Background: The primary aim of this review was to establish whether health literacy interventions, in adults, are effective for improving health literacy. Two secondary aims assessed the impact of health literacy interventions on health behaviours and whether health literacy interventions have been conducted in cardiovascular patients. Methods: A systematic review (Prospero registration: CRD42018110772) with no start date running through until April 2020. Eligible studies were conducted in adults and included a pre/post measure of health literacy. Medline, Embase, Eric, PsychINFO, CINAHL, Psychology and Behavioural Science, HMIC, Web of Science, Scopus, Social Care Online, NHS Scotland Journals, Social Policy and Practice, and Global Health were searched. Two thousand one hundred twenty-seven papers were assessed, and 57 full text papers screened to give 22 unique datasets from 23 papers. Risk of bias was assessed regarding randomisation, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting and other biases. Intervention reporting quality was assessed using the TIDieR checklist. Results: Twenty-two studies were included reporting on 10,997 participants in nine countries. The majority of studies (14/22) were published in 2018 or later. Eight studies (n = 1268 participants) also reported on behavioural outcomes. Health literacy interventions resulted in improvements in at least some aspect of health literacy in 15/22 studies (n = 10,180 participants) and improved behavioural outcomes in 7/8 studies (n = 1209 participants). Only two studies were conducted with cardiovascular patients. All studies were at risk of bias with 18 judged as high risk. In addition, there was poor reporting of intervention content with little explication of the theoretical basis for the interventions. Conclusions: Health literacy interventions can improve health literacy and can also lead to changes in health behaviours. Health literacy interventions offer a way to improve outcomes for populations most at risk of health inequalities. Health literacy is a developing field with very few interventions using clear theoretical frameworks. Closer links between health literacy and behaviour change theories and frameworks could result in higher quality and more effective interventions. Prospero registration: Prospero registration: CRD42018110772

Following a diagnosis of cardiovascular disease there is a need for patients to self-manage. Health literacy has been shown to be lower in patients with cardiovascular disease, yet research into health literacy in this population is limited. This study used the Health Literacy Questionnaire (HLQ) to examine the health literacy and associated health, health behaviours and psychological profiles of cardiac rehabilitation patients from a remote and rural regional programme in the Scottish Highlands. Consecutive patients referred to the service in a calendar year were sent a cross-sectional questionnaire by post. Hierarchical cluster analysis grouped respondents based on their health literacy profile, and nonparametric methods were used to analyse differences between clusters on the other measures. A total of 282 participants responded (45.7%). Respondents were older (median: 71 years) and more likely to be from more affluent areas. Five health literacy clusters emerged with different profiles of health, physical activity, self-efficacy, motivation and illness perceptions. There was no difference in relation to cardiac rehabilitation attendance by health literacy cluster, but those with lower health literacy were less likely to be aware of the referral. Patterns of health literacy are associated with health, health behaviours and some psychological constructs. Knowledge of distinct cluster characteristics may help services better target interventions.

Physical activity has been shown to be an ideal intervention for body image and wellbeing, but very little research has focused on the role of resistance training in women, and more specifically, its role in supporting positive body image. The aim of this study was to identify the role of resistance training to positive body image in women, aged 30–55 as an under-represented demographic in this field. A qualitative approach was used and data included semi-structured interviews with 12 women from UK, USA, and New Zealand, analysed in accordance with constructivist grounded theory. The findings proposed a model of how resistance training works to foster self-efficacy and develop positive body image and psychological wellbeing. Themes that emerged included: Social and Environmental Factors, Characteristics of Resistance Training, Consequences of Resistance Training and Wellbeing Benefits. Ultimately, this research creates a springboard for future positive body image research to refine and develop ways to encourage and support more women to experience the benefits resistance training can bring.

BACKGROUND By 2035, the UK is projected to have over 21% of the population aged 65 and above, prompting a re-evaluation of old-age support. The aging population challenges traditional dependency models, emphasizing the importance of maintaining healthy behaviours and social support. Being physically active in older age has been shown to reduce the need for support in older populations. While digital behaviour interventions can be effective, older adults may lag in digital skills and technology use. OBJECTIVE The primary aim of this rapid review is to identify strategies to support older adults to engage with a digital app for becoming more physically active. METHODS PubMed was searched for full text articles published in peer reviewed journals focused on the experiences of older adults (aged 50 or over) using smartphones. Eligible papers included both qualitative and quantitative studies (of any design) reporting on primary data. Quality appraisal utilized Critical Appraisal Skills Programme checklists. A narrative synthesis approach combined evidence using a deductive approach based on the COM-B logic model and Theoretical Domains Framework. RESULTS 135 unique papers were screened and 27 retrieved for full text evaluation. 7 qualitative and 2 quantitative papers were included in the rapid review with 427 participants (range 9 – 138) aged 50 – 92. 94 findings were aggregated into 14 categories and then 6 themes which corresponded with all aspects of the COM-B model of behaviour change. The findings highlight actionable points for developers, utilizing the COM-B model of behaviour change. Results showed that motivation, influenced by both automatic and reflective factors, is crucial, with concerns like fear of being scammed, and anxiety about doing something wrong and breaking the device, addressed through clear training and support. Opportunity involves physical access and social support, emphasizing the need for affordability, multi-platform options, and a clear referral pathway to make technology accessible. Leveraging existing trusted relationships such as with support organisations and healthcare professionals. is vital, emphasizing ongoing support. Capability is hindered by a lack of understanding of technology benefits and usage. Developers are advised to implement staged programs and involve older adults in development to address psychological and physical capability challenges, considering decreased sensory abilities and manual dexterity. CONCLUSIONS The review integrates findings from various areas like m-health, digital apps, digital literacy, and computer training, providing actionable recommendations for app developers working with older adults. However, limitations include reliance on a single database (PubMed) and the focus on older adults with specific health conditions, potentially differing from healthy older adults. Despite these limitations, the findings reveal a high degree of consensus across categories and themes. CLINICALTRIAL Not applicable.