Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2021

Open Access 01-12-2021 | Research

Association of health literacy and medication adherence with health-related quality of life (HRQoL) in patients with ischemic heart disease

Authors: Muzna Suhail, Hamid Saeed, Zikria Saleem, Saman Younas, Furqan Khurshid Hashmi, Fawad Rasool, Muhammad Islam, Imran Imran

Published in: Health and Quality of Life Outcomes | Issue 1/2021

Login to get access

Abstract

Background

Medication Adherence (MA) and Health Related Quality of Life (HRQoL) are two inter-connected concepts, co-influenced by Health Literacy (HL), with significant impact on patient management and care. Thus, we aimed to estimate the association of HL and MA with HRQoL in IHD patients.

Methods

Cross-sectional study of 251 IHD patients recruited from Lahore over 6 months period. HL, MA and HRQoL was assessed using validated questionnaires; 16-items of HL, Morisky Green Levine Scale (MGLS) and SF-12, respectively. Chi-square for significance, logistic-regression for association and linear regression for predictions were used.

Results

IHD patients; males (p = 0.0001), having secondary—higher education (p = 0.0001), middle/upper class (p = 0.0001) and employed (p = 0.005) had adequate HL, and were more likely to be adherent (OR; 4.3, p = 0.014). Both physical (PCS-12) and mental (MCS-12) component scores of HRQoL for age, gender, education, area of residence, employment and MA were significantly higher in patients with adequate HL. In multinomial regression, improved PCS-12 scores tend to be higher in subjects having secondary—higher education (OR; 3.5, p = 0.067), employed (OR; 6.1, p = 0.002) and adherent (OR; 2.95, p = 0.218), while MCS-12 scores tend to be higher in patients < 65 years (OR; 2.2, p = 0.032), employed (OR; 3, p = 0.002) and adherent (OR; 4, p = 0.004). In adjusted model, HL (β;0.383, p = 0.0001) and MA (β; − 0.133, p = 0.018) were significantly associated with PCS-12, and MCS-12 with MA (β; − 0.161, p = 0.009) only.

