The effects of medication adherence and health literacy on health-related quality of life in older people with hypertension

Association Between High Blood Pressure-Specific Health Literacy and Health-Related Quality of Life Among Patients With Hypertension in Urban-Rural Fringe Communities in China: A Mediation Analysis of Social Support and Self-management

BACKGROUND

Despite rapid urbanization, no researchers have focused on patients with hypertension in urban-rural fringe areas, where rural characteristics are retained but the influences of urbanization are typically found.

OBJECTIVE

In this study, we aimed to reduce health inequities by examining the status quo of health-related quality of life (HRQOL), high blood pressure-specific health literacy (HBP-HL), and social support and self-management and to explore how HBP-HL influences HRQOL among patients with hypertension in urban-rural fringe communities.

METHODS

Four hundred six patients with hypertension completed physical examinations and HBP-HL, HRQOL, self-management, and social support assessments via in-person interviews. Bootstrap multiple mediating effect analysis was used to explore associations between HBP-HL and HRQOL.

RESULTS

Only 24.2% of participants had a high HRQOL. None of the participants had adequate HBP-HL, only 23.2% had limited HBP-HL, and 76.8% had moderate HBP-HL. The HBP-HL score was directly correlated with HRQOL (β = 0.802; 95% confidence interval, 0.344-1.259) and indirectly correlated with HRQOL via social support (β = 0.368; 95% confidence interval, 0.202-0.568) and self-management (β = 0.314; 95% confidence interval, 0.102-0.560). The total contribution rate of the mediating effect was 41.4%.

CONCLUSIONS

The HRQOL and HBP-HL scores of patients with hypertension were intermediate and inadequate, respectively. In addition, HBP-HL directly and indirectly influenced HRQOL through social support and self-management. Health providers should screen for inadequate HBP-HL in patients with hypertension before intervention. Health-promoting interventions involving HBP-HL as a breakthrough point should be tailored to control blood pressure and improve HRQOL.

Dietary vitamin intake and its association with hypertension (HPT) among Malaysian adults

This study aims to investigate the association between dietary vitamin (A, B6, B9, B12, C, E, and K) intake and hypertension (HPT) among Malaysian adult population. This is a cross-sectional analysis of baseline data from a population-based cohort of 10,031 participants from the Malaysia arm of the Prospective Urban and Rural Epidemiology (PURE) study. Participants were classified as having HPT if they reported a diagnosis of high blood pressure (systolic blood pressure (SBP)/diastolic blood pressure (DBP) > 140/90). Participants' usual dietary intake was assessed using a validated food frequency questionnaire. Vitamin (A, B6, B9, B12, C, E, and K) intake was calculated using nutrient databases. The Mann-Whitney U test was used to assess differences in vitamin intake between the HPT groups. This study found that the prevalence of HPT among 10,031 respondents was 43.5%. The overall dietary intake of vitamins A and C was adequate, but the intake of vitamins B6, B9, B12, E, and K was inadequate compared to Malaysia's Recommended Nutrient Intakes (RNI). The intake of vitamins A, B6, B9, B12, E, and K was significantly lower among patients with HPT compared to those without HPT (p-value < 0.001). This study found that the Malaysian adult population is not receiving sufficient intake of vitamins B6, B9, B12, E, and K from their diet. Improving vitamin intake can be achieved through nutrition education, a diet that includes a variety of healthy foods, and food fortification and supplementation.

Effectiveness of a BCW-based interactive pictorial health education program among patients with hypertension in the urban-rural fringe area in China

OBJECTIVE

To evaluate the effects of the interactive pictorial health education (IPHE) program on enhancing high blood pressure-specific health literacy (HBP-HL), controlling blood pressure, and improving self-management behavior (SMB) and Health-related Quality of Life (HRQOL) among hypertensive patients with inadequate HBP-HL (HPIH) in the urban-rural fringe area in China.

METHODS

A quasi-experimental study with repeated measures was used. The intervention group (n = 60) received IPHE program, while the control group (n = 60) received health education lectures. Outcome measures were HBP-HL, systolic blood pressure (SBP), diastolic blood pressure (DBP), SMB and HRQOL evaluated at baseline (T0), six months (T6), nine months (T9), and 12 months (T12).

RESULTS

The effects of intervention factors on HBP-HL, SBP and HRQOL were stronger over time (P < 0.05), but not on DBP and SMB. The SMB scores were better in the intervention group at T6, T9 and T12 (P < 0.05). Compared to T0, the SBP and DBP in the intervention group decreased by 9.22 and 4.27 mmHg at T12.

CONCLUSION

The IPHE program can enhance HBP-HL, control blood pressure, and improve SMB and HRQOL among HPIH.

PRACTICE IMPLICATIONS

The IPHE program was an active and promising method to manage HPIH.

Exploring the relationship between health literacy and chronic diseases among middle-aged and older adults: evidence from Zhejiang, China

Background

Chronic diseases have emerged as a significant public health challenge owing to the escalating global demographic shift toward an aging population. Middle-aged and older individuals are particularly vulnerable to chronic illnesses owing to physiological and socioeconomic changes. By leveraging health literacy data from the Zhejiang Province, this study aimed to elucidate the correlation between health literacy levels and the prevalence of chronic diseases in this demographic cohort.

Methods

In this cross-sectional study, a stratified multistage whole-cluster random sampling method was used to select 12,116 permanent residents aged 45-69 years from 30 monitoring sites in Zhejiang Province from June to November 2023, using the National Health Literacy Monitoring Questionnaire for the Population. Multivariate regression analysis was employed to unravel the correlation between proficiency in health education and the prevention of chronic illnesses.

Results

Sex, age, income, education, self-assessed health status, and smoking status emerged as significant predictors across the different models. Notably, self-assessed health and smoking statuses were identified as confounders that significantly affected the association between health literacy and chronic diseases. Furthermore, this study explored the influence of independent variables on specific chronic diseases, such as hypertension and cerebrovascular disease, with consistent patterns observed across models.

Conclusion

Health literacy is instrumental in thwarting chronic diseases among middle-aged and older individuals. Those with higher levels of health literacy are less likely to suffer from chronic diseases, and high health literacy is a protective factor against hypertension and cerebrovascular disease.

The Association Between Medication Adherence and Rational Drug Use Knowledge and Health Literacy in Older Adults Residing in Nursing Homes

BACKGROUND

Medication adherence is a crucial factor in managing and treating chronic diseases in older adults. Health literacy (HL) skills and rational drug use (RDU) knowledge are important for individuals to make informed decisions about medication adherence behaviours.

AIM

This study was conducted to determine the association between medication adherence and rational drug use knowledge and health literacy in older adults residing in nursing homes.

METHODS

The cross-sectional study was conducted with 121 older adults residing in a nursing home in Turkey. The data were collected using the Participant Information Form, the Medication Adherence Report Scale (MARS-5), the Rational Drug Use Scale (RDUS), and The Turkish version of the European Health Literacy Survey Questionnaire (HLS EUEU-Q-TR).

RESULTS

The mean age of the older adults was 69.92 ± 6.45 years and 76.9% were male. The mean score of MARS-5 was 21.80 ± 3.55. Among older adults, 43.8% were found to have inadequate RDU knowledge, 28.9% had inadequate HL, and 46.3% had problematic-limited HL. The RDU knowledge was a statistically significant strong predictor of medication adherence (R2 = 0.495, p < 0.001). The HL was a statistically significant predictor of medication adherence (R2 = 0.037, p < 0.05).

CONCLUSION

The study found that medication adherence among older adults residing in nursing homes was moderate, RDU knowledge and HL levels were low, and medication adherence increased as RDU knowledge and HL levels increased.

Determinants of medication adherence among elderly with high blood pressure living in deprived areas

INTRODUCTION

The current study was conducted to determine the impact of health literacy and factors related to adherence to drug treatment, using the model proposed by the World Health Organization, in older adults with hypertension residing in informal settlements in Hamadan.

