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Trust, Multidimensional Health Literacy, and Medication Adherence among Patients Undergoing Long-Term Hemodialysis
Ryohei Inanaga1,2, Tatsunori Toida1,3, Tetsuro Aita1,4
1Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Japan.
Insights
Physician trust mediates the relationship between health literacy and medication adherence in dialysis patients. Functional and communicative health literacy improve adherence, while critical health literacy hinders it, with trust playing a key role.
Area of Science:
- Nephrology
- Health Services Research
- Patient Adherence
Background:
- Health literacy and physician trust are crucial for medication adherence in dialysis patients.
- The specific roles of different dimensions of health literacy and the mediating effect of physician trust require further investigation.
Purpose of the Study:
- To assess the inter-relationships between health literacy, physician trust, and medication adherence in patients undergoing hemodialysis.
- To investigate the mediating role of physician trust in the association between health literacy and medication adherence.
Main Methods:
- A multicenter cross-sectional study involving 455 Japanese adults receiving outpatient hemodialysis.
- Measurement of multidimensional health literacy (Functional, Communicative, Critical), physician trust, and medication adherence using validated scales.
- Analysis using general linear models and mediation analysis to explore associations and mediating effects.
Main Results:
- Higher functional and communicative health literacy were linked to fewer medication adherence difficulties.
- Higher critical health literacy was associated with greater medication adherence difficulties.
- Physician trust partially or completely mediated the associations between different dimensions of health literacy and medication adherence.
Conclusions:
- Functional and communicative health literacy positively impact medication adherence, while critical health literacy has a negative association.
- Physician trust is a significant mediator in the relationship between health literacy dimensions and medication adherence in dialysis patients.
Background:
Basic health literacy and trust in physicians can influence medication adherence in patients receiving dialysis. However, how high-order health literacy is associated with medication adherence and how trust in physicians mediates this association remain unclear. We assessed the inter-relationships between health literacy, trust in physicians, and medication adherence. We investigated the mediating role of trust in physicians in the relationship between health literacy and medication adherence.
Methods:
This multicenter cross-sectional study included Japanese adults receiving outpatient hemodialysis at six dialysis centers. Multidimensional health literacy was measured using the 14-item Functional, Communicative, and Critical Health Literacy scale. Trust in physicians was measured using the five-item Wake Forest Physician Trust scale. Medication adherence was measured using the 12-item Adherence Starts with Knowledge scale. A series of general linear models were created to analyze the associations between health literacy and Adherence Starts Knowledge scores with and without trust in physicians. Mediation analysis was performed to determine whether trust in physicians mediated this association.
Results:
In total, 455 patients were analyzed. Higher functional and communicative health literacies were associated with less adherence difficulties (per 1-point higher: -1.79 [95% confidence interval (CI): -2.59 to -0.99] and -2.21 [95% CI: -3.45 to -0.96], respectively), whereas higher critical health literacy was associated with greater adherence difficulties (per 1-point higher: 1.69 [95% CI: 0.44 to 2.94]). After controlling for trust in physicians, the magnitude of the association between health literacies and medication adherence decreased. Trust in physicians partially mediated the association between functional or communicative health literacy and medication adherence (especially beliefs) and completely mediated the association between critical health literacy and medication adherence (especially behaviors).
Conclusions:
Functional and communicative health literacies were positively associated with medication adherence, whereas critical health literacy was negatively associated with it. Each association was mediated by trust in physicians.
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