OBJECTIVE: To inform the design and implementation of osteoarthritis (OA) education for people with knee and hip OA, this review investigated: i) the impact of OA education on knowledge, beliefs and behavior, ii) how and why these changes occur. METHODS: Five databases - MEDLINE, Excerpta Medica Database (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Physiotherapy Evidence Database (PEDro) - were searched in August 2023. Eligible studies were quantitative, qualitative and mixed-methods, involving OA education interventions, assessing knowledge, beliefs and/or behavioral outcomes. An interpretivist analytic process guided data evaluation, synthesis and description of meta-themes. RESULTS: Ninety-eight studies were included (80 quantitative, 12 qualitative, 6 mixed-methods). OA education was heterogeneous in content and delivery. Outcome measures varied, with poor distinction between knowledge, beliefs and behavior constructs. Trends toward short-term knowledge improvement were observed, but there were no clear trends in beliefs or behavior change. Intrinsic factors (e.g. pre-existing beliefs) and extrinsic factors (e.g. socioeconomic factors) appeared to influence change. Three meta-themes described how and why changes may occur: i) Engagement - how individuals relate with education content and delivery, ii) Embodiment - the role of experiential factors in learning, and iii) Empowerment - the level of agency education generates. CONCLUSION: Beyond the provision of information and instruction, OA education is a complex, relational process influenced by multidimensional factors. This review identifies potentially important strategies at individual, interpersonal and community levels to support the design and delivery of engaging education that promotes holistic, embodied learning, and facilitates meaningful, empowering change.