METHODS

This cross-sectional study was conducted on 405 patients in Hamadan city, located in the western part of Iran. Data were collected using an interviewer-administered questionnaire that included the 5-dimensional model proposed by the World Health Organization, Health Literacy for Iranian Adults, and Morisky Medication Adherence Scale-8. A two-stage sampling procedure was used to select patients from 14 comprehensive health service centers and health bases. The data were analyzed using SPSS v.24.

RESULTS

The study found that medication adherence was suboptimal in 63% of the participants. Additionally, 87.5% of patients had inadequate or insufficient health literacy. Factors related to medication adherence included age (odds ratio (OR) = 1.07), annual income (OR = 0.17), duration of hypertension (OR = 7.33), health literacy (OR = 1.03), self-reported health status (P < 0.05), and regular medication use (P < 0.008).

CONCLUSION

The results of this study indicate that more than half of the older adults in the study had suboptimal medication adherence and insufficient health literacy. The study also found that various factors, such as socioeconomic status, disease and treatment-related factors, and patient-related factors, influence medication adherence among older adults.

A cross-sectional analysis of the PURE study on minerals intake among Malaysian adult population with hypertension

Hypertension (HPT) is the leading modifiable risk factor for cardiovascular diseases and premature death worldwide. Currently, attention is given to various dietary approaches with a special focus on the role of micronutrient intake in the regulation of blood pressure. This study aims to measure the dietary intake of selected minerals among Malaysian adults and its association with HPT. This cross-sectional study involved 10,031 participants from the Prospective Urban and Rural Epidemiological study conducted in Malaysia. Participants were grouped into HPT if they reported having been diagnosed with high blood pressure [average systolic blood pressure (SBP)/average diastolic blood pressure (DBP) ≥ 140/90 mm Hg]. A validated food frequency questionnaire (FFQ) was used to measure participants' habitual dietary intake. The dietary mineral intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, sodium, and zinc was measured. The chi-square test was used to assess differences in socio-demographic factors between HPT and non-HPT groups, while the Mann-Whitney U test was used to assess differences in dietary mineral intake between the groups. The participants' average dietary intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, sodium, and zinc was 591.0 mg/day, 3.8 mg/day, 27.1 mg/day, 32.4 mg/day, 0.4 mg/day, 1431.1 mg/day, 2.3 g/day, 27.1 µg/day, 4526.7 mg/day and 1.5 mg/day, respectively. The intake was significantly lower among those with HPT than those without HPT except for calcium and manganese. Continuous education and intervention should be focused on decreasing sodium intake and increasing potassium, magnesium, manganese, zinc, and calcium intake for the general Malaysian population, particularly for the HPT patients.

Current status and influencing factors of health literacy among older adults in combined medical and nursing care institutions: a cross-sectional study

Introduction

Health literacy is linked to the health status of older adults and is a critical component in achieving active aging. This study to characterize the current health literacy status among older adults in combined medical and nursing care institutions, as well as the factors that influenced this status.

Methods

This cross-sectional study used a convenience sampling method to select 740 older adults who were in 16 combined medical and nursing care institutions in Chengdu, China, from July 2022 to June 2023, using the Health Literacy Management Scale, the Social Support Rating Scale, and the Short Form-36 Health Survey.

Results

The results showed a health literacy score of 75.25 ± 12.33, the percentage of older adults with basic health literacy was 6.33%, a social support score of 37.37 ± 6.10, and a health-related quality of life score of 55.34 ± 15.48. Factors influencing health literacy included age, educational level, previous occupation, family size, monthly per capita household income, and health-related quality of life.

Discussion

Health literacy is an essential factor in improving the health status of older adults. Relevant departments should therefore improve health education and health promotion interventions for older adults in combined medical and nursing care institutions to improve health literacy.

Factors associated with poor health literacy in older adults: A systematic review

OBJECTIVES

To identify factors associated with poor health literacy in older adults.

METHODS

A systematic literature review was conducted, employing the descriptors "Aged" and "Health Literacy".

PROSPERO - CRD

42022350140.

RESULTS

Out of 23,500 articles screened, 176 were selected. Several factors associated with poor health literacy in older adults were identified, such as sociodemographic (e.g., advanced age, low educational level, non-white population, and others), social (e.g., poor family/social support, loneliness, social isolation, few social activities, and others), economic (e.g., lower income and/or lower socioeconomic status) and health aspects (e.g., poor health, chronic conditions, mental health challenges, hospitalizations, frailty, physical inactivity, cognitive impairment, and others).

CONCLUSIONS

The factors associated with poor health literacy in older adults identified in this review could contribute to future research, support interventions to improve health literacy, and assist professionals in planning educational activities and public policies.

Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics

Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.

Prevalence and Factors Associated with Prehypertension and Hypertension Among Adults: Baseline Findings of PURE Malaysia Cohort Study

Background

Although prehypertension and hypertension can be detected at the primary healthcare level and low-cost treatments can effectively control its complications, hypertension is still the world's leading preventable risk factor. Therefore, the present study aimed to determine its prevalence and its risk factors among Malaysian adults.

Methods

A cross-sectional study involving 7585 adults was performed covering the rural and urban areas. Respondents with systolic blood pressure (SBP) of 120-139 mmHg and/or diastolic blood pressure (DBP) of 80-89 mmHg were categorized as prehypertensive, and hypertensive categorization was used for respondents with an SBP of ≥140 mmHg and/or DBP of ≥90 mmHg.

Results

Respondents reported to have prehypertension and hypertension were 40.7% and 38.0%, respectively. Those residing in a rural area, older age, male, family history of hypertension, and overweight or obese were associated with higher odds of prehypertension and hypertension. Unique to hypertension, the factors included low educational level (AOR: 1.349; 95% CI: 1.146, 1.588), unemployment (1.350; 1.16, 1.572), comorbidity of diabetes (1.474; 1.178, 1.844), and inadequate fruit consumption (1.253; 1.094, 1.436).

Conclusions

As the prehypertensive state may affect the prevalence of hypertension, proactive strategies are needed to increase early detection of the disease among specific group of those residing in a rural area, older age, male, family history of hypertension, and overweight or obese.

Hypertension literacy: Concept analysis

AIM

Analysis of the concept of hypertension literacy to ensure clarity, reduce ambiguities and promote consistency in usage.

DESIGN

Walker and Avant's concept analysis method was adopted.

METHODS

Searched four electronic databases using keywords combined with the appropriate Boolean operators. After removing duplicates, thirty titles were identified, and ten articles met the basic criteria for inclusion. The analysis was done using a convergent synthesis design to integrate results and transform them into qualitative descriptions.

RESULTS

Hypertension literacy's defining attributes were hypertension information search skills, comprehension of numeracy associated with blood pressure and medication and utilization of hypertension prevention information. The identified antecedents were formal education and improved cognitive, social, economic and health-related experiences. Consequences of hypertension literacy included improved self-reported and increased health awareness. Hypertension literacy allows nurses to assess and accurately improve knowledge and facilitate people to adopt prevention behaviours.

Relationship between People's Interest in Medication Adherence, Health Literacy, and Self-Care: An Infodemiological Analysis in the Pre- and Post-COVID-19 Era

The prevalence of non-communicable diseases has risen sharply in recent years, particularly among older individuals who require complex drug regimens. Patients are increasingly required to manage their health through medication adherence and self-care, but about 50% of patients struggle to adhere to prescribed treatments. This study explored the relationship between interest in medication adherence, health literacy, and self-care and how it changed during the COVID-19 pandemic. We used Google Trends to measure relative search volumes (RSVs) for these three topics from 2012 to 2022. We found that interest in self-care increased the most over time, followed by health literacy and medication adherence. Direct correlations emerged between RSVs for medication adherence and health literacy (r = 0.674, p < 0.0001), medication adherence and self-care (r = 0.466, p < 0.0001), and health literacy and self-care (r = 0.545, p < 0.0001). After the COVID-19 pandemic outbreak, interest in self-care significantly increased, and Latin countries showed a greater interest in self-care than other geographical areas. This study suggests that people are increasingly interested in managing their health, especially in the context of the recent pandemic, and that infodemiology may provide interesting information about the attitudes of the population toward chronic disease management.

