Association of health literacy and medication self-efficacy with medication adherence and diabetes control

Abstract

IntroductionThe exact pathway linking health literacy, self-efficacy, medication adherence, and glycemic control for type 2 diabetes remains unclear. Understanding the relationship between patient factors, medication adherence, and lower glycated hemoglobin (HbA1c) may help patients better manage their disease. This study examined the association of health literacy and medication self-efficacy with self-reported diabetes medication adherence, and the association of health literacy, medication self-efficacy, and self-reported diabetes medication adherence with HbA1c of patients with type 2 diabetes.MethodsThis cross-sectional study utilized a face-to-face questionnaire at two family medicine clinics in a Midwestern state among 174 patients; subjects enrolled were at least 20 years old with diagnosed type 2 diabetes, prescribed at least one oral diabetes medicine, and understood English. Questionnaires were administered to assess the participants’: health literacy, using the Newest Vital Sign six-item questionnaire (NVS); self-efficacy for medication use, using the 13-item Self-Efficacy for Appropriate Medication Use Scale; and self-report medication adherence, using the eight-item Morisky Medication Adherence Scale. HbA1c values were obtained from participants’ electronic medical records. Multiple linear regressions were used to explore the association of health literacy and medication self-efficacy with both medication adherence and HbA1c level after controlling for all other covariates.ResultsSelf-reported health status (β = 0.17, p = 0.015) and medication self-efficacy (β = 0.53, p < 0.001) were positively associated with diabetes medication adherence. Health literacy was neither associated with diabetes medication adherence (β = −0.04, p = 0.586) nor HbA1c (β = −0.06, p = 0.542). Lower diabetes medication adherence (β = −0.26, p = 0.008) and higher number of prescribed medications (β = 0.28, p = 0.009) were correlated with higher HbA1c.ConclusionHealth literacy, as measured by the NVS, does not correlate with medication adherence or glycemic control among patients with type 2 diabetes. Interventions to improve patients’ self-efficacy of medication use may improve diabetes medication adherence.

Strengthening Medication Adherence Practices in Chronic Disease Patients-clinical Pharmacist Driven Focused Approach

“…Privacy and confidentiality should always be maintained throughout the discussion. [26][27][28][29][30][31]40,41 Issue based discussion can be initiated by involving patients in the discussion process with the objective of clarifying from patients the reason for being nonadherent. After obtaining the reason, the plan can be made to resolve the specified problem.…”

“…This will enhance the confidence level of the patients thereby encouraging them to follow the right practice and consume medications on time. [25][26][27][28][29][30] Clinical pharmacist driven approach may promote better understanding of medications apart from web-based information. For in-patients at the time of discharge, medication related instructions can be provided by showing the medications patient is supposed to take during post-discharge period.…”

“…Physical verification of tablets/capsules in presence of healthcare professionals will certainly improve the understanding of the patient. [26][27][28][29][30][31][32][33][34][35][36][37][38]…”

“…Awareness campaign being the most appropriate channel for spreading the message across masses has been utilized before in many health awareness campaigns. 28,29 To spread awareness among community, various mobile phone applications and social networking sites can be also be used in addition to general awareness campaign. Patients can be motivated to participate in web activities if found feasible and blog by sharing their own experiences without disclosing the personal identity.…”

Conceptualization, Development and Psychometric Evaluations of a New Medication-Related Health Literacy Instrument: The Chinese Medication Literacy Measurement

“…According to the above definition of health literacy, recent reviews show that the association between health literacy and medication adherence is either weak [ 24 , 25 , 26 , 27 ] or inconclusive [ 28 , 29 ] across different illnesses. One reason for this poor association might be because existing instruments of health literacy are too general to capture wide ranges of abilities specific to medication use [ 20 ].…”