Conclusion

Data suggested that adequate HL was significantly associated with adherence and both physical and mental dimensions of HRQoL were higher in IHD patients with adequate HL. Besides, HL and MA are independent predictors of HRQoL in IHD patients.
Literature
1.
World Health Organization. WHO maps: non-communicable disease trend in all countries. World Health Global Report, World Health Organization; 2011.
2.
Balakumar P, Maung-U K, Jagadeesh G. Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacol Res. 2016;113:600–9.PubMedCrossRef
3.
Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation. 1998;97(6):596–601.PubMedCrossRef
4.
Turin TC, Shahana N, Wangchuk LZ, Specogna AV, Al Mamun M, Khan MA, Choudhury SR, Zaman MM, Rumana N. Burden of cardio-and cerebro-vascular diseases and the conventional risk factors in South Asian population. Glob Heart. 2013;8(2):121–30.PubMedCrossRef
5.
Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, Bo J, Lou Q, Lu F, Liu T. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med. 2014;371(9):818–27.PubMedCrossRef
6.
Hong E. Health-related quality of life and health condition of community-dwelling populations with cancer, stroke, and cardiovascular disease. J Phys Ther Sci. 2015;27(8):2521–4.PubMedPubMedCentralCrossRef
7.
Ludt S, Wensing M, Szecsenyi J, Van Lieshout J, Rochon J, Freund T, Campbell SM, Ose D. Predictors of health-related quality of life in patients at risk for cardiovascular disease in European primary care. PLoS ONE. 2011;6(12):e29334.PubMedPubMedCentralCrossRef
8.
Smith SG, O’Conor R, Curtis LM, Waite K, Deary IJ, Paasche-Orlow M, Wolf MS. Low health literacy predicts decline in physical function among older adults: findings from the LitCog cohort study. J Epidemiol Community Health. 2015;69(5):474–80.PubMedCrossRef
9.
Marathe J, Ogden K, Woodroffe J. Health literacy, genetic literacy and outcomes in patients with genetic cardiac disease: a review of the literature. Heart Lung Circ. 2014;23:e12.
10.
Evangelista LS, Rasmusson KD, Laramee AS, Barr J, Ammon SE, Dunbar S, Ziesche S, Patterson JH, Yancy CW. Health literacy and the patient with heart failure—implications for patient care and research: a consensus statement of the Heart Failure Society of America. J Cardiac Fail. 2010;16(1):9–16.CrossRef
11.
Lemay J, Waheedi M, Al-Sharqawi S, Bayoud T. Medication adherence in chronic illness: do beliefs about medications play a role? Patient Prefer Adherence. 2018;12:1687.PubMedPubMedCentralCrossRef
12.
Gazmararian JA, Kripalani S, Miller MJ, Echt KV, Ren J, Rask K. Factors associated with medication refill adherence in cardiovascular-related diseases. J Gen Intern Med. 2006;21(12):1215–21.PubMedPubMedCentralCrossRef
13.
Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–34.PubMedCrossRef
14.
Saeed H, Saleem Z, Naeem R, Shahzadi I, Islam M. Impact of health literacy on diabetes outcomes: a cross-sectional study from Lahore, Pakistan. Public Health. 2018;156:8–14.PubMedCrossRef
15.
16.
Lu M, Ma J, Lin Y, Zhang X, Shen Y, Xia H. Relationship between patient’s health literacy and adherence to coronary heart disease secondary prevention measures. J Clin Nurs. 2019;28(15–16):2833–43.PubMedCrossRef
17.
Thakkar J, Kurup R, Laba TL, Santo K, Thiagalingam A, Rodgers A, Woodward M, Redfern J, Chow CK. Mobile telephone text messaging for medication adherence in chronic disease: a meta-analysis. JAMA Intern Med. 2016;176(3):340–9.PubMedCrossRef
18.
Wang C, Lang J, Xuan L, Li X, Zhang L. The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study. Int J Equity Health. 2017;16(1):58.PubMedPubMedCentralCrossRef
19.
Ho PM, Spertus JA, Masoudi FA, Reid KJ, Peterson ED, Magid DJ, Krumholz HM, Rumsfeld JS. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med. 2006;166(17):1842–7.PubMedCrossRef
20.
Bansilal S, Castellano JM, Garrido E, Wei HG, Freeman A, Spettell C, Garcia-Alonso F, Lizano I, Arnold RJ, Rajda J, et al. Assessing the impact of medication adherence on long-term cardiovascular outcomes. J Am Coll Cardiol. 2016;68(8):789–801.CrossRefPubMed
21.
Bahall M, Legall G, Khan K. Quality of life among patients with cardiac disease: the impact of comorbid depression. Health Qual Life Outcomes. 2020;18(1):189.PubMedPubMedCentralCrossRef
22.
Samiei Siboni F, Alimoradi Z, Atashi V, Alipour M, Khatooni M. Quality of life in different chronic diseases and its related factors. Int J Prev Med. 2019;10:65.PubMedPubMedCentralCrossRef
23.
Park NH, Song MS, Shin SY, Jeong Jh, Lee HY. The effects of medication adherence and health literacy on health-related quality of life in older people with hypertension. Int J Older People Nurs. 2018;13(3):e12196.PubMedCrossRef
24.
González-Chica DA, Mnisi Z, Avery J, Duszynski K, Doust J, Tideman P, Murphy A, Burgess J, Beilby J, Stocks N. Effect of health literacy on quality of life amongst patients with ischaemic heart disease in Australian general practice. PLoS ONE. 2016;11(3):e0151079.PubMedPubMedCentralCrossRef
