Rethinking Adherence: A Health Literacy–Informed Model of Medication Self-Management

Abstract

Medication adherence has received a great deal of attention over the past several decades; however, its definition and measurement remain elusive. The authors propose a new definition of medication self-management that is guided by evidence from the field of health literacy. Specifically, a new conceptual model is introduced that deconstructs the tasks associated with taking prescription drugs; including the knowledge, skills and behaviors necessary for patients to correctly take medications and sustain use over time in ambulatory care. This model is then used to review and criticize current adherence measures as well as to offer guidance to future interventions promoting medication self-management, especially among patients with low literacy skills.

Adherence to tetrahydrobiopterin therapy in patients with phenylketonuria

“…Taking medications is a multi-step process and requires filling the prescription, understanding the drug regimen, organizing and taking the medication as directed, tolerating any side effects and then continuing the medication over the longterm [8]. This process may break down at any point; 24% of new prescriptions are never filled [9], 50% of patients do not take medication as directed [10], and (with statin medication for hypercholesterolemia, for example) 25-50% stop taking the medication after one year and 75% after two years [11].…”

Seeking an expanded, multidimensional conceptual approach to health literacy and health disparities research

“…Koh et al and Bailey, Oramasionwu, and Wolf added some of the clinical benefits linked to health literacy interventions include: reduced mortality; improved patient adherence to medical instructions; and overall patient safety [21,60]. In a summary of research findings, the National Network of Libraries of Medicine noted health literacy interventions therapeutically assisted patients with cancer, diabetes, asthma, and hypertension [9].…”

Association between Psychological Wellbeing and Antiretroviral Therapy Adherence in North-Central, Nigeria

“…This is also consistent with Hardon et al, (2006) who reported 77% in sub-Sahara Africa. Bailey, Oramasionwu, & Wolf, [7], also noted that patient's failure in maintaining dose time and schedule contributed to poor adherence which was reported at 56.8%. Some studies have also documented challenges facing AIDS patients in adhering to ART and its implications for multiple poor health outcomes such as drug resistance [4], high rate of relapse and rehospitalization [6], co-morbidities with other diseases [7], high mortality and increased global burden of the disease [11].…”