Estimation of health literacy levels in patients with cardiovascular diseases in a Gulf country

INTRODUCTION

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. In the United Arab Emirates (UAE), the prevalence of deaths associated with CVD is higher than the global average, and the incidence of premature coronary heart disease is 10-15 years earlier than in Western nations. In patients with CVD, inadequate health literacy (HL) is significantly associated with poor health outcomes. The goal of this study is to assess HL levels among patients with CVD in the UAE to develop effective health system strategies for disease prevention and management.

METHODS

A nationwide cross-sectional survey to assess HL levels in patients with CVD was conducted between January 2019 and May 2020 in the UAE. The association between health literacy level with patient age, gender, nationality, and education was determined using the Chi-Square test. The significant variables were further analyzed by ordinal regression.

RESULTS

Of 336 participants (86.5% response rate), approximately half 51.5% (173/336) of the respondents were women, and 46% (146/336) of them attained high school level of education. More than 75% (268/336) of the participants were above the age of 50 years. Overall, 39.3% (132/336) of respondents possessed inadequate HL, and 46.4% (156/336) and 14.3% (48/336) demonstrated marginal and adequate HL, respectively. Inadequate health literacy was more prevalent among women, as compared to men. Age was significantly associated with HL levels. Participants under age 50 had higher adequate HL levels 45.6% (31/68), (95% CI (3.8-57.4), P < 0.001). There was no correlation between education and health literacy levels.

CONCLUSION

The inadequate HL levels found in outpatients with CVD is a major health concern in the UAE. To improve population health outcomes, health system interventions, including targeted educational and behavioral programs for the older population are necessary.

Relationship Between Health Literacy, Quality of Life, and Treatment Adherence in Patients with Acute Coronary Syndrome

BACKGROUND

Acute coronary syndrome is a significant global health concern that can affect patients' health outcomes and quality of life. In addition, adherence to treatment and health literacy can affect health outcomes.

OBJECTIVE

This study aimed to investigate the relationship between treatment adherence, health literacy, and quality of life among patients with acute coronary syndrome.

METHODS

This cross-sectional study was conducted on 407 patients in Iran from April 2019 to November 2019. Patients were selected by convenience sampling method. Data were collected using demographic questionnaire, World Health Organization Quality of Life Brief Version, Adherence to Treatment Questionnaire, and Health Literacy for Iranian Adults questionnaire. SPSS 25 was used for statistical analysis.

RESULTS

Based on descriptive statistics in this study, most of the participants had good treatment adherence level (56.5%); 28.7% of the participants had insufficient health literacy level. The mean score of quality of life was 51.41 ± 12.03, which was greater than the midpoint of the questionnaire. Furthermore, Pearson's correlation coefficient showed a negative association between health literacy, treatment adherence (r = -0.167, p < .01), and quality of life (r = -0.153, p < .01), and a positive association between treatment adherence and quality of life (r = 0.169, p < .01).

CONCLUSION

The results of the current study showed a negative relationship between health literacy, quality of life, and treatment adherence among patients with acute coronary syndrome. [HLRP: Health Literacy Research and Practice. 2023;7(2):e71-e79.].

Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study

BACKGROUND

Previous studies have examined the associations of health literacy and social support with medication adherence among patients with hypertension. However, limited evidence exists regarding the mechanisms underlying the relationship between these factors and medication adherence.

PURPOSE

To explore the prevalence of medication adherence and its determinants in patients with hypertension in Shanghai.

METHODS

A community-based cross-sectional study was conducted among 1697 participants with hypertension. We collected sociodemographic and clinical characteristics as well as data regarding health literacy, social support, and medication adherence using questionnaires. We examined interactions among the factors using a structural equation model.

RESULTS

The participants included 654 (38.54%) patients with a low degree of medication adherence and 1043 (61.46%) patients with a medium/high degree of adherence. Social support directly influenced adherence (β = 0.165, P < 0.001) and indirectly influenced adherence through health literacy (β = 0.087, P < 0.001). Health literacy directly influenced adherence (β = 0.291, P < 0.001). Education indirectly affected adherence through both social support (β = 0.048, P < 0.001) and health literacy (β = 0.080, P < 0.001). Moreover, there was a sequential mediating effect of social support and health literacy on the association between education and adherence (β = 0.025, P < 0.001). After controlling for age and marital status, similar results were also obtained, indicating a good model fit.

CONCLUSIONS

The degree of medication adherence among hypertensive patients needs to improve. Health literacy and social support had both direct and indirect effects on adherence, and thus, these factors should be considered as tools to improve adherence.

Investigation of health literacy level and its effect on quality of life in patients with spinal cord injury

OBJECTIVES

To determine the health literacy (HL) level in patients with traumatic spinal cord injury (SCI) and evaluate the relationship between HL and the quality of life (QoL).

STUDY DESIGN

Cross-sectional study.

SETTING

Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Turkey.

PARTICIPANTS

A total of 77 patients with traumatic SCI aged 15-65 years where the trauma had occurred at least a month ago before data collection and who were attending the rehabilitation program at the hospital as inpatients we included in the study.

OUTCOME MEASURES

The European Health Literacy Questionnaire Turkish Adaptation (HLS-TR) was used for the evaluation of the HL level, and the Short Form-36 was used for the evaluation of the QoL.

RESULTS

The HL level was inadequate in 32.5%, problematic-limited in 40.3%, sufficient in 19.5%, and excellent in 7.8% of the patients. The vitality and mental health subdimensions of the QoL were found to be statistically significantly better in participants with excellent, sufficient or problematic-limited HL compared to those with an inadequate level.

CONCLUSIONS

According to our results, the HL level of the majority of patients with SCI who are hospitalized in our hospital is low, and there is a relationship between HL and QoL. In conclusion, steps need to be taken to increase the HL levels of patients to improve their QoL, taking into account the important effect of HL on the QoL.

Cognitive Function and the Relationship With Health Literacy and Secondary Prevention in Patients With Acute Coronary Syndrome at Early Discharge: A Prospective Observational Study

BACKGROUND

Cognitive impairment (CI) may contribute to difficulties in understanding and implementing secondary prevention behavior change after acute coronary syndrome (ACS), but the association is poorly understood.

OBJECTIVES

The aim of this study was to explore the prevalence of CI in patients 4 weeks post ACS and the association with health literacy and secondary prevention.

METHODS

Patients with ACS who were free from visual deficits, auditory impairment, and dementia diagnoses were recruited and assessed 4 weeks post discharge for cognitive function (Montreal Cognitive Assessment and Hopkins Verbal Learning Test), health literacy (Newest Vital Sign), depression (Patient Health Questionnaire), physical activity (Fitbit Activity Tracker and Physical Activity Scale for the Elderly), and medication knowledge and adherence.

RESULTS

Participants (n = 45) had an average age of 65 ± 11 years, 82% were male, 64% were married/partnered, and 82% had high school education or higher. Overall CI was identified in 28.9% (n = 13/45) of the patients 4 weeks after discharge, which was composed of patients detected on both the Montreal Cognitive Assessment and Hopkins Verbal Learning Test (n = 3), patients detected on Montreal Cognitive Assessment alone (n = 6), and patients detected on Hopkins Verbal Learning Test alone (n = 4). Fewer patients with CI had adequate health literacy (61.4%) than patients with normal cognition (90.3%, P = .024). Significant correlations were found between Hopkins Verbal Learning Test scores and medication knowledge (0.4, P = .008) and adherence (0.33, P = .029).