25.
Hussain N, Said AS, Khan Z. Influence of health literacy on medication adherence among elderly females with type 2 diabetes in Pakistan. Int Q Community Health Educ. 2019;2019:0272684X19896724.
26.
Bitton A, Choudhry NK, Matlin OS, Swanton K, Shrank WH. The impact of medication adherence on coronary artery disease costs and outcomes: a systematic review. Am J Med. 2013;126(4):357.e357-357.e327.CrossRef
27.
Uchmanowicz B, Chudiak A, Mazur G. The influence of quality of life on the level of adherence to therapeutic recommendations among elderly hypertensive patients. Patient Prefer Adherence. 2018;12:2593.PubMedPubMedCentralCrossRef
28.
Westlake C, Sethares K, Davidson P. How can health literacy influence outcomes in heart failure patients? Mechanisms and interventions. Curr Heart Fail Rep. 2013;10(3):232–43.PubMedCrossRef
29.
Berkman DD, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Literacy and health outcomes: summary. In: AHRQ evidence report summaries. AHRQ Publication Number 04‐E007‐1; 2004.
30.
Howard DH, Gazmararian J, Parker RM. The impact of low health literacy on the medical costs of Medicare managed care enrollees. Am J Med. 2005;118(4):371–7.PubMedCrossRef
31.
Cutler RL, Fernandez-Llimos F, Frommer M, Benrimoj C, Garcia-Cardenas V. Economic impact of medication non-adherence by disease groups: a systematic review. BMJ Open. 2018;8(1):e016982.PubMedPubMedCentralCrossRef
32.
Gast A, Mathes T. Medication adherence influencing factors—an (updated) overview of systematic reviews. Systems Control Found Appl. 2019;8(1):112.
33.
Saeed A, Saeed H, Saleem Z, Fang Y, Babar Z-U-D. Evaluation of prices, availability and affordability of essential medicines in Lahore Division, Pakistan: a cross-sectional survey using WHO/HAI methodology. PLoS ONE. 2019;14(4):e0216122.PubMedPubMedCentralCrossRef
34.
Chu SH, Lee WH, Yoo JS, Kim SS, Ko IS, Oh EG, Lee J, Choi M, Cheon JY, Shim CY. Factors affecting quality of life in Korean patients with chronic heart failure. Jpn J Nurs Sci. 2014;11(1):54–64.PubMedCrossRef
35.
Macabasco-O’Connell A, DeWalt DA, Broucksou KA, Hawk V, Baker DW, Schillinger D, Ruo B, Bibbins-Domingo K, Holmes GM, Erman B. Relationship between literacy, knowledge, self-care behaviors, and heart failure-related quality of life among patients with heart failure. J Gen Internal Med. 2011;26(9):979–86.CrossRef
36.
Al Sayah F, Majumdar SR, Williams B, Robertson S, Johnson JA. Health literacy and health outcomes in diabetes: a systematic review. J Gen Intern Med. 2013;28(3):444–52.PubMedCrossRef
37.
Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient Educ Couns. 2003;51(3):267–75.PubMedCrossRef
38.
Sudore RL, Mehta KM, Simonsick EM, Harris TB, Newman AB, Satterfield S, Rosano C, Rooks RN, Rubin SM, Ayonayon HN. Limited literacy in older people and disparities in health and healthcare access. J Am Geriatr Soc. 2006;54(5):770–6.PubMedCrossRef
39.
Kamal AK, Muqeet A, Farhat K, Khalid W, Jamil A, Gowani A, Muhammad AA, Zaidi F, Khan D, Elahi T. Using a tailored health information technology-driven intervention to improve health literacy and medication adherence in a Pakistani population with vascular disease (Talking Rx)—study protocol for a randomized controlled trial. Trials. 2016;17(1):1–13.CrossRef
40.
Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Health. 2004;11:12.
41.
42.
43.
Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2014;130(19):1749–67.PubMedCrossRef
44.
Tavakolikia N, Kheiltash A, Shojaeefar E, Montazeri A, Shariati M, Meysamie A. The most well-known health literacy questionnaires: a narrative review. Soc Determ Health. 2017;3(2):104–13.
45.
Xia J, Wu P, Deng Q, Yan R, Yang R, Lv B, Wang J, Yu J. Relationship between health literacy and quality of life among cancer survivors in China: a cross-sectional study. BMJ Open. 2019;9(12):e028458.PubMedPubMedCentralCrossRef
46.
Koschack J, Marx G, Schnakenberg J, Kochen MM, Himmel W. Comparison of two self-rating instruments for medication adherence assessment in hypertension revealed insufficient psychometric properties. J Clin Epidemiol. 2010;63(3):299–306.PubMedCrossRef
47.
Beyhaghi H, Reeve BB, Rodgers JE, Stearns SC. Psychometric properties of the Four-Item Morisky green levine medication adherence scale among atherosclerosis risk in communities (ARIC) study participants. Value in Health. 2016;19(8):996–1001.PubMedPubMedCentralCrossRef
48.
Ware J, Kosinski M, Keller S. SF-12: how to score the SF-12 physical and mental health summary scales. 1998.
49.
Ware JE Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33.PubMedCrossRef
50.
