Abstract
Aim: The objective of this study was to determine the relationship between medication adherence and
health literacy of individuals with a chronic disease in a rural area.
Materials and Methods: This cross-sectional study was conducted on 332 people over 18 years of
age in two villages in the rural area of Aydın, a province of Western Turkey. The data were collected
through a face-to-face interview technique by means of a questionnaire including questions about
socio-demographic and health conditions, Morisky Medication Adherence Scale-8 and European
Health Literacy Survey Questionnaire between March-October 2022. Chi-squared test and logistic
regression analysis were used to evaluate the relationship between medication adherence and health
literacy.
Results: Among the respondents 56.7% were female and the mean age of the respondents was
61.99±9.66. While 67.2% of the participants had low treatment adherence, 32.8% had moderate
treatment adherence, there was no participant with high treatment adherence. Among the
respondents, 64.2% had insufficient health literacy. Medication adherence was 2.2 times (95% CI
1.44-3.95) higher in men, 2.6 times (1.14- 4.04) higher in people with good and perfect health literacy
levels, 3.6 times (2.65-6.68) higher in people who had regular health checks, 0.5 times (0.27-0.86)
lower in people who followed their diet and 0.3 times (0.15-0.77) lower in people who had not been
hospitalized.
Conclusion: This study conducted on participants with a chronic disease in a rural area found that
these people had low levels of medication adherence and health literacy. Additionally, health literacy
was determined to be an important factor that affected medication adherence. If primary healthcare
centers providing healthcare services especially in rural areas follow individuals with chronic diseases
closely and take actions to improve their health literacy levels, this will contribute to increasing
medication adherence.
References
- WHO, Noncommunicable Diseases Key Facts [cited 10 Nov 2022]. Available from: https://www.who.int/newsroom/fact-sheets/detail/noncommunicable-diseases
- Global Burden of Disease Collaborative Network, Global Burden of Disease Study 2019 Results [cited 10 Nov 2022]. Available from: https://vizhub.healthdata.org/gbd-results/
- WHO. Noncommunicable Diseases Progress Monitor [cited 10 Nov 2022]. Available from: https://www.who.int/publications/i/item/9789240047761
- Walsh CA, Cahir C, Tecklenborg S, Byrne C, Culbertson MA, Bennett KE. The association between medication non-adherence and adverse health outcomes in ageing populations: A systematic review and meta-analysis. British Journal of Clinical Pharmacology 2019;85(11):2464–78. Doi:10.1111/bcp.14075
- Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clinic Proceedings 2011; 86(4):304–14. Doi: 10.4065/mcp.2010.0575
- Rolnick SJ, Pawloski PA, Hedblom BD, Asche SE, Bruzek RJ. Patient characteristics associated with medication adherence. Clinical Medicine & Research 2013;11(2):54–65. Doi: 10.3121/cmr.2013.1113
- Nakajima R, Watanabe F, Kamei M. Factors associated with medication non-adherence among patients with lifestyle-related non-communicable diseases. Pharmacy (Basel) 2021;9(2):90. Doi: 10.3390/pharmacy9020090
- Sampaio R, Azevedo LF, Dias CC, Lopes JMC. Non-adherence to pharmacotherapy: a prospective multicentre study about ıts ıncidence and ıts causes perceived by chronic pain patients. Patient Prefer Adherence 2020;14:321–32. doi: 10.2147/PPA.S232577
- Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Annals of Internal Medicine, 2011;155(2):97–107. Doi: 10.7326/0003-4819-155- 2-201107190-00005
- Kripalani S, Gatti ME, Jacobson TA. Association of age, health literacy, and medication management strategies with cardiovascular medication adherence. Patient Education and Counseling 2010;81(2):177–81. Doi: 10.1016/j.pec.2010.04.030
- Halladay JR, Donahue KE, Cené CW, Li Q, Cummings DM, Hinderliter AL, et al. The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial. Patient Education and Counseling 2017;100(3):542–9. Doi: 10.1016/j.pec.2016.10.015
- Özonuk E, Yılmaz M. Tip 2 Diabetes Mellitus tanılı hastaların sağlık okuryazarlığı ve tedavi uyumu arasındaki ilişki, Hemşirelikte Eğitim ve Araştırma Dergisi 2019;16(2):96–103. Doi:10.5222/HEAD.2019.096
- Coskun S, Bagcivan G. Associated factors with treatment adherence of patients diagnosed with chronic disease: Relationship with health literacy. Applied Nursing Research 2021;57:151368. doi: 10.1016/j.apnr.2020.151368
- Eşki Ş, Yalçınöz Baysal H. An investigation of the diabetes health literacy level and compliance to the treatment in patients with diabetes in Turkey. Anatolian Current Medical Journal 2022;4(1):1–7. Doi.org/10.38053/acmj.969412
- Bakan G, Inci FH. Hipertansiyonlu hastalarda tedavi uyumu ve sağlık okuryazarlığı. Kardiyovasküler Hemşirelik Dergisi, 2021;12(28):81–7. Doi: 10.5543/khd.2021.21032
- Ocakoglu G, Demirci H, Guclu OA, Guclu Y. Association between health literacy and medication adherence ın the elderly population with chronic disease. The Ethiopian Journal of Health Development. 2020;34(2):91– 5.