CONCLUSIONS

In this exploratory study, 30% of patients with ACS demonstrated CI at 4 weeks post discharge. Two screening instruments were required to identify all cases. Cognitive impairment was significantly associated with health literacy and worth further investigation.

Gender differences in factors associated with the health literacy of hospitalized older patients with chronic diseases: A cross-sectional study

Background

To identify gender differences in factors associated with the health literacy of hospitalized older patients with chronic diseases.

Methods

A total of 471 hospitalized older patients with chronic diseases in four hospitals were investigated from May 2019 to June 2020. The self-developed demographic information questionnaire, the "Health Literacy Scale for Patients with Chronic Diseases" and the "Self-Efficacy for Managing Chronic Diseases 6-item Scale" were applied in this study. Multiple linear regression was used to assess the factors influencing health literacy among older patients with chronic diseases by gender.

Results

The factors influencing health literacy differed by gender. Male health literacy was related to education background, number of children, monthly income, duration of chronic disease and chronic disease self-efficacy. For females, health literacy was associated with age, education background, monthly income, duration of chronic disease and chronic disease treatment.

Conclusion

Healthcare providers should focus on the above-mentioned factors that could help identify those with low health literacy differ base on gender. Gender-specific strategies should be developed to improve the health literacy of older patients with chronic diseases and strengthen their chronic disease management.

Health literacy, health literacy interventions and decision-making: a systematic literature review

Purpose

The purpose of this paper is to assess the relationship between elderly people's health literacy skills and those people's decision to make use of digital health service platforms. Despite the substantial influence of digitisation on the delivery of healthcare services, understanding how health intervention strategies might help empower elderly people's health literacy skills is critical.

Design/methodology/approach

This paper analyses the existing trends in research on the convergence of health literacy, health intervention programmes and digital health service platforms by reviewing 34 studies published between 2000 and 2020.

Findings

The findings of the review indicate three primary themes (health literacy skills, health management competency and attitude/confidence), which provide a summary of the current literature, and in all three the results show that health intervention programmes help to enhance health literacy skills of elderly people. Based on the review results and by organising the fragmented status quo of health intervention research, the authors develop a comprehensive research model and identify future research directions for research in this domain.

Practical implications

The findings will be useful to health professionals in two ways: (1) the findings provide practical information about the growing need to implement health literacy intervention programmes to satisfy elderly people's appetite for accessing health services due to cognitive and physiological impairments, and (2) the finding help them to understand that with digital health platforms, elderly people have quicker access to health services, improving the quality of care provided to them.

Originality/value

This paper presents a comprehensive research model for analysing the impact of health literacy skills on older people's ability and intention to access digital health information sources, considering various health intervention approaches.

A behavior change wheel-based interactive pictorial health education program for hypertensive patients with low blood pressure health literacy: study protocol for a randomized controlled trial

Background

The prevalence of hypertension is increasing worldwide. Hypertension self-management usually involves the application and consideration of oral, written, or quantitative information. Hypertensive patients in China have limited high blood pressure health literacy (HBP-HL), which may lead to poorer clinical outcomes. This study aims to determine the feasibility and effectiveness of an interactive pictorial health education program based on behavior change wheel (BCW) theory and its effect on HBP-HL, self-efficacy, self-management ability, and health-related quality of life (HRQOL) in hypertensive patients with low HBP-HL.

Methods

This study is a randomized controlled trial (RCT). One of the municipal districts in Huzhou, China, will be randomly selected, and two communities with similar conditions within this district will be screened and selected. A total of 120 hypertensive patients aged 18 years and older will be recruited from these two community settings. One of the communities will be randomly allocated to an interactive pictorial health education program conducted by a comprehensive health literacy strategy that includes (i) training participants in effective health communication skills that address issues encountered in seeking medical care and (ii) the use of self-developed interactive pictorial hypertension education to improve patient understanding and behaviors versus a control group (routine community lecture health education only). The primary outcome measure is HBP-HL. Secondary outcomes are self-efficacy, self-management ability, HRQOL, social support, and improvement in blood pressure. Outcomes will be collected at 6, 9, and 12 months from trial entry.

Discussion

The strengths of this study are the establishment of a new health management program for hypertensive patients that closely combines BCW theory and health literacy. This trial has the potential to improve HBP-HL in hypertensive Chinese patients with low health literacy to improve the self-management of hypertension and help control blood pressure.

Trial registration

Clinical Trials.gov Protocol Registration and Results System ID NCT04327102. Prospectively registered on February 29, 2020

Self-reported health literacy and medication adherence in older adults: a systematic review

OBJECTIVES

To give an overview over the associations between self-reported health literacy and medication adherence in older adults.

DESIGN

A systematic literature review of quantitative studies published in English and German.

DATA SOURCES

MEDLINE via PubMed, CINAHL, Cochrane Library, Epistemonikos and LIVIVO were searched.

ELIGIBILITY CRITERIA

Included studies had to examine the associations between self-reported health literacy and medication adherence in the elderly (samples including ≥66% of ≥60 years old) and had to use a quantitative methodology and had to be written in English or German.

DATA EXTRACTION AND SYNTHESIS

All studies were screened for inclusion criteria by two independent reviewers. A narrative synthesis was applied to analyse all included studies thematically. Quality assessment was conducted using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

RESULTS

We found 2313 studies, of which nine publications from eight studies were included in this review. Five studies reported a majority of participants with limited health literacy, one study reported a majority of participants with adequate health literacy, and three publications from two studies only reported mean levels of health literacy. Eight publications from seven studies used self-reports to measure medication adherence, while one study used the medication possession ratio. Overall, six publications from five studies reported significantly positive associations between health literacy and medication adherence while two studies reported positive but non-significant associations between both constructs and one study reported mixed results.

CONCLUSION

In this review, associations between self-reported health literacy and medication adherence are rather consistent, indicating positive associations between both constructs in older adults. However, concepts and measures of health literacy and medication adherence applied in the included studies still show a noteworthy amount of heterogeneity (eg, different use of cutoffs). These results reveal the need for more differentiated research in this area.

PROSPERO REGISTRATION NUMBER

CRD42019141028.

Do Patient Engagement Platforms in Total Joint Arthroplasty Improve Patient-Reported Outcomes?

BACKGROUND

Web-based patient engagement portals are increasing in popularity after total hip and knee arthroplasty (THA and TKA). The literature is mixed regarding patient utilization of these modalities and potential clinical benefit. We sought to determine which demographic factors are associated with increased platform participation and to quantify the impact of a web-based patient portal on patient-reported outcome measures (PROMs).

METHODS

We performed a retrospective analysis of consecutive primary THA (n = 554) and TKA (n = 485) at a single academic institution with minimum follow-up of 12 months. Patients were divided into those who opted-in and those who opted-out of portal use. Global health and joint-specific PROMs were collected preoperatively and postoperatively. Linear mixed effects modeling, bivariate analysis, and logistic regression were utilized.

RESULTS

Of the 1039 included patients, 60.6% (336) THA and 62.7% (304) TKA patients enrolled in the portal. Those who opted-in were younger (P < .001, P < .003), had higher body mass index (P = .024, P = .011), and had a higher household income (P < .001, P < .001) in THA and TKA cohorts, respectively. Portal participation in the TKA but not the THA cohort was associated with significant improvement in physical function (P = .017) and joint-specific function (P = .045). For THA patients who opted-in, increased portal logins were associated with more rapid improvement and higher functional scores (P = .013).

CONCLUSION

There is an inherent difference between patients who opt-in to and those who opt-out of web-based portals. Added resources and support provided by portals may translate to improved PROMs for TKA patients but not THA patients.

