Association between medication literacy and medication adherence and the mediating effect of self-efficacy in older people with multimorbidity

Abstract

Background Multimorbidity has a significant impact on public health and primary care. Medication adherence is recognized as the most effective measure for managing and preventing multimorbidity. Studies have shown that medication literacy has a positive effect on medication adherence in patients with multimorbidity. However, limited knowledge exists regarding the underlying mechanisms of this relationship in older adults with multimorbidity. Therefore, the aim of this study was to investigate the mediating role of self-efficacy in the association between medication literacy and medication adherence in this population. Methods This study employed a cross-sectional design and convenience sampling method to survey older patients with multimorbidity in six communities in Zhengzhou, China, from July 12, 2021, to December 15, 2021. Participants were assessed using a demographic questionnaire, the Chinese Version of the Medication Literacy Scale (C-MLS), the Self-Efficacy for Appropriate Medication Use Scale (SEAMS), and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8). Data were analyzed using descriptive statistics, t-tests, one-way analysis of variance, Pearson correlation analysis, and mediation analysis. Results A total of 350 elderly patients met the inclusion criteria, and 328 valid questionnaires were collected. The mean age of the participants was 74.90 ± 7.37 years, with a slightly higher proportion of males (55.8%) than females (44.2%). The mean score for medication adherence was 4.85 ± 1.57, indicating poor medication adherence among the participants. Medication adherence scores varied significantly among participants of different ages, education levels, employment statuses and kinds of medication (p < 0.01). Scores for medication literacy and self-efficacy showed a significant positive correlation with medication adherence scores (all p < 0.001). The standardized coefficient for the total effect and direct effect of medication literacy on medication adherence was 0.268 (95% CI: 0.201, 0.335) and 0.187 (95% CI: 0.123, 0.252), respectively. After introducing self-efficacy into the model, the standardized coefficient for the indirect effect was 0.081 (95% CI: 0.049, 0.120), indicating that self-efficacy partially mediated the relationship between medication literacy and medication adherence, accounting for 30.22% of the total effect. Conclusion This study might suggest that medication literacy indirectly affected medication adherence in older people with multimorbidity through self-efficacy. Health care providers should be aware of the importance of improving medication literacy and implement strategies aimed at increasing self-efficacy to achieve the goal of improving medication adherence in older adults with multimorbidity.

Factors associated with adherence to antihypertensive agents in the older adult

“…Non-adherence to treatment is a health problem that prevails in all age groups, but its incidence is higher in older adults 29 . Furthermore, it is associated with not only poor blood pressure control and increased hospital admission rate 30 but also an acceleration in the development of serious complications and morbidities 31 , which can affect the quality of life.…”

“…Non-adherence to treatment among older people with HBP is not only associated primarily with inadequate blood pressure control and more recurrent hospital stays 28 but also hastens the onset of severe morbidities 31 that can impact the quality of life.…”

The Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients with Type 2 Diabetes

“… 28 The scale has been widely used in the measurement of medication adherence for various types of patients, such as those with hypertension, elderly individuals with multimorbidity and those with type 2 diabetes. 13 , 29 , 30 Each item of the MMAS-8 used in this study had only language differences from the original English version.…”

Latent Profile Analysis of Medication Beliefs in Patients with Type 2 Diabetes in the Hospital-Home Transition and Comparison with Medication Adherence

“…8 Compared to chronic disease patients abroad, Chinese patients exhibit lower overall medication adherence levels. 9 Data indicates that as many as 33% to 69% of chronic disease patients experience readmissions due to adverse outcomes stemming from medication non-adherence. 10 Additionally, instances of diabetes patients experiencing emergent complications as a result of low medication adherence have been observed.…”