Predictors of medication self-management skill in a low-literacy population

Abstract

BACKGROUND: Patients' ability to manage medications is critical to chronic disease control. Also known as medication management capacity (MMC), it includes the ability to correctly identify medications and describe how they should be taken. OBJECTIVE: To evaluate the effects of low literacy, medication regimen complexity, and sociodemographic characteristics on MMC. DESIGN: Cross‐sectional analysis of enrollment data from participants in a randomized trial. PARTICIPANTS: Patients with coronary heart disease in an inner‐city clinic. MEASUREMENTS: Medication management capacity was measured with the Drug Regimen Unassisted Grading Scale (DRUGS), which scores subjects' ability to identify, open, describe the dose, and describe the timing of their medications. DRUGS overall and component scores were compared by literacy, Mini Mental State Exam score, regimen complexity (number of prescription medications), and sociodemographic characteristics. RESULTS: Most of the 152 participants were elderly (mean age 65.4 years), women (54.6%), and African American (94.1%). Approximately half (50.7%) had inadequate literacy skills, and 28.9% had marginal skills. In univariate analysis, MMC was significantly associated with literacy (P<.001), and this effect was driven by the ability to identify medications. In multivariable models, patients with inadequate literacy skills had 10 to 18 times the odds of being unable to identify all of their medications, compared with those with adequate literacy skills (P<.05). CONCLUSIONS: Adults with inadequate literacy skills have less ability to identify their medications. Techniques are needed to better educate low‐literacy patients about their medications, as a potential strategy to enhance adherence.

Association of Health Literacy With Medication Knowledge, Adherence, and Adverse Drug Events Among Elderly Veterans

“…In this study of elderly veterans' medication knowledge, adherence, and adverse drug events, we found a significant association between health literacy and knowledge of the medication name and purpose, as has been shown in other studies (e.g., Kripalani et al, 2006). However, we found no significant association between health literacy and adherence, or between health literacy and ADEs.…”

“…Low health literacy may lead to increased incidence of ADEs through misunderstanding of prescription instructions and warning labels (Davis et al, 2006), incorrect selfadministration (Kripalani et al, 2006), inability to communicate symptoms or signs effectively, or barriers to accessing care for monitoring and evaluation (Murray et al, 2009). Health literacy may also influence outcomes through an effect on medication adherence (Pignone, DeWalt, Sheridan, Berkman, & Lohr, 2005), although studies have shown inconsistent and sometimes contradictory relations (Berkman et al, 2011).…”

Limited Health Literacy is a Barrier to Medication Reconciliation in Ambulatory Care

“…Prior findings in HIV treatment found inconclusive results as to the relationship between health literacy and medication adherence. 10,13,[18][19][20] Yet HIV may differ from hypertension. Antiretroviral medications generally have a single manufacturer, and a prior study found that patients with limited literacy often rely on pill characteristics for identification.…”

Improving Medication Adherence through Graphically Enhanced Interventions in Coronary Heart Disease (IMAGE-CHD): A Randomized Controlled Trial

“…6,7 Patients may be non-adherent for many reasons, including forgetfulness, lack of motivation, and barriers such as high drug costs. 8,9 Inadequate health literacy, 2,10-12 poor understanding of the medication regimen, 13 low selfefficacy, 14 and medication regimen complexity can also adversely affect adherence. 15 A number of complex interventions have demonstrated moderate success in enhancing medication adherence.…”