Health-Related Quality of Life Is a Mediator of the Relationship Between Medication Adherence and Cardiac Event-Free Survival in Patients with Heart Failure

BACKGROUND

Health-related quality of life (HRQOL) is an important patient-reported outcome that is related to medication adherence, hospitalization and death. The nature of the relationships among medication adherence, HRQOL, and hospitalization and death is unknown. We sought to determine the relationships among medication adherence, HRQOL, and cardiac event-free survival in patients with heart failure.

METHODS AND RESULTS

We enrolled 218 patients with heart failure. Patients' medication adherence was measured objectively using the Medication Event Monitoring System. HRQOL was assessed using the Minnesota Living with Heart Failure Questionnaire. Patients were followed for up to 3.5 years to collect hospitalization and mortality data. Mediation analysis was used to determine the nature of the relationships among the variables. Patients with better medication adherence had better HRQOL (P = .014). Medication adherence and HRQOL were associated with cardiac event-free survival (both P < .05). Patients with medication nonadherence were 1.86 times more likely to experience a cardiac event than those with better medication adherence (P = .038). Medication adherence was not associated with cardiac event-free survival after entering HRQOL in the model (P = .118), indicating mediation by HRQOL of the relationship between medication adherence and cardiac event-free survival.

CONCLUSIONS

HRQOL mediated the relationship between medication adherence and cardiac event-free survival. It is important to assess medication adherence and HRQOL regularly and develop interventions to improve medication adherence and HRQOL to decrease hospitalization and mortality in patients with heart failure.

Potentially Inappropriate Medication Use in Older People: A Cross-sectional Study Using Beers Criteria

BACKGROUND

The use of Potentially Inappropriate Medications (PIMs) is common and negatively affects elderly health and disease prognosis.

OBJECTIVE

This study aims to analyze the frequency of PIMs in the elderly health records registered to a family health center and to identify risk factors, prescription/nonprescription distribution, distribution by healthcare institutions, number of doctors visits, and health literacy.

METHODS

In this cross-sectionalstudy, a stratified sampling method was used to select individuals aged ≥ 65 years. The health records of the participants up to the last 12 months were examined, and medicines used by participants were evaluated according to Beers 2019 criteria.

RESULTS

Most of the participants (89.7%, n:183) had PIMs in health records. The mean number of PIMs used by the elderly was 2.9±1.9(min:0, max:8). A positive linear relationship was observed between multimorbidity and the number of PIMs (p=0.001). There was no significant difference in terms of PIMs frequency among healthcare institutions. Prescription and nonprescription PIMs were found to belong to the same drug groups (Pain relievers and stomach medications). A linear and significant correlation was found between the number of PIMs and doctor visits (p=0.047).

CONCLUSION

The doctor should examine prescription and over-the-counter medications used by the elderly during the visit. It will be useful to establish a warning system stating that PIMs are available while registering the medications in the electronic system. So, it will be possible for health authorities to re-evaluate the treatment and replace PIMs with rational drug options.

Assessing forgetfulness and polypharmacy and their impact on health-related quality of life among patients with hypertension and dyslipidemia in Greece during the COVID-19 pandemic

Purpose

We estimate the association between forgetfulness to take medications as prescribed and polypharmacy and health-related quality of life (HRQoL) among a cohort of patients with hypertension, dyslipidemia or both in Greece during the COVID-19 pandemic.

Methods

A telephone survey of 1018 randomly selected adults was conducted in Greece in June 2020. Participants were included in the survey, if they (a) had a diagnosis of hypertension, dyslipidemia or both and (b) were on prescription treatment for these conditions. HRQoL was calculated using the short form (SF) -12 Patient Questionnaire. A multivariable generalized linear regression model (GLM) was used to estimate the association between forgetfulness and polypharmacy and HRQoL, controlling for sociodemographic and health-related covariates.

Results

Overall, 351 respondents met the inclusion criteria, of whom 28 did not fully complete the questionnaire (response rate: 92%, n = 323). Of those, 37% were diagnosed with hypertension only, 28% with dyslipidemia only, and 35% with both. Most reported good to average physical (64.1%) and mental health (48.6%). Overall, 25% indicated that they sometimes forget to take their prescribed medications, and 12% took two or more pills multiple times daily. Total HRQoL score was 68.9% (s.d. = 18.0%). About 10% of participants reported paying less attention to their healthcare condition during the pandemic. Estimates of multivariable analyses indicated a negative association between forgetfulness (− 9%, adjusted β: − 0.047, 95% confidence interval − 0.089 to − 0.005, p = 0.029), taking two or more pills multiple times daily compared to one pill once a day (− 16%, adjusted β: − 0.068, 95% confidence interval − 0.129 to − 0.008, p = 0.028) and total HRQoL.

Conclusion

Our results suggest that among adult patients with hypertension, dyslipidemia or both in Greece, those who forget to take their medications and those with more complex treatment regimens had lower HRQoL. Such patients merit special attention and require targeted approaches by healthcare providers to improve treatment compliance and health outcomes.

The effect of high blood pressure-health literacy, self-management behavior, self-efficacy and social support on the health-related quality of life of Kazakh hypertension patients in a low-income rural area of China: a structural equation model

Background

Health-Related Quality of Life (HRQoL) of hypertensive patients is not only affected by the disease itself but also by some subjective factors. Low health literacy is prevalent among ethnic minorities. Considering the Kazakh-Chinese people have the highest prevalence of hypertension in Xinjiang, and the High Blood Pressure-Health Literacy (HBP-HL) has not been included in the study of HRQoL. The synergistic effects and the potential mechanism HBP-HL, self-management behavior, therapeutic adherence, self-efficacy, social support on HRQoL remain unclear. This study aimed to introduce the HBP-HL, and develop a structural equation model (SEM) to identify the factors influencing of the HRQoL among Kazakh hypertensive patients.

Methods

The data was obtained by questionnaire survey and physical examination in 2015. Patients with hypertension were recruited through random cluster sampling in Kazakh settlements in Xinjiang. Firstly, the blood pressure was measured. Then the one-for-one household interviews were conducted by Kazakh investigators. The questionnaires regarding HBP-HL, HRQoL, self-management behavior, therapeutic adherence, self-efficacy, and social support were used to collect data. Finally, SEM was constructed, and p ≤ 0.05 was taken as significant.

Results

The data was analysed by SPSS18.0 and AMOS18.0 software. 516 Kazakh hypertension patients were recruited, and 94.4% of them had a relatively low HBP-HL score. The mean standardized scores of HRQoL, self-management, therapeutic adherence were poor; they were 63.5, 66.2, and 64.4, respectively. But 96.1% and 98.3% of the participants had high levels of self-efficacy and social support. The SEM of the HRQoL had a good overall fit (χ²/df = 2.078, AGFI = 0.944, GFI = 0.968, CFI = 0.947, IFI = 0.949, RMSEA = 0.046). The model indicated that the HBP-HL has the highest correlation with HRQoL, following with self-management behavior, social support, and self-efficacy.

Conclusions

Low HBP-HL is a major influenced factor of HRQoL among Kazakh hypertensive patients. Future programs should consider HBP-HL as the breakthrough point when designing targeting intervention strategies.

Association of health literacy and medication adherence with health-related quality of life (HRQoL) in patients with ischemic heart disease

BACKGROUND

Medication Adherence (MA) and Health Related Quality of Life (HRQoL) are two inter-connected concepts, co-influenced by Health Literacy (HL), with significant impact on patient management and care. Thus, we aimed to estimate the association of HL and MA with HRQoL in IHD patients.

METHODS

Cross-sectional study of 251 IHD patients recruited from Lahore over 6 months period. HL, MA and HRQoL was assessed using validated questionnaires; 16-items of HL, Morisky Green Levine Scale (MGLS) and SF-12, respectively. Chi-square for significance, logistic-regression for association and linear regression for predictions were used.

