity at the healthcare delivery level.

India is witnessing an epidemiologic transition from infectious diseases to non-communicable diseases (NCDs). Prevention of the NCD risk factors is an effective way, and future doctors play a vital role in preventing the disease epidemics. Undergraduate medical education forms the basis of knowledge development, including NCD risk factors. With this backdrop, the scoping review aimed to map available evidence on the knowledge, attitude, perception and practices related to NCD risk factors amongst medical undergraduates in India. A systematic search was conducted using key terms from five electronic databases of peer-reviewed articles. Two reviewers independently screened all articles for eligibility and assessed the quality of included studies. Studies were included if they reported on the medical students’ knowledge, attitude, perception and practice related to NCD risk factors. Thirteen studies on undergraduate medical students in India were included in the systematic review. Twelve of these reported on students’ knowledge about NCD risk factors, nine explored their attitude towards NCD risk factor prevention, and eleven studies were on the practice of NCD prevention. The studies revealed a high level of knowledge about NCD risk factors. Still, their attitude and practices about NCD reduction were deficient. An overall rise in health-risking behaviour and a fall in health-promoting behaviour was observed by various studies. The level of physical activity among girls was significantly lower compared to the boys. Studies show many few students take patient history or counsel their patients to quit unhealthy lifestyle habits. Various studies found a rise in health-risking behaviour and a fall in health-promoting behaviour among medical students, which suggest creating an enabling environment and conducive climate for promoting healthy behaviour that can then be taught to their patients.