Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis

Miller, Tricia A.

doi:10.1016/j.pec.2016.01.020

Cited by 479 publications

(392 citation statements)

References 40 publications

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“…Our findings are consistent with that from a recent meta-analysis, which found a significant and positive relationship between health literacy and adherence with a 14% increased risk of non-adherence in those with lower health literacy [39]. Non-adherence rates were 1.33 times greater in those with limited health literacy [39]. A unique aspect of this study is the demonstration of this relationship with the HLQ, which is a contemporary tool compared to those used in previous studies (e.g.…”

Section: Discussionsupporting

confidence: 92%

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An observational study of health literacy and medication adherence in adult kidney transplant recipients

2016

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BackgroundThere is a high prevalence of non-adherence to immunosuppressants in kidney transplant recipients. Although limited health literacy is common in kidney recipients and is linked to adverse outcomes in other medical populations, its effect on medication adherence in kidney transplant recipients remains poorly understood. The objective was to investigate the effect of lower health literacy on immunosuppressant adherence.MethodsKidney recipients who were at least 6 months post-transplant and outpatients of Vancouver General Hospital in B.C., Canada were recruited through invitation letters. A total of 96 recipients completed the Health Literacy Questionnaire, which provides a multifactorial profile of self-reported health literacy and the Transplant Effects Questionnaire-Adherence subscale measuring self-reported immunosuppressant adherence. Hierarchical linear regression was used to analyze the association between health literacy and adherence after controlling for identified risk factors of non-adherence.ResultsOur sample was on average 53 years old, 56% male and 9 years post-transplant. Kidney recipients reported low levels of health literacy on scales measuring active health management and critical appraisal of information and 75% reported non-perfect adherence. Worse adherence was associated with poorer overall health literacy (ΔR2 = 0.08, P = 0.004) and lower scores on six of nine of the health literacy factors.ConclusionsPoorer health literacy is associated with lower immunosuppressant adherence in adult kidney transplant recipients suggesting the importance of considering a recipient's level of health literacy in research and clinical contexts. Medication adherence interventions can target the six factors of health literacy identified as being risk factors for lower medication adherence.

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Section: Discussionsupporting

confidence: 92%

“…Six out of the nine factors emerged as [39] significantly correlated with self-reported medication adherence (Table 4). In each case, lower scores on these factors were related to poorer medication adherence.…”

Section: Resultsmentioning

confidence: 99%

An observational study of health literacy and medication adherence in adult kidney transplant recipients

2016

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“…33 These findings are in accordance with reviews which advocated that health literacy in itself cannot account for medication adherence, but that other variables should also be taken into consideration. 7,8,34 We suggest that self-efficacy is an important mediator of the effect of health literacy on medication adherence. Moreover, besides health literacy and self-efficacy, patients’ acceptance of their doctor’s advice was a covariate in the present model, so it is also an important factor in terms of medication adherence.…”

Section: Resultsmentioning

confidence: 86%

“…However, the evidence is mixed concerning cardiovascular patients, as some studies reported that low health literacy was associated with poor adherence, while others studies found no significant relationship. 7,8 It is worth noting that the majority of the studies operationalized health literacy as basic numeracy and reading skills or health-related knowledge, but relatively little research has been done on its complex cognitive components, such as judgment skills. The term judgment skills refers to one’s ability to examine one’s own capabilities and limitations in order to make appropriate health decisions.…”

Section: Introductionmentioning

confidence: 99%

Intentional and Unintentional Medication Non-Adherence in Hypertension: The Role of Health Literacy, Empowerment and Medication Beliefs

