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

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.

Download Full-text

Effects of combination drugs on antihypertensive medication adherence in a real-world setting: a Korean Nationwide Study

BMJ Open ◽

10.1136/bmjopen-2019-029862 ◽

2019 ◽

Vol 9 (6) ◽

pp. e029862 ◽

Cited By ~ 3

Author(s):

Seung Jae Kim ◽

Oh Deog Kwon ◽

BeLong Cho ◽

Seung-Won Oh ◽

Cheol Min Lee ◽

...

Keyword(s):

Medication Adherence ◽

Real World ◽

Antihypertensive Drugs ◽

Medication Possession Ratio ◽

The Elderly ◽

Population Based ◽

Angiotensin Ii Receptor Blocker ◽

Angiotensin Ii Receptor ◽

Improve Medication Adherence ◽

Real World Setting

ObjectivesWe tried to clarify, by using representative national data in a real-world setting, whether single-pill combinations (SPCs) of antihypertensives actually improve medication adherence.DesignA nationwide population-based study.SettingWe used a 2.2% cohort (n=1 048 061) of the total population (n=46 605 433) that was randomly extracted by National Health Insurance of Korea from 2008 to 2013.ParticipantsWe included patients (n=116 677) who were prescribed with the same antihypertensive drugs for at least 1 year and divided them into groups of angiotensin II receptor blocker (ARB)-only, calcium channel blocker (CCB)-only, multiple-pill combinations (MPCs) and SPCs of ARB/CCB.Primary outcome measuresMedication possession ratio (MPR), a frequently used indirect measurement method of medication adherence.ResultsAdjusted MPR was higher in combination therapy (89.7% in SPC, 87.2% in MPC) than monotherapy (81.6% in ARB, 79.7% in CCB), and MPR of SPC (89.7%, 95% CI 89.3 to 90.0) was higher than MPR of MPC (87.2%, 95% CI 86.7 to 87.7) (p<0.05). In subgroup analysis, adherence of SPC and MPC was 92.3% (95% CI 91.5 to 93.0) vs 88.1% (95% CI 87.1 to 89.0) in those aged 65–74 years and 89.3% (95% CI 88.0 to 90.7) vs 84.8% (95% CI 83.3 to 92.0) in those ≥75 years (p<0.05). According to total pill numbers, adherence of SPC and MPC was 90.9% (CI 89.8 to 92.0) vs 85.3% (95% CI 84.1 to 86.5) in seven to eight pills and 91.2% (95% CI 89.3 to 93.1) vs 82.5% (95% CI 80.6 to 84.4) in nine or more (p<0.05). The adherence difference between SPC and MPC started to increase at five to six pills and at age 50–64 years (p<0.05). When analysed according to elderly status, the adherence difference started to increase at three to four pills in the elderly (≥65 years) and at five to six in the non-elderly group (20–64 years) (p<0.05). These differences all widened further with increasing age and the total medications.ConclusionSPC regimens demonstrated higher adherence than MPC, and this tendency is more pronounced with increasing age and the total number of medications.

Download Full-text

Reassessing health literacy best practices to improve medication adherence among patients with dyslexia

Patient Education and Counseling ◽

10.1016/j.pec.2019.05.024 ◽

2019 ◽

Vol 102 (11) ◽

pp. 2122-2127

Author(s):

Ann Ritter ◽

Vinu Ilakkuvan

Keyword(s):

Medication Adherence ◽

Health Literacy ◽

Best Practices ◽

Improve Medication Adherence

Download Full-text

“Why Am I Not Taking Medications?” Barriers and Facilitators of Diabetes Medication Adherence Across Different Health Literacy Levels

Qualitative Health Research ◽

10.1177/1049732320945296 ◽

2020 ◽

Vol 30 (14) ◽

pp. 2331-2342 ◽

Cited By ~ 2

Author(s):

Yen-Ming Huang ◽

Kristen E. Pecanac ◽

Olayinka O. Shiyanbola

Keyword(s):

Medication Adherence ◽

Health Literacy ◽

Diabetes Management ◽

Daily Routine ◽

Structured Interviews ◽

Improve Medication Adherence ◽

Internal Locus Of Control ◽

Tailored Interventions ◽

The Cost

Medication adherence is important for diabetes management. Better knowledge of how patient factors relate to medication adherence allows us to develop more tailored interventions. We explore patients’ perceptions of the barriers to and facilitators of medication adherence across different levels of health literacy. Semi-structured interviews with 23 participants with type 2 diabetes (T2D) were completed, and direct content analysis identified the facilitators of and the barriers to medication adherence through the lens of the Health Literacy Pathway model. Linking medication-taking to daily routine and focusing on the internal locus of control are imperative approaches to fostering self-efficacy of medication use. Understanding patients’ life experiences and clarifying medication misinformation help patients address their concerns with medications. Lowering the cost of medications and simplifying therapy regimens can alleviate participants’ perceived barriers to medication-taking. In this study, we explore medication adherence from the experience of people with T2D and can inform tailored interventions to improve medication adherence.

Download Full-text

Adherence through education: A call to clinicians to educate all patients on medication use

Mental Health Clinician ◽

10.9740/mhc.n117761 ◽

2012 ◽

Vol 2 (4) ◽

pp. 83-85 ◽

Cited By ~ 1

Author(s):

Kristen Allison

Keyword(s):

Medication Adherence ◽

Patient Education ◽

Medication Use ◽

Medication Nonadherence ◽

Improve Medication Adherence ◽

Therapeutic Outcomes

Medication nonadherence contributes to lack of achievement of desired therapeutic outcomes. This article reviews the evidence supporting patient education as a one of the tools to promote medication adherence. Patient education and provision of tools to help patients overcome adherence barriers are effective ways to improve medication adherence.

Download Full-text