- T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Kronik Hastalıklar ve Yaşlı Sağlığı Dairesi Başkanlığı, Türkiye bulaşıcı olmayan hastalıklar ve risk faktörleri kohort çalışması. Yayın No: 1206, Ankara, 2021.
- Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. Journal of Clinical Hypertension 2008;10(5):348–54. Doi: 10.1111/j.1751- 7176.2008.07572.x.
- Sayiner ZA, Savas E, Kul S, Morisky DE. Validity and Reliability of the Turkish Version of the 8-Item Morisky Medication Adherence Scale in Patients With Type 2 Diabetes. European Journal of Therapeutics 2020;26(1):47–52. Doi: 10.5152/eurjther.2020.19132
- Sørensen K, Van Den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health 2013;13(1):1–10. Doi: 10.1186/1471-2458-13-948
- Abacıgil F, Harlak, H. & Okyay P, Avrupa Sağlık Okuryazarlığı Ölçeği Türkçe uyarlaması. Okyay P. & Abacıgil F. (Ed.) Türkiye sağlık okuryazarlığı ölçekleri güvenilirlik ve geçerlilik çalışması içinde. T.C. Sağlık Bakanlığı. Ankara, Türkiye 2016:21-41.
- Song MS, Park S. Comparing two health literacy measurements used for assessing older adults’ medication adherence. Journal of Clinical Nursing 2020;29(21):4313–20. Doi.org/10.1111/jocn.1546823
- Mayo-Gamble TL, Mouton C. Examining the association between health literacy and medication adherence among older adults. Health Communication 2018;33(9):1124–30. Doi: 10.1080/10410236.2017.1331311
- Al-Noumani H, Al-Harrasi M, Jose J, Al-Naamani Z, Panchatcharam SM. Medication adherence and patients’ characteristics in chronic diseases: a national multi-center study. Clinic Nursing Research 2021;31(3):426– 34. Doi: 101177/10547738211033754
- Lee YM, Yu HY, You MA, Son YJ. Impact of health literacy on medication adherence in older people with chronic diseases. Collegian 2017;24(1):11–8. Doi: 10.1016/j.colegn.2015.08.003
- T.C. Sağlık Bakanlığı Sağlığın Geliştirilmesi Genel Müdürlüğü, Türkiye sağlık okuryazarlığı düzeyi ve ilişkili faktörleri araştırması. Yayın No: 1103, Ankara, 2018.
- Ayaz-Alkaya S, Ozturk FO. Health literacy levels of women and related factors in Turkey. The Journal of Nursing Research 2021;29(6):e180. Doi: 10.1097/JNR.0000000000000452
- Aparcı M, Kardeşoğlu E, Yiğiner Ö, Özmen N, Cebeci BS. Comparison of the treatment period and ındividual properties of patients with hypertension followed up in the two cottage hospitals from the different social cultural subgroups. TAF Prevention Medical Bulletin 2008; 7(4):333-38.
Abstract
Amaç: Bu çalışmada kırsal bir bölgede yaşayan kronik hastalığı olan bireylerin tedavi uyumu ve sağlık
okuryazarlığı arasındaki ilişkinin belirlenmesi amaçlanmıştır.