Kripalani S, Henderson LE, Chiu EY, Robertson R, Kolm P, Jacobson TA. Predictors of medication self-management skill in a low-literacy population. J Gen Intern Med. 2006;21(8):852–6.PubMedPubMedCentralCrossRef
51.
Cochran WG. Sampling techniques. New York: Wiley; 1963.
52.
Abbas S, Kitchlew A, Abbas S. Disease burden of Ischemic Heart Disease in Pakistan and its risk factors. Ann Pak Inst Med Sci. 2009;5(3):145–50.
53.
Nesbitt T, Doctorvaladan S, Southard JA, Singh S, Fekete A, Marie K, Moser DK, Pelter MM, Robinson S, Wilson MD. Correlates of quality of life in rural patients with heart failure. Circul Heart Fail. 2014;7(6):882–7.CrossRef
54.
Al-Kaade S, Hauptman PJ. Health-related quality of life measurement in heart failure: challenges for the new millennium. J Cardiac Fail. 2001;7(2):194–201.CrossRef
55.
Saqlain M, Riaz A, Malik MN, Khan S, Ahmed A, Kamran S, Ali H. Medication adherence and its association with health literacy and performance in activities of daily livings among elderly hypertensive patients in Islamabad, Pakistan. Medicina. 2019;55(5):163.PubMedCentralCrossRef
56.
Tung H-H, Lu T-M, Chen L-K, Liang S-Y, Wu S-F, Chu K-H. Health literacy impact on elderly patients with heart failure in Taiwan. J Clin Gerontol Geriatr. 2014;5(3):72–6.CrossRef
57.
Jovanić M, Zdravković M, Stanisavljević D, Jović Vraneš A. Exploring the importance of health literacy for the quality of life in patients with heart failure. Int J Environ Res Public Health. 2018;15(8):1761.PubMedCentralCrossRef
58.
Santesmases-Masana R, Gonzalez-de Paz L, Real J, Borras-Santos A, Siso-Almirall A, Navarro-Rubio MD. Health literacy in patients with heart failure treated in primary care. Aten Primaria. 2016;49(1):28–34.PubMedPubMedCentralCrossRef
59.
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107.PubMedCrossRef
60.
Kripalani S, Gatti ME, Jacobson TA. Association of age, health literacy, and medication management strategies with cardiovascular medication adherence. Patient Educ Couns. 2010;81(2):177–81.PubMedCrossRef
61.
Mahmood S, Jalal Z, Hadi MA, Orooj H, Shah KU. Non-adherence to prescribed antihypertensives in primary, secondary and tertiary healthcare settings in Islamabad, Pakistan: a cross-sectional study. Patient Prefer Adherence. 2020;14:73.PubMedPubMedCentralCrossRef
62.
Billups SJ, Malone DC, Carter BL. The relationship between drug therapy noncompliance and patient characteristics, health-related quality of life, and health care costs. Pharmacother J Hum Pharmacol Drug Ther. 2000;20(8):941–9.CrossRef
63.
Krack G, Holle R, Kirchberger I, Kuch B, Amann U, Seidl H. Determinants of adherence and effects on health-related quality of life after myocardial infarction: a prospective cohort study. BMC Geriatr. 2018;18(1):136.PubMedPubMedCentralCrossRef
64.
Wang C, Kane RL, Xu D, Meng Q. Health literacy as a moderator of health-related quality of life responses to chronic disease among Chinese rural women. BMC Womens Health. 2015;15(1):34.PubMedPubMedCentralCrossRef
65.
Kastien-Hilka T, Rosenkranz B, Schwenkglenks M, Bennett BM, Sinanovic E. Association between health-related quality of life and medication adherence in pulmonary tuberculosis in South Africa. Front Pharmacol. 2017;8:919.PubMedPubMedCentralCrossRef
66.
Peacock E, Joyce C, Craig LS, Lenane Z, Holt EW, Muntner P, Krousel-Wood M. Low medication adherence is associated with decline in health-related quality of life: results of a longitudinal analysis among older women and men with hypertension. J Hypert. 2020;39:153–61.CrossRef
67.
Côté I, Farris K, Feeny D. Is adherence to drug treatment correlated with health-related quality of life? Qual Life Res. 2003;12(6):621–33.PubMedCrossRef
Metadata
Title
Association of health literacy and medication adherence with health-related quality of life (HRQoL) in patients with ischemic heart disease
Authors
Muzna Suhail
Hamid Saeed
Zikria Saleem
Saman Younas
Furqan Khurshid Hashmi
Fawad Rasool
Muhammad Islam
Imran Imran
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2021
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-021-01761-5

Other articles of this Issue 1/2021

Health and Quality of Life Outcomes 1/2021 Go to the issue

Research

Associations of resilience with quality of life levels in adults experiencing homelessness and mental illness: a longitudinal study

Research

Cross-cultural adaptation and psychometric properties of the Mexican version of the Early Childhood Oral Health Impact Scale (ECOHIS)

Research

The effect of fear of progression on quality of life among breast cancer patients: the mediating role of social support

Research

Validation of living with chronic illness scale in a type 2 diabetes mellitus population

Research

Prevalence of mental health problems in frontline healthcare workers after the first outbreak of COVID-19 in China: a cross-sectional study

Research

Pediatric patients’ reasons for visiting dentists in all WHO regions