The Association Between Self‐Care and Health Literacy in Patients With Chronic Diseases: A Systematic Review and Meta‐Analysis

Background: Chronic diseases are a major global health burden, contributing to morbidity, mortality and healthcare costs. Self-care is essential for effective disease management, with health literacy (HL) and digital health literacy (eHL) playing a role in enabling individuals to engage in health-promoting behaviours. However, the relationship between HL and self-care remains inconclusive, necessitating further investigation to clarify its impact. Objective: To synthesise evidence on the association between HL and self-care in chronic diseases and identify mediating and moderating factors influencing this relationship. Information Sources: A systematic search was conducted across PubMed, CINAHL, PsycINFO, Embase, Web of Science and Cochrane CENTRAL, supplemented by manual reference checks and author correspondence. Methods: This systematic review and meta-analysis followed PRISMA guidelines, including observational studies and RCTs assessing HL and self-care. Meta-analyses were performed using Fisher's Z transformation. Risk of bias was assessed using ROBINS-E and certainty of evidence was evaluated through GRADE. Results: A total of 138 studies were included, with 52 meta-analysed. Higher HL was associated with improved self-care behaviours, including medication adherence, disease monitoring and lifestyle modifications across chronic diseases, including type 2 diabetes, heart failure, hypertension, chronic kidney disease, asthma, coronary artery disease, arthritis and COPD. Psychological (self-efficacy, empowerment), cognitive (disease knowledge, decision-making) and social (healthcare communication, social support) factors mediated this relationship, while distress and depression moderated it. Meta-analysis revealed a moderate positive association between HL and self-care (r = 0.29, 95% CI: 0.26–0.31, p < 0.001). Subgroup analyses showed consistent positive effects across conditions. No significant publication bias was detected (Egger's test, p = 0.294). Risk of bias was high in 62 studies, while certainty of evidence ranged from very low to moderate. Conclusions: HL positively influences self-care in chronic diseases, with its impact shaped by multiple mediators and moderators. Future interventions should integrate tailored education, digital tools and mental health support to enhance HL effectiveness. Registration: PROSPERO (CRD42024488061, registered 20.01.2024).