RESULTS

IHD patients; males (p = 0.0001), having secondary-higher education (p = 0.0001), middle/upper class (p = 0.0001) and employed (p = 0.005) had adequate HL, and were more likely to be adherent (OR; 4.3, p = 0.014). Both physical (PCS-12) and mental (MCS-12) component scores of HRQoL for age, gender, education, area of residence, employment and MA were significantly higher in patients with adequate HL. In multinomial regression, improved PCS-12 scores tend to be higher in subjects having secondary-higher education (OR; 3.5, p = 0.067), employed (OR; 6.1, p = 0.002) and adherent (OR; 2.95, p = 0.218), while MCS-12 scores tend to be higher in patients < 65 years (OR; 2.2, p = 0.032), employed (OR; 3, p = 0.002) and adherent (OR; 4, p = 0.004). In adjusted model, HL (β;0.383, p = 0.0001) and MA (β; - 0.133, p = 0.018) were significantly associated with PCS-12, and MCS-12 with MA (β; - 0.161, p = 0.009) only.

CONCLUSION

Data suggested that adequate HL was significantly associated with adherence and both physical and mental dimensions of HRQoL were higher in IHD patients with adequate HL. Besides, HL and MA are independent predictors of HRQoL in IHD patients.

Self-Reported Nonadherence to Medication Is Not Associated with Health-Related Quality of Life in Parkinson's Disease

Nonadherence is a growing issue in the treatment of Parkinson’s disease (PD). Many factors are known to influence nonadherence, but little is known about the influence of quality of life (QoL). Detailed clinical data were obtained from 164 patients with PD using the Parkinson’s Disease Questionnaire-39 (PDQ-39) and the German Stendal Adherence with Medication Score (SAMS). Descriptive statistics were used to identify reasons for nonadherence, and multivariable linear models were used to study associations between QoL and clinical parameters as well as nonadherence. Multivariate analysis of variance (MANOVA) and multivariate analysis of covariance (MANCOVA) were used to study the effect of the SAMS on PDQ domains and other medical covariates. The results showed that 10.4% (n = 17) of patients were fully adherent, 66.4% (n = 109) were moderately nonadherent, and 23.2% (n = 38) were nonadherent. Nonadherence was associated with male gender, lower Montreal Cognitive Assessment (MoCA) score, higher non-motor symptoms questionnaire (NMS-Quest) score, greater number of medications per day (an indicator of comorbidity), and higher Beck Depression Inventory (BDI) score. QoL was correlated with male gender, lower MoCA score, higher NMS-Quest score, more comorbidities, and higher BDI score, but was not correlated with nonadherence.

Low medication adherence is associated with decline in health-related quality of life: results of a longitudinal analysis among older women and men with hypertension

OBJECTIVE

The aim of this study was to determine the association of low antihypertensive medication adherence with decline in health-related quality of life (HRQOL) over 1 year.

METHODS

We used data from older men and women with hypertension (n = 1525) enrolled in the Cohort Study of Medication Adherence among Older Adults. Adherence was measured using the validated self-report four-item Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4) (low adherence = score ≥1) and prescription refill-based proportion of days covered (PDC) (low adherence = PDC < 0.80). We defined decline in HRQOL as a decrease in Mental Component Summary (MCS) or Physical Component Summary (PCS) score (from the RAND 36-Item Health Survey 1.0 administered at two time points - at the time of adherence assessment and 1 year later) equivalent to the minimal important difference (MID) for each respective summary score, calculated as the average of MID estimates derived from distribution and anchor-based approaches.

RESULTS

The prevalence of low adherence was 38.6% using the K-Wood-MAS-4 and 23.9% using PDC. On the basis of mean MID estimates of 4.40 for MCS and 5.16 for PCS, 21.8 and 25.2% of participants experienced a decline in MCS and PCS, respectively, over 1 year. Low adherence was associated with a decline in MCS for K-Wood-MAS-4 [prevalence ratio = 1.32, 95% confidence interval (95% CI) 1.08-1.62, P = 0.008], but not PDC (prevalence ratio  = 1.17, 95% CI 0.94-1.47, P = 0.168). Low adherence was not associated with decline in PCS (K-Wood-MAS-4: prevalence ratio  = 0.95, 95% CI 0.79-1.16; PDC: prevalence ratio  = 1.10, 95% CI 0.90-1.35).

CONCLUSION

Low self-report medication adherence is associated with decline in mental HRQOL over 1 year in older adults with hypertension.

Relationship between Health Literacy and Medication Adherence of Turkish Cancer Patients Receiving Oral Chemotherapy

Objective:

The aim of this study was to explore the relationship between health literacy and self-report medication adherence of Turkish cancer patients receiving oral chemotherapy.

Methods:

The present research was a descriptive and cross-sectional study and conducted with 100 voluntary cancer patients who were admitted to the medical oncology outpatient clinic and received oral chemotherapy. The data were collected through a questionnaire form consisting of the Oral Chemotherapy Adherence Scale and the Turkish Health Literacy Scale (TSOY-32). The collected data were analyzed using descriptive statistics, one-way ANOVA, and Pearson's correlation coefficient.

Results:

The results revealed that 57% of the patients were female, 35% were primary school graduates, 51% were breast cancer, and 36% took capecitabine. The mean index scores of the participants on both scales were calculated as 12.39 ± 1.51 and 73.25 ± 6.18, respectively. Overall, a positive and strong correlation was found between oral chemotherapy adherence and health literacy of the participants (r = 0.707, P = 0.000).

Conclusions:

Medication adherence and health literacy levels among the cancer patients in Turkey are alarming so that patient-centered interventions and training are required to overcome the barriers to medication adherence.

Physical Comorbidity and Health Literacy Mediate the Relationship Between Social Support and Depression Among Patients With Hypertension

Depression is a common comorbidity among patients with hypertension. Patients with hypertension and depression have worse health outcomes compared to those without depression. The combined effects of social support, physical comorbidity, and health literacy on depression among individuals with hypertension remain unclear. A survey was conducted between December 2017 and May 2018 to investigate the relationships among social support, physical comorbidity, health literacy, and depression in a population of patients with hypertension in rural areas of Sichuan province, China. Multiple linear regression was used to examine factors that influenced depression, and structural equation modeling (SEM) was used to examine the relationships among the four study variables. The mean scores of 549 patients with hypertension were 37.17 ± 6.84 for social support, 14.62 ± 6.26 for health literacy, and 3.56 ± 3.05 for depression; furthermore, 34.2% of participants had physical comorbidity. Gender and per capita annual family income were significantly associated with depression. Physical comorbidity was directly positively related to depression while health literacy was directly negatively related to depression. Social support had an indirect negative association with depression by the mediating effects of health literacy and physical comorbidity. Adequate social support and health literacy, and less physical comorbidity could potentially contribute to reducing depression. The study highlights the importance of social support in maintaining mental health among patients with hypertension. Strategies that target the enhancement of social support and health literacy should be prioritized to relieve depression among patients with hypertension. More attention should be paid to women, low-income individuals, and patients with physical comorbidities.

Identifying Adherence Patterns Across Multiple Medications and Their Association With Health Outcomes in Older Community-Dwelling Adults With Multimorbidity

OBJECTIVES

To classify older people with multimorbidity according to their adherence patterns and to examine the association between medication adherence and health outcomes.

METHODS

This is a secondary analysis of a cohort study. Community-dwelling adults aged ≥70 years were recruited from 15 general practices in Ireland in 2010 (wave 1) and followed up 2 years later (wave 2). Participants had ≥2 RxRisk-V multimorbidity conditions at wave 1 and had ≥2 dispensations of RxRisk-V medications (wave 1-wave 2). Average adherence across RxRisk-V conditions was estimated based on continuous multiple-interval measure of medication availability (CMA7 function in AdhereR). Group-based trajectory models were used to group participants' adherence patterns for RxRisk-V medications. Multilevel regression was used to examine the association between adherence and (1) EuroQol 5-dimension (EQ-5D) utility (linear) and (2) vulnerability, using the Vulnerable Elders Survey (≥3 defined as vulnerable; logistic) at wave 2, controlling for potential confounders.

