Linking health literacy to medication adherence in chronic disease management from a community pharmacy perspective

Health literacy is an important health determinant that is associated with adherence to medication. This complex relationship affects the control of chronic medical conditions and may offer opportunities that impact the role of community pharmacist.

This is a cross-sectional study conducted through interviews with patients in the community pharmacy settings. The adherence to medication was assessed using the validated Arabic version of the Morisky Medication Adherence Scale (MMAS-8). Health literacy was evaluated using the validated Arabic version of the Health Literacy Survey European Questionnaire's short version (HLS-EU-Q16).

Half of the participants exhibited low adherence (n = 272, 54.2%), 27.3% demonstrated medium adherence (n = 137), and one-fifth achieved high adherence (n = 93, 18.5%). Only one fifth of the participants received counselling at every refill and few participants reported experiencing private counselling in community pharmacies. Most participants demonstrated sufficient health literacy (n = 330, 65.7%). A smaller proportion were classified as having problematic health literacy (n = 123, 24.5%), while inadequate health literacy was observed in 49 participants (9.8%). Patients with inadequate health literacy had the highest proportion of low adherence. Significant predictors of adherence included health literacy, geographical region, and individuals' perception of their health.

Inadequate health literacy was associated with low adherence. Health literacy, geographic/regional location, and health status were significant predictors of adherence. Community pharmacists play an important role in improving health literacy through interventions that can be implemented in an individualized manner taking into consideration the characteristics of the patients.