**2.3 Factors influencing health literacy and medication adherence**

Research has shown that there are several factors which influence health literacy among individual groups**.**


However, women reported more depressive symptoms of chronic diseases than men [11]. A question could be raised as to why these women would suffer depressive symptoms while we expect them to be healthy and in control of their diseases since they report frequently to the health facilities. This could be that, when women are sick, they lack proper care from their spouses or anyone to care for them, or they could be inappropriately taking their medications.

3.**Educational level –** Most of the diabetes mellitus patients (47%) attended school up to high school whereas only 11% did not attend school at all.

Observations from previous studies illustrate that individuals with higher socioeconomic status or higher education levels had a better comprehension of prescribed medications and medication labels hence leading to the minor occurrence of adverse medication occasions [12]. Despite this, failure to comprehend and interpret medication prescriptions is still prevalent through all

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*The Importance of Health Literacy Related to Medications Instructions to Promote Adherence…*

educational levels [12]. However, it is evident that a bit of general literacy plays part in augmenting health literacy. This was observed in patients who used many sources of medication information and found to be more informed than those who relied on one information source, for instance, using medication labels only while others used also some internet, books, and leaflets [12]. Having attained higher educational qualifications together with a family history of diabetes mellitus was significantly concomitant with a better understanding of health teaching and instructions [13]. It is evident that having enough health literacy is not the only factor related to good glycaemic control, rather the effect of adequate health literacy in attaining good glycaemic control can be disguised by patients with a better understanding of health education and instructions [13]. Therefore, patients can be health literate, but still, fail to

4.**Age –** Eighty-two percent (82%) of the participants were 50 years and above. It is well known that the risk of diabetes mellitus especially Type 2 is associated with age. However, as people age, their memory also deteriorates which could affect medication instructions comprehension. So, age has not been identified as a feature in the misapprehension and misinterpretation of prescription medication and medication labels. Misunderstanding was common across all age groups. Hence a more specific and clearer explanation is needed for the diabetes mellitus patients to understand medication instructions. Conversely, research affirms that health literacy is a durable predictor of health outcomes

5.**Complexity of medication therapy –** fifty percent (50%) of the respondents were using four and more drugs for diabetes and other comorbidities. Diabetes patients on complex regimen were three times non-adherent than those with a simple regimen [14]. Therefore, simplifying diabetic medication therapy to at least single or two medications could make it easier for patients to follow [14].

6.**Poor health literacy -** other contributory factors to non-adherence in diabetes mellitus patients were identified as follow: firstly, poor health literacy coupled with low health numeracy [15]. This is irrespective of whether an individual is generally literate or not. Secondly, deficient or unclear teaching on medication, particularly if the teaching is not personalised for the patient or on each medication. Some patients do not interpret medication labels and medication information correctly and this is common even when labelling requires minimal reading skills. For example, instructions to take medicine twice daily (which is vague since 'daily' means once per day), or every 12 hours means individuals should make further decisions to understand the instructions. "Take medication as directed" is further, more difficult to interpret since the instructions need to be further broken down. Patients are more likely to understand more specific medication administration times such as 08 A.M., 06 P.M. but instituting periods can be useful or suit some individuals better. Using multifaceted medication regimens independently predicts the probability that patients interpret medication instructions, advice, or education incorrectly.

Health professionals are the major role players in disseminating health information and are the first and most precise sources of information in healthrelated matters. Although they have restricted time with patients during consultations, they fail to issue out information as expected and patients opt for sources with questionable credibility, such as the internet, television, and

than socio-economic status, age, or ethnic background [6].

*DOI: http://dx.doi.org/10.5772/intechopen.95902*

comprehend medication instructions.

### *The Importance of Health Literacy Related to Medications Instructions to Promote Adherence… DOI: http://dx.doi.org/10.5772/intechopen.95902*

educational levels [12]. However, it is evident that a bit of general literacy plays part in augmenting health literacy. This was observed in patients who used many sources of medication information and found to be more informed than those who relied on one information source, for instance, using medication labels only while others used also some internet, books, and leaflets [12].

Having attained higher educational qualifications together with a family history of diabetes mellitus was significantly concomitant with a better understanding of health teaching and instructions [13]. It is evident that having enough health literacy is not the only factor related to good glycaemic control, rather the effect of adequate health literacy in attaining good glycaemic control can be disguised by patients with a better understanding of health education and instructions [13]. Therefore, patients can be health literate, but still, fail to comprehend medication instructions.


Health professionals are the major role players in disseminating health information and are the first and most precise sources of information in healthrelated matters. Although they have restricted time with patients during consultations, they fail to issue out information as expected and patients opt for sources with questionable credibility, such as the internet, television, and

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

• Higher rates of hospitalisations, death, and longer hospital stay.

• Higher rates of hospital readmissions within three days of discharge.

**2.2 Characteristics of individuals with low health literacy**

• Decreased capacity to manage chronic diseases.

• Have less knowledge on own illness management [6].

tion therapy because they do not understand.

appropriate factors linked with health literacy.

**2.3 Factors influencing health literacy and medication adherence**

Research has shown that there are several factors which influence health literacy

1.**Poor labelling instructions** on medication, packaging, lack of patient teaching on medication use, and disease processes contribute to non-adherence [10]. Patients therefore do not see the importance of following correct medica-

2.**Gender -** Sixty-eight percent (68%) of the study participants were females. This could be because most women tend to report a lot of health issues and have greater utilisation of medical services than men [11]. Furthermore, this can be due to the traditional role of caring for sick family members and children. This traditional gender anticipation offers women with more interactions with the healthcare system, providing them additional chances to build their knowledge base, and consequently resulting in increased levels of health literacy than those of men. Gender differences in health literacy among Korean adults revealed that Korean women had a significantly higher level of health literacy compared to men, in understanding instructions on medication bottles [11]. The study explored gender differences in the level of health literacy and

However, women reported more depressive symptoms of chronic diseases than men [11]. A question could be raised as to why these women would suffer depressive symptoms while we expect them to be healthy and in control of their diseases since they report frequently to the health facilities. This could be that, when women are sick, they lack proper care from their spouses or anyone to care for them, or they could be inappropriately taking their medications.

3.**Educational level –** Most of the diabetes mellitus patients (47%) attended school up to high school whereas only 11% did not attend school at all.

Observations from previous studies illustrate that individuals with higher socioeconomic status or higher education levels had a better comprehension of prescribed medications and medication labels hence leading to the minor occurrence of adverse medication occasions [12]. Despite this, failure to comprehend and interpret medication prescriptions is still prevalent through all

• More likely to make errors with medications.

• Seek medical care when they are more ill.