RESULTS

Average adherence (CMA7) was 77% across 501 participants. Group-based trajectory models identified 5 adherence groups: (1) initial low adherers, gradual increase; (2) high adherers, sharp decline; (3) steady adherers, gradual decline; (4) consistent high adherers; and (5) consistent nonadherers. Higher average adherence was associated with a significant increase in EQ-5D utility (adjusted β = 0.11, robust standard error 0.04). Group 5 was associated with significantly increased vulnerability compared to group 4 (adjusted odds ratio = 1.88; 95% confidence interval 1.01-3.50).

CONCLUSION

Increased average adherence was associated with higher EQ-5D utility. Adherence grouping did not significantly impact utility. Suboptimal adherence to multiple medications in older adults with multimorbidity was associated with vulnerability.

Utility of medicines information leaflets in hypertensive care in a setting with low health literacy: A cross-sectional study

Introduction:

Higher levels of health literacy improve utilization of health information, medication adherence and outcomes. Few studies evaluate the utility of medicines information in hypertensive care in settings with low health literacy.

Aim:

To determine the level of health literacy and utility of medicines information leaflets (MILs) among hypertensive patients in public health care in Namibia.

Methods:

A hospital-based survey among hypertensive patients receiving care at a referral hospital in Namibia from the 8 June 2018 to 29 June 2018. Patient’s health literacy and utility of MIL were assessed using three literacy tools and a survey questionnaire. Quantitative data were analysed using descriptive statistics and qualitative thematic content analysis for factors associate with the utility of the MIL.

Results:

Of the 139 patients, 63% were female and the mean age was 45.7 (range: 19.0–84.0) years. Over 85.6% had of low literacy skills (Rapid Estimate of Literacy in Medicine (REALM) score <44, that is, unable to read simple health materials), 38.8% had positive Single Item Literacy Screener (SILS) scores (⩾2, require help to read medicines information) and 66.9% had inadequate skills for comprehension, appraisal and decision-making with regard to health information (Health Literacy Skills Instrument-Short Form (HLSI-SF) score <70%). The level of access to and utility of MIL were low, 32.4% and 34.6%, respectively. The main factors associated with poor utility of the MIL were low patient health literacy, lack of guidelines on the use of MIL and MIL written in non-native languages.

Conclusion:

Low rates of health literacy and utility of MIL were observed among hypertensive patients in Namibia. The integration of health literacy programmes, and MIL guidelines are needed to promote utility of medicine information and improve medication adherence.

Relationship Between Medication Literacy and Medication Adherence in Inpatients With Coronary Heart Disease in Changsha, China

Background: Medication literacy may be associated with medication safety, and medication adherence is critical in treating coronary heart disease. Few studies have explored the association between medication literacy and medication adherence in patients with coronary heart disease. The aim was to investigate the status of medication literacy and medication adherence among Chinese inpatients with coronary heart disease, and explore the association between medication literacy and medication adherence.

Methods: The study was a cross-sectional survey. Four hundred seventy inpatients with coronary heart disease were recruited from hospitals in Changsha, Hunan, China. Participants’ demographic and clinical data were retrieved from hospital charts. Medication adherence was assessed using the four-item Morisky Medication Adherence Scale. Medication literacy was assessed using the Chinese Version of the Medication Literacy Scale. For univariate analysis, potential factors influencing medication adherence were tested by T-tests, analysis of variance, and the Kruskal–Wallis H test. Binary logistic regression model was conducted with medication adherence as the outcome variable in order to analyze the association between medication literacy and medication adherence in inpatients with coronary heart disease.

Results: Among 512 participants, 470 (91.8%) produced valid responses for the survey. Mean (SD) of medication adherence score was 2.26 (13.6); only 13.6% had optimal medication adherence. Mean (SD) of medication literacy score was 7.52 (4.09); participants with adequate medication literacy was 30.2% (142). Binary logistic regression analysis indicated that medication literacy was an independent predictor associated with medication adherence. Participants with adequate medication literacy were more likely to have optimal medication adherence (OR 1.461 [95% CI: 0.114, 0.643]; P = 0.005), and participants with a high level of education (OR 0.613 [95% CI: 0.284, 0.694]; P< 0.001), a fewer number of medicines (OR 1.514 [95% CI: -0.631, -0.198]; P < 0.001), having medical insurance (OR 0.770 [95% CI: -1.769, 0.059]; P = 0.043), and single inpatients were more likely to be adherent (OR 1.655 [95% CI:-0.858, -0.149]; P = 0.005).

Conclusions: The study indicates a significant association between medication literacy and medication adherence in patients with coronary heart disease. These results suggest that medication literacy is an important consideration in the development, implementation, and evaluation of medication adherence interventions.

The association between medication non-adherence and adverse health outcomes in ageing populations: A systematic review and meta-analysis

AIMS

The aim of this systematic review and meta-analysis was to synthesise the evidence relating to medication non-adherence and its association with health outcomes in people aged ≥50 years.

METHODS

Seven databases were searched up to February 2019 for observational studies that measured medication (non-)adherence as a predictor of the following health outcomes in adults aged ≥50 years: healthcare utilisation (hospitalisation, emergency department visits, outpatient visits and general practitioner visits), mortality, adverse clinical events and quality of life. Screening and quality assessment using validated criteria were completed by 2 reviewers independently. Random effects models were used to generate pooled estimates of association using adjusted study results. The full methodological approach was published on PROSPERO (ID: CRD42017077264).

RESULTS

Sixty-six studies were identified for qualitative synthesis, with 11 of these studies eligible for meta-analyses. A meta-analysis including 3 studies measuring medication non-adherence in adults aged ≥55 years showed a significant association with all-cause hospitalisation (adjusted odds ratio 1.17, 95% confidence interval [CI] 1.12, 1.21). A meta-analysis including 2 studies showed that medication non-adherence was not significantly associated with an emergency department visit (adjusted odds ratio 1.05, 95% CI 0.90, 1.22). Good adherence was associated with a 21% reduction in long-term mortality risk in comparison to medication non-adherence (adjusted hazard ratio 0.79, 95% CI 0.63, 0.98).

CONCLUSION

Medication non-adherence may be significantly associated with all-cause hospitalisation and mortality in older people. Medication adherence should be monitored and addressed in this cohort to minimise hospitalisation, improve clinical outcomes and reduce healthcare costs.

Evaluating self-directed learning abilities as a prerequisite of health literacy among older people: Findings from a validation and a cross-sectional study

AIMS AND OBJECTIVES

To validate a tool measuring self-directed learning (SDL) abilities and to determine these abilities among older individuals attending the University of the Third Age.

BACKGROUND

Health literacy (HL) and SDL abilities have been documented as being closely linked to each other and as prerequisites in enhancing self-management competences required by older people to protect their health and to manage health issues. Furthermore, individuals with SDL abilities have been documented to have a full understanding of their health treatment prescriptions, to be able to demonstrate increased compliance and to further develop self-care competences.

DESIGN

A validation and a cross-sectional study design.

METHODS

A consecutive sample of 313 older people (68.7% female) who attended lessons in two Italian Universities of the Third Age and who were willing to participate in the study were enrolled. The Self-Rating Scale of Self-Directed Learning (SRSSDL) validated previously in the healthcare context, was used.

RESULTS

At the exploratory and confirmatory factor analysis, the SRSSDL in Older people (SRSSDLO) has demonstrated good psychometric properties: the tool is composed by four factors ("Awareness," "Attitudes," "Availability" and "Motivation") and 13 items. According to the findings, the average SDL score was 54.27 ± 6.69 out of 65, and women achieved significantly higher scores compared with men (54.81 ± 6.69 vs. 53.08 ± 6.54, p = .033), while participants with a university degree (55.95 ± 6.56) or secondary education (54.75 ± 6.13) had higher scores than those with lower secondary education (50.37 ± 7.34, p = .002).

