Effectiveness of Health Literacy Interventions for Blood Pressure Control, Medication Adherence, and Self‐Efficacy In Older Adults With Hypertension: A Systematic Review and Meta‐Analysis

This systematic review and meta-analysis contributes to the Journal's focus on clinical care improvement and evidence-based medicine by evaluating the global evidence for a scalable, person-centred intervention-health literacy-in the management of hypertension among older adults. BACKGROUND: Health literacy (HL) is the ability to access, understand, and apply health information to make informed decisions. However, evidence regarding the comprehensive effects of HL interventions on multiple outcomes in older adults with hypertension remains unclear. AIMS: This study aimed to evaluate the effectiveness of HL interventions for improving systolic blood pressure (SBP), diastolic blood pressure (DBP), medication adherence, and self-efficacy in older adults with hypertension. METHODS: We searched PubMed, Web of Science, Scopus, Embase, the Cochrane Library, and CINAHL from inception to June 2025 for relevant randomized controlled trials (RCTs). Study quality was assessed using the Cochrane RoB 2.0 tool. Pooled mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated using random-effects models. Subgroup and sensitivity analyses were conducted. RESULTS: Forty-two RCTs (9,332 participants) were included; 25 studies (59.5%) had a low risk of bias. Meta-analysis revealed that HL interventions significantly reduced SBP (MD: -6.90 mmHg; 95% CI: -8.51 to -5.29; p < 0.01) and DBP (MD: -3.03 mmHg; 95% CI: -4.12 to -1.94; p < 0.01), and improved medication adherence (SMD: 0.69; 95% CI: 0.26 to 1.12; p < 0.01) and self-efficacy (SMD: 0.35; 95% CI: 0.10 to 0.60; p < 0.01). Greater benefits were observed in trials conducted in Eurasian regions and those emphasizing active participant engagement. CONCLUSIONS: HL interventions are effective in improving SBP and DBP control, medication adherence, and self‑efficacy among older adults with hypertension. The findings support the integration of structured, participatory HL strategies into routine geriatric hypertension management.