Mediators of the association of limited English health literacy with medication non-adherence among Singaporean elderly

Abstract

Background: In Singapore, English is predominantly used on prescription medication labels (PMLs). However, many older Singaporeans cannot read English, and among those who read English, their English health literacy (EHL) proficiency varies. It is thus pertinent to examine the link between EHL and medication use outcomes in this population. The present research aims to address this question. Methods: Data from a national survey, on 1167 home-dwelling elderly on ⩾1 prescribed medication was analysed. The validated Health Literacy Test for Singapore was used to determine EHL. Medication non-adherence was self-reported. Path analysis examined the association between limited EHL and medication non-adherence and tested possible mediators. Results: Limited EHL was associated with medication non-adherence (total effect=0.35; p-value: 0.032), and ‘uncertainty in taking medications correctly due to difficulty in understanding written information on PMLs’ was a significant mediator (indirect effect=0.23, 95% confidence interval (0.12–0.39)). Conclusions: Elderly people with limited EHL were significantly more likely than those with adequate EHL to report that they were uncertain about taking medications correctly because they had difficulty understanding the information on PMLs and this misunderstanding contributed to medication non-adherence. Interventions focused on incorporating bilingual text and/or pictograms on PMLs may reduce uncertainty in taking medication correctly and improve medication adherence among the elderly.

Comparison of self‐reported EDACS versus physician‐reported EDACS for the triage of chest pain patients in the emergency department

“…Population health literacy is also affected by confounders, such as educational level and healthcare exposure, which were not sought for in the questionnaire to keep it as abbreviated as possible. As Singapore has a low prevalence of health literacy even among those who can read English (31.6%), 9 it is postulated that the correlation between S/P-EDACS would be even closer for predominantly English-speaking Western populations with higher health literacy.…”

Multilingualism across the Lifespan

“…The case of FM74 who pretended to understand the consultation is potentially dangerous and posed a serious risk to her well-being. Medication compliance for older adults who have multiple chronic conditions can be very complicated and any error in following instructions due to language barriers have been found to have very disastrous ramifications (Suppiah et al 2020).…”

Conformity of prescription medication labels with label format and content recommendations

“…1,2 Patients in Singapore have reported challenges in reading and understanding PMLs, especially older patients with limited English literacy. 15,16 No study has assessed the conformity of PMLs in Singapore to best practice recommendations and their variability across public and private healthcare institutions. Importantly, such an assessment will document the extent of deviation from recommendations and inform the need to improve deficiencies in current labelling practices.…”