CONCLUSIONS

Participants were responsible for their learning processes and were capable of identifying learning needs and goals. They were also internally motivated to develop learning methods and to organise learning activities. However, they were less able to keep up to date with the learning resources available.

IMPLICATIONS FOR PRACTICE

The SRSSDLO can help nurses identify healthy older people that lack SDL abilities and design tailored educational interventions to prevent health conditions and/or promote self-care management in chronic conditions.

Improved adherence in older patients with hypertension: An observational study of a community-based intervention

AIMS AND OBJECTIVES

This study sought to assess the effect of a community-based intervention influencing adherence status at baseline, 1, 3 and 6 months, and to evaluate the impact that a community-based intervention and socio-economic factors have on adherence.

BACKGROUND

Although high-quality treatment and modern hypertension clinical practice guidelines have been developed worldwide, the outcomes of patients with hypertension in Thailand are not optimal. Implementing a person-centred and integrated health services model to improve hypertension management, such as a community-based intervention, is challenging for healthcare providers in Thailand.

DESIGN

An observational study of a community-based intervention.

METHODS

The study comprised residents in 17 villages in one province of Thailand. A sample of 156 participants was allocated into the intervention and the control groups. Inclusion criteria were people aged 60 years or older diagnosed with hypertension. Exclusion criteria included the latest record of extreme hypertension and having a documented history of cognitive impairment. The intervention group received the 4-week community-based intervention programme. Multiple linear regression was applied to predict the adherence status at each phase. Multiple logistic regression was then implemented to predict influencing factors between the groups.

RESULTS

Patients who received the intervention had significantly lower adherence scores (reflecting a higher level of adherence) at 3 and 6 months after intervention by 1.66 and 1.45 times, respectively, when adjusting for other variables. After 6 months, the intervention was associated with a significant improvement in adherence when adjusting for other variables.

CONCLUSION

This study provides evidence to support the use of community-based interventions as an effective adjunct to hospital-based care of hypertension patients in Thailand.

IMPLICATIONS FOR PRACTICE

Understanding factors between health outcomes and social determinants of health is crucial for informing the development of culturally appropriate interventions.

Medication Adherence and Its Association with Health Literacy and Performance in Activities of Daily Livings among Elderly Hypertensive Patients in Islamabad, Pakistan

Background and Objective: Medication non-adherence is a preventable reason for treatment failure, poor blood pressure control among hypertensive patients and the geriatric population owing to poor physical activity is more vulnerable strata. The objective of this study is to investigate medication adherence and its associated factors among Pakistani geriatric hypertensive patients. Methods: A cross-sectional survey-based study was conducted at the out-patient department of the cardiac center from May 2018 to August 2018. A universal sampling technique was used to approach patients and 262 eligible consented patients were interviewed to collect information about socio-demographics, health, and disease-related characteristics using a structured questionnaire. The Morisky Levine Green test was used for the assessment of medication adherence. The Barthel index and single item literacy screener (SILS) was used to measure performance in activities of daily living and health literacy respectively. Chi-square tests and multivariate binary logistic regression analysis were performed to find factors by using SPSS version 20. Results: Of the total 262 participants, about 38.9% (n = 102) were scored 4 and considered adherent while 61.1% (n = 160) were considered as non-adherent. In logistic regression analysis, self-reported moderate (OR = 3.538, p = 0.009) and good subjective health (OR = 4.249, p = 0.008), adequate health literacy (OR = 3.369, p < 0.001) and independence in performing activities of daily living (OR = 2.968, p = 0.002) were found to be independent predictors of medication adherence among older hypertensive patients. Conclusion: Medication adherence among the older hypertensive population in Pakistan is alarmingly low. This clearly requires patient-centered interventions to overcome barriers and educating them about the importance of adherence.

Utilization of an Electronic Patient Portal Following Total Joint Arthroplasty Does Not Decrease Readmissions

BACKGROUND

At the investigating institution, an electronic messaging portal (MyChart) allows patients to directly communicate with their healthcare provider. As reimbursement models evolve, there is an increasing effort to decrease 90-day hospital resource utilization and patient returns, and secure messaging portals have been proposed as one way to achieve this goal. We sought to determine which patients utilize this portal, and to determine the impact of secure messaging on emergency department (ED) visits and readmissions within 90 days postoperatively.

METHODS

The institutional database was used to analyze 6426 procedures including 3297 primary total knee and 3129 primary total hip arthroplasties. Patient demographics, comorbidities, and secure communication activity status were recorded. Subsequently, statistical analysis was performed to determine which patients utilized MyChart, as well as to correlate patient outcomes to the utilization of secure messaging portals.

RESULTS

Active MyChart users were significantly more likely to be young, healthy (American Society of Anesthesiologists 1 or 2), Caucasian, married, employed, have private insurance, and be discharged to home. Decreased utilization was seen in patients who were unhealthy (American Society of Anesthesiologists 3 or 4), were African American, unmarried, unemployed, had Medicare or Medicaid insurance, and were discharged to a skilled nursing facility; these characteristics were also independent significant risks for returning to the ED. Active MyChart status was not significantly associated with 90-day ED return (P = .781) or readmission (P = .512). However, if multiple messages to providers were sent, and the provider response rate was <75%, patients had significantly more readmissions (P = .004).

CONCLUSION

Primary total joint arthroplasty patients who were at high risk for ED returns were less likely to utilize MyChart. However, MyChart use did not decrease the 90-day rate of return to the ED or readmissions. A low provider response rate to the secure messages may lead to increased resource utilization in patients using secure messaging as their preferred communication tool. Alternative means of communication with the most vulnerable patients must be investigated to effectively decrease postoperative complications and resource utilization.

Exploring stroke survivors' self-efficacy in understanding and taking medication and determining associated factors: a cross-sectional study in a neurology clinic in Malaysia

BACKGROUND AND AIM

Evidence-based prescribing practices for stroke-preventive medication have benefited stroke survivors; however, medication-nonadherence rates remain high. Medication understanding and use self-efficacy (MUSE) has shown great importance in medication-taking behavior, but its relationship with medication nonadherence in stroke-preventive regimens lacks exploration. The aim of this study was to determine the prevalence of MUSE and its association with nonadherence causes and other potential factors among stroke survivors in Malaysia.

METHODS

This cross-sectional study was conducted among 282 stroke patients who provided informed consent and were in follow-up at the Neurology Outpatient Department of Hospital Kuala Lumpur, Malaysia. The study employed a data-collection form that gathered information on sociodemographics, clinical treatment, outcome measures on MUSE, and medication-nonadherence reasons.

RESULTS

The prevalence of poor medication understanding and use self-efficacy among stroke patients was 46.5%, of which 29.1% had poor "learning about medication" self-efficacy, while 36.2% lacked self-efficacy in taking medication. Beliefs about medicine (74.02%) was the commonest reason for medication nonadherence, followed by medication-management issues (44.8%). In the multivariate model, independent variables significantly associated with MUSE were health literacy (AOR 0.2, 95% CI 0.069-0.581; P=0.003), medication-management issues (AOR 0.073, 95% CI 0.020-0.266; P<0.001), multiple-medication issues (AOR 0.28, 95% CI 0.085-0.925; P=0.037), beliefs about medicine (AOR 0.131, 95% CI 0.032-0.542; P=0.005), and forgetfulness/convenience issues (AOR 0.173, 95% CI 0.050-0.600; P=0.006).

CONCLUSION

The relatively poor learning about medication and medication-taking self-efficacy in this study was highly associated with health literacy and modifiable behavioral issues related to nonadherence, such as medication management, beliefs about medicine, and forgetfulness/convenience. Further research ought to explore these underlying reasons using vigorous techniques to enhance medication understanding and use self-efficacy among stroke survivors to determine cause-effect relationships.