Náfrádi

Galimberti

Nakamoto

et al. 2016

Journal of Public Health Research

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BackgroundMedication non-adherence is a major public health issue, creating obstacles to effective treatment of hypertension. Examining the underlying factors of deliberate and non-deliberate non-adherence is crucial to address this problem. Thus, the goal of the present study is to assess the socio-demographic, clinical and psychological determinants of intentional and unintentional non-adherence.Design and methodsA cross-sectional survey was conducted between March, 2015 and April, 2016. The sample consisted of hypertension patients holding at least one medical prescription (N=109). Measurements assessed patients’ medication adherence, health literacy, empowerment, self-efficacy, medication beliefs, and patients’ acceptance of their doctor’s advice, socio-demographic and clinical characteristics.ResultsPatients who occasionally engaged in either intentional or unintentional non-adherence reported to have lower adherence selfefficacy, higher medication concern beliefs, lower meaningfulness scores and were less likely to accept the doctor’s treatment recommendations. Patients who occasionally engaged in unintentional nonadherence were younger and had experienced more side effects compared to completely adherent patients. Adherence self-efficacy was a mediator of the effect of health literacy on patients’ medication adherence and acceptance of the doctor’s advice was a covariate.ConclusionsRegarding the research implications, health literacy and adherence self-efficacy should be assessed simultaneously when investigating the factors of non-adherence. Regarding the practical implications, adherence could be increased if physicians i) doublecheck whether their patients accept the treatment advice given and ii) if they address patients’ concerns about medications. These steps could be especially important for patients characterized with lower self-efficacy, as they are more likely to engage in occasional nonadherence.Significance for public healthMedication non-adherence is a critical public health issue, leading to increased health care costs, morbidity and mortality across several chronic conditions. Medication non-adherence is also one of the main obstacles to effective hypertension care, as between 20-50% of the patients do not follow appropriately their prescribed medication regimen. Despite the large body of empirical evidence available, relatively little is known about the potential differences between the determinants underpinning intentional versus unintentional nonadherence. Shedding light on the factors of medication non-adherence is inevitable to develop interventions and health campaigns addressing the issue. Thus, the present study quantitatively examines the patient-related factors of medication non-adherence to antihypertensive drugs, distinguishing between the determinants of deliberate versus non-deliberate non-adherence. Moreover, based on the outcomes, we advocate potential new approaches to address medication non-adherence in hypertension.

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“…This finding concurs with other studies that showed that a substantial proportion of Thai patients have inadequate health literacy, including knowledge about medication used in various chronic diseases, such as hypertension18 and schizophrenia 19. This problem needs to be addressed, as health literacy is positively associated with medication adherence 20,21…”

Section: Discussionmentioning

confidence: 99%

Patient opinions on medicine-use review: exploring an expanding role of community pharmacists

Aimaurai¹,

Jumpated²,

Krass³

et al. 2017

PPA

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BackgroundCurrent evidence supports the benefit of medicine-use review (MUR) for the safe and effective use of medicines. However, little is known about opinions of consumers regarding their preference for undertaking MUR, especially in the developing world, eg, in some Asian countries. We aimed to explore patients’ opinions about potential MUR and other enhanced services provided by community pharmacists.Patients and methodsA qualitative study using focus groups was conducted at Naresuan University’s community pharmacy, Phitsanulok, Thailand. MUR-naïve patients were recruited from two pharmacies in Phitsanulok. All focus groups were audio-recorded, transcribed, and thematically analyzed.ResultsTwenty participants attended four focus groups. The following themes were identified: 1) requirement and need for the service, 2) accessibility and convenience of receiving the service, 3) pharmacist attributes needed in delivering the service, and 4) how to promote the use of MUR successfully. The majority of participants had poor understanding about their medicines and were interested in receiving a MUR service. Regarding accessibility, convenience and close proximity of pharmacies to homes were deemed to be supportive of participants to use the service. However, several potential barriers to uptake were identified: perceived difficulty on the part of recipients in making time to receive the service and the inconvenience of having to provide medicines/records of medicines to pharmacists. The following domains of pharmacists’ characteristics were viewed as supportive determinants: personality (friendliness and confidence in giving information) and attitude (willingness to provide the service and not commercially oriented). The participants suggested that promoting the services using a mix of strategies would increase an awareness of MUR service.ConclusionRecognizing the unmet needs of patients for information on their medicines provides a good opportunity for community pharmacists to offer an MUR service to ensure quality use of medicines in the community.

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Health literacy and adherence to medical treatment in chronic and acute illness: A meta-analysis

Cited by 479 publications

References 40 publications

An observational study of health literacy and medication adherence in adult kidney transplant recipients

An observational study of health literacy and medication adherence in adult kidney transplant recipients

Intentional and Unintentional Medication Non-Adherence in Hypertension: The Role of Health Literacy, Empowerment and Medication Beliefs

Patient opinions on medicine-use review: exploring an expanding role of community pharmacists

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