Gereç ve Yöntem: Kesitsel tipte olan araştırma Aydın ili kırsalında iki köyde 18 yaş üstü kronik
hastalığı olan 332 kişide yapılmıştır. Veriler Mart-Ekim 2022 tarihlerinde sosyo-demografik ve sağlık
durumuna ilişkin sorulardan oluşan, Morisky Tedavi Uyum Ölçeği-8 ve Avrupa Sağlık Okuryazarlığı
Ölçeğini içeren bir anket aracılıyla yüz yüze görüşme tekniği ile toplanmıştır. Tedavi uyumu ve sağlık
okuryazarlığı arasındaki ilişkiyi değerlendirmede Ki kare testi ve lojistik regresyon analizi
kullanılmıştır.
Bulgular: Çalışmaya katılan bireylerin %56,9’u kadın ve yaş ortalaması 61,99±9,66’dır. Katılımcıların
%67,2’si düşük tedavi uyumuna, %32,8’i orta tedavi uyuma sahip iken yüksek tedavi uyumuna sahip
katılımcı yoktur. Katılımcıların %64,2’si yetersiz sağlık okuryazarlığı düzeyine sahiptir. Tedaviye uyum
erkeklerde 2,2 kat (%95 GA 1,44-3,95), sağlık okuryazarlığı düzeyi iyi ve mükemmel olanlarda 2,6 kat
(1,14- 4,04), hekim kontrollerine düzenli gidenlerde 3,6 kat (2,65-6,68) fazla bulunurken diyetine
uyanlarda 0,5 kat (0,27-0,86), hastaneye yatışı olmayanlarda 0,3 kat (0,15-0,77) daha az bulunmuştur.
Sonuç: Kırsal bir bölgede kronik hastalığı olan kişilerde yürütülen bu çalışmada bireylerin tedaviye
uyum ve sağlık okuryazarlığı düzeyleri düşük bulunmuştur. Ayrıca sağlık okuryazarlığı tedavi uyumunu
etkileyen önemli bir faktör olarak belirlenmiştir. Özellikle kırsal alana hizmet veren birinci basamak
sağlık kurumlarının kronik hastalığı olan bireyleri yakından izlemesi ve sağlık okuryazarlık düzeyini
arttırmaya yönelik girişimler yapması tedavi uyumunun arttırılmasına katkı sağlayacaktır.
References
- WHO, Noncommunicable Diseases Key Facts [cited 10 Nov 2022]. Available from: https://www.who.int/newsroom/fact-sheets/detail/noncommunicable-diseases
- Global Burden of Disease Collaborative Network, Global Burden of Disease Study 2019 Results [cited 10 Nov 2022]. Available from: https://vizhub.healthdata.org/gbd-results/
- WHO. Noncommunicable Diseases Progress Monitor [cited 10 Nov 2022]. Available from: https://www.who.int/publications/i/item/9789240047761
- Walsh CA, Cahir C, Tecklenborg S, Byrne C, Culbertson MA, Bennett KE. The association between medication non-adherence and adverse health outcomes in ageing populations: A systematic review and meta-analysis. British Journal of Clinical Pharmacology 2019;85(11):2464–78. Doi:10.1111/bcp.14075
- Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clinic Proceedings 2011; 86(4):304–14. Doi: 10.4065/mcp.2010.0575
- Rolnick SJ, Pawloski PA, Hedblom BD, Asche SE, Bruzek RJ. Patient characteristics associated with medication adherence. Clinical Medicine & Research 2013;11(2):54–65. Doi: 10.3121/cmr.2013.1113
- Nakajima R, Watanabe F, Kamei M. Factors associated with medication non-adherence among patients with lifestyle-related non-communicable diseases. Pharmacy (Basel) 2021;9(2):90. Doi: 10.3390/pharmacy9020090
- Sampaio R, Azevedo LF, Dias CC, Lopes JMC. Non-adherence to pharmacotherapy: a prospective multicentre study about ıts ıncidence and ıts causes perceived by chronic pain patients. Patient Prefer Adherence 2020;14:321–32. doi: 10.2147/PPA.S232577
- Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Annals of Internal Medicine, 2011;155(2):97–107. Doi: 10.7326/0003-4819-155- 2-201107190-00005
- Kripalani S, Gatti ME, Jacobson TA. Association of age, health literacy, and medication management strategies with cardiovascular medication adherence. Patient Education and Counseling 2010;81(2):177–81. Doi: 10.1016/j.pec.2010.04.030
- Halladay JR, Donahue KE, Cené CW, Li Q, Cummings DM, Hinderliter AL, et al. The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial. Patient Education and Counseling 2017;100(3):542–9. Doi: 10.1016/j.pec.2016.10.015
- Özonuk E, Yılmaz M. Tip 2 Diabetes Mellitus tanılı hastaların sağlık okuryazarlığı ve tedavi uyumu arasındaki ilişki, Hemşirelikte Eğitim ve Araştırma Dergisi 2019;16(2):96–103. Doi:10.5222/HEAD.2019.096
- Coskun S, Bagcivan G. Associated factors with treatment adherence of patients diagnosed with chronic disease: Relationship with health literacy. Applied Nursing Research 2021;57:151368. doi: 10.1016/j.apnr.2020.151368
- Eşki Ş, Yalçınöz Baysal H. An investigation of the diabetes health literacy level and compliance to the treatment in patients with diabetes in Turkey. Anatolian Current Medical Journal 2022;4(1):1–7. Doi.org/10.38053/acmj.969412
- Bakan G, Inci FH. Hipertansiyonlu hastalarda tedavi uyumu ve sağlık okuryazarlığı. Kardiyovasküler Hemşirelik Dergisi, 2021;12(28):81–7. Doi: 10.5543/khd.2021.21032
- Ocakoglu G, Demirci H, Guclu OA, Guclu Y. Association between health literacy and medication adherence ın the elderly population with chronic disease. The Ethiopian Journal of Health Development. 2020;34(2):91– 5.
