Abstract
Purpose: Examine associations between health literacy and several medication self-management constructs among a population of adults with uncontrolled hypertension. Patients and Methods: Cross-sectional study of health center patients from the Chicago area with uncontrolled hypertension enrolled between April 2012 and February 2015. Medication self-management constructs—applied to hypertension medications, chronic condition medications and all medications—included: 1) medication reconciliation, 2) knowledge of drug indications, 3) understanding instructions and dosing, and 4) self-reported adherence over 4 days (no missed doses). We determined associations between health literacy and self-management outcomes using multivariable generalized linear regression. Results: There were 1460 patients who completed screening interviews; 62.9% enrolled and had complete baseline data collected, and were included in the analysis. Of 919 participants, 47.4% had likely limited (low), 33.2% possibly limited, and 19.4% likely adequate health literacy. Compared to participants with likely adequate health literacy, participants with low health literacy were less likely to have chronic medications reconciled (18.0% versus 29.6%, p=0.007), know indications for chronic medications (64.1% versus 83.1%, p<0.001), and demonstrate understanding of instructions and dosing (68.1% versus 82.9%, p=0.001). Self-reported adherence to hypertension medications was higher among the low health literacy group (65.6% versus 56.0%, p=0.010). In multivariable models, health literacy was strongly associated with knowledge of drug indications, and understanding of instructions and dosing. Conclusion: Low health literacy was associated with worse medication self-management in several domains. However, non-adherence was greatest in the most health literate in unad-justed analysis. Among a population of patients with uncontrolled hypertension, the drivers of poor control may vary by health literacy.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 87-95 |
| Number of pages | 9 |
| Journal | Patient Preference and Adherence |
| Volume | 14 |
| DOIs | |
| State | Published - 2020 |
Funding
This study was supported by Grant Number R01NR012745 from the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health. The funder had no role in the design; data collection; execution of intervention; analysis, interpretation or reporting of data; or the decision to submit the findings for publication. The authors thank Milton “Mickey” Eder, PhD for his contribution to this study. The authors also acknowledge and thank staff members of the participating health centers and Northwestern University. This study was presented in part at the Society of General Internal Medicine’s Annual Meeting, April 21, 2017, Washington D.C. Funding This study was supported by Grant Number R01NR012745 from the National Institute of Nursing Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health. The funder had no role in the design; data collection; execution of intervention; analysis, interpretation or reporting of data; or the decision to submit the findings for publication.
Keywords
- Community health centers
- Health literacy
- Hypertension
- Medication reconciliation
ASJC Scopus subject areas
- Pharmacology, Toxicology and Pharmaceutics (miscellaneous)
- Health Policy
- Medicine (miscellaneous)
- Social Sciences (miscellaneous)