This scoping review will be conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines [29]. A completed PRISMA-ScR checklist will be provided as a supplementary file upon manuscript submission. The methodological framework is guided by the seminal work by Arksey and O’Malley [30] on scoping studies, further refined by the work by Levac et al [31] and updated with methodological guidance for conducting scoping reviews [32]. We plan to initiate the database search in October 2025, complete study selection and data extraction by November 2025, and finalize data synthesis by December 2025. In accordance with the primary objective of this scoping review—to map the range, nature, and conceptualization of qualitative evidence rather than evaluate intervention effectiveness or methodological rigor—we will not conduct a formal critical appraisal of individual studies. This approach is consistent with established scoping review methodology and PRISMA-ScR recommendations [29].

We will search the following databases: PubMed, MEDLINE, CINAHL, PsycInfo, Web of Science, and Academic Search Complete. The search strategy will combine MeSH (Medical Subject Headings) and free-text terms related to health literacy and patient-provider communication. Textbox 1 shows the combination of keywords that will be used in our search. We will not filter our searches based on the year of publication. The reference lists of eligible articles and relevant reviews will also be screened for additional information.

Textbox 2 shows the inclusion and exclusion criteria for this study.

We will use the Rayyan software (Qatar Computing Research Institute) [33] to manage and screen the citations. Duplicates will be removed automatically. Two reviewers (TO and HO) will independently screen the titles and abstracts against the inclusion criteria. Disagreements will be resolved through discussion, and if a consensus cannot be reached, a third reviewer (RY) will be consulted. The same process will be applied to the full-text screening. The selection process will be documented using a PRISMA-ScR flow diagram.

One reviewer (TO) will extract the data using a standardized form developed in Microsoft Excel. The following data will be extracted:

To ensure accuracy, the second (HO) and third (RY) reviewers will verify the extracted data for omissions or errors.

The initial data synthesis will be conducted by the first reviewer (TO) using thematic synthesis [34]. This approach, endorsed by The Cochrane Collaboration as a rigorous strategy for integrating qualitative evidence [35], involves several stages. In the first stage, TO, who has a background in qualitative methodology and extensive experience in conducting qualitative research, will perform open, line-by-line coding of the findings and quotations presented in the results sections of the included articles. In the second stage, both the first (TO) and second (HO) reviewers will independently cluster the codes that emerged from the initial coding into descriptive themes that will be data driven. Any discrepancies will be resolved through discussion with a third reviewer (RY). In the third stage, TO will generate analytical themes by interpreting and extending the descriptive themes from the previous step. These analytical themes will aim to provide insights beyond the findings of individual studies. The development of these themes will be discussed collaboratively among TO, HO, and RY, and all codes and themes will be created inductively through this iterative synthesis process. In addition, study characteristics (eg, setting, population, country, and clinical context) and intervention-related information will be summarized using descriptive numerical analysis and structured tables. These multiple layers of synthesis will be integrated to construct a conceptual model that visually represents the relational pathways linking health literacy, shame, concealment, provider behaviors, and communication outcomes.

We will present the findings in both a summary table and conceptual diagram and elaborate on them through descriptive and narrative synthesis. A conceptual model will be constructed to depict the interplay between patients’ experiences of shame and concealment and the behaviors and communication of health care providers. Following completion of data synthesis, the findings will be submitted to a peer-reviewed journal and disseminated at international conferences.

This scoping review will be the first to systematically map how shame and concealment are experienced by patients with LHL and how health care providers’ behaviors may exacerbate or mitigate these experiences. By synthesizing evidence from qualitative and mixed methods studies with qualitative findings, our review will provide a more comprehensive understanding of this psychosocial phenomenon.

Shame and concealment are not isolated experiences but relational processes shaped by clinical encounters and broader social contexts. Previous studies have shown that patients with LHL often hide their reading or comprehension difficulties out of fear of being judged, which prevents them from accessing the necessary support [18,19]. Such concealment can act as a coping mechanism, protecting patients from embarrassment while simultaneously restricting their ability to obtain information and engage fully in care [13]. Our review will highlight how these dynamics contribute to health inequities, particularly among populations already disadvantaged by socioeconomic or cultural factors.

These findings will have implications for both clinical practice and professional training. Health care providers may unintentionally reinforce shame through hurried communication, the use of jargon, or assumptions about patients’ abilities [21]. For example, patients often report that rush consultations and lack of plain language increase their reluctance to ask questions [22]. By mapping the available evidence, this review will identify strategies that can reduce these risks, such as adopting plain language, using the teach-back method, and creating safe spaces for patient questions.

This study may have some limitations. First, because we will restrict our inclusion to studies published in English, relevant evidence reported in other languages may be overlooked. This limitation is particularly important given that health literacy and the associated experiences of shame and concealment are strongly influenced by cultural and linguistic contexts. Second, although we will attempt to identify gray literature, some relevant reports, theses, or conference proceedings may not be retrieved because of limited indexing. Third, in accordance with the objectives of this scoping review, we will not quantitatively evaluate the effectiveness of the interventions. Consequently, our findings will not provide pooled estimates or definitive conclusions regarding intervention outcomes. Despite these limitations, the scoping review approach is well suited to our aims as it enables us to capture a broad and heterogeneous body of evidence, clarify conceptual boundaries, and identify important gaps in future research.

To the best of our knowledge, this will be the first scoping review to systematically map how shame and concealment are experienced by patients with LHL in the context of health care communication. By synthesizing evidence from qualitative and mixed methods studies with qualitative findings, this review will provide a comprehensive overview of how these psychosocial processes influence patient-provider interactions.

The insights generated will contribute to a deeper understanding of the relational dynamics that shape health communication and highlight how shame and concealment may reinforce existing inequities in care. These findings can inform the design of targeted interventions, guide professional education and training for health care providers, and support the development of organizational- and policy-level strategies to foster more equitable communication practices.

Ultimately, this review aims to provide a foundation for future empirical research and practical initiatives that seek to reduce the hidden barriers posed by shame and concealment, thereby promoting more inclusive, patient-centered, and effective health care communication.