JMIR Publications

ABSTRACT

Background:

Health literacy, defined as the ability to obtain, understand, evaluate, and use health information, influences health behaviors and outcomes. Low health literacy (LHL) is associated withmisunderstandings of treatment instructions, poor adherence, and inadequate preventive behaviors, all of which contribute to health disparities. Although universal precautions, such as plain language and teaching-back, are recommended, recent studies have indicated that these measures alone cannot address the challenges faced by patients with LHL. Shame and concealment are key psychosocial mechanisms in this context. Patients may feel embarrassment when admitting difficulties, avoiding questions, or pretending to understand. These experiences are shaped by healthcare providers’ communication and can reduce satisfaction and care quality. Existing evidence is fragmented, highlighting the need for a scoping review.

Objective:

This review aims to map how patients with LHL experience shame and concealment, how healthcare providers’ behaviors and communication influence these experiences, and how these processes affect patient–provider communication and care. It will also identify strategies to reduce the impact of shame and concealment in clinical practice.

Methods:

This review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science, and Academic Search Complete will be searched using terms related to health literacy, patient-provider communication, and qualitative research. Qualitative and mixed-method studies with qualitative findings will be included, and quantitative-only studies will be excluded. The participants may include patients, healthcare providers, or both. Data extraction will include study characteristics, participant details, experiences of shame and concealment, provider communication behaviors, key findings and practical implications. The accuracy of the data will be verified by multiple reviewers. Data will be synthesized using thematic synthesis, with the findings presented in tables, narrative synthesis, and a conceptual model depicting the interactions between shame, concealment, and provider communication.

Results:

The findings will describe how shame and concealment are conceptualized, how they shape communication and care, and the strategies suggested to reduce their effects. A conceptual diagram will be developed to illustrate these dynamics. We anticipate submitting our findings to a peer-reviewed journal and presenting them at international conferences on health communication and health literacy.

Conclusions:

To the best of our knowledge, this will be the first scoping review to systematically map the roles of shame and concealment in healthcare communication among patients with LHL. Synthesizing qualitative evidence will provide insights into the relational dynamics of shame and concealment, inform professional education and training, and guide organizational- and policy-level strategies to promote equitable and patient-centered healthcare communication.