- T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü Kronik Hastalıklar ve Yaşlı Sağlığı Dairesi Başkanlığı, Türkiye bulaşıcı olmayan hastalıklar ve risk faktörleri kohort çalışması. Yayın No: 1206, Ankara, 2021.
- Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. Journal of Clinical Hypertension 2008;10(5):348–54. Doi: 10.1111/j.1751- 7176.2008.07572.x.
- Sayiner ZA, Savas E, Kul S, Morisky DE. Validity and Reliability of the Turkish Version of the 8-Item Morisky Medication Adherence Scale in Patients With Type 2 Diabetes. European Journal of Therapeutics 2020;26(1):47–52. Doi: 10.5152/eurjther.2020.19132
- Sørensen K, Van Den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health 2013;13(1):1–10. Doi: 10.1186/1471-2458-13-948
- Abacıgil F, Harlak, H. & Okyay P, Avrupa Sağlık Okuryazarlığı Ölçeği Türkçe uyarlaması. Okyay P. & Abacıgil F. (Ed.) Türkiye sağlık okuryazarlığı ölçekleri güvenilirlik ve geçerlilik çalışması içinde. T.C. Sağlık Bakanlığı. Ankara, Türkiye 2016:21-41.
- Song MS, Park S. Comparing two health literacy measurements used for assessing older adults’ medication adherence. Journal of Clinical Nursing 2020;29(21):4313–20. Doi.org/10.1111/jocn.1546823
- Mayo-Gamble TL, Mouton C. Examining the association between health literacy and medication adherence among older adults. Health Communication 2018;33(9):1124–30. Doi: 10.1080/10410236.2017.1331311
- Al-Noumani H, Al-Harrasi M, Jose J, Al-Naamani Z, Panchatcharam SM. Medication adherence and patients’ characteristics in chronic diseases: a national multi-center study. Clinic Nursing Research 2021;31(3):426– 34. Doi: 101177/10547738211033754
- Lee YM, Yu HY, You MA, Son YJ. Impact of health literacy on medication adherence in older people with chronic diseases. Collegian 2017;24(1):11–8. Doi: 10.1016/j.colegn.2015.08.003
- T.C. Sağlık Bakanlığı Sağlığın Geliştirilmesi Genel Müdürlüğü, Türkiye sağlık okuryazarlığı düzeyi ve ilişkili faktörleri araştırması. Yayın No: 1103, Ankara, 2018.
- Ayaz-Alkaya S, Ozturk FO. Health literacy levels of women and related factors in Turkey. The Journal of Nursing Research 2021;29(6):e180. Doi: 10.1097/JNR.0000000000000452
- Aparcı M, Kardeşoğlu E, Yiğiner Ö, Özmen N, Cebeci BS. Comparison of the treatment period and ındividual properties of patients with hypertension followed up in the two cottage hospitals from the different social cultural subgroups. TAF Prevention Medical Bulletin 2008; 7(4):333-38.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Services and Systems (Other) |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 18, 2023 |
| Submission Date | January 4, 2023 |
| Published in Issue | Year 2023Volume: 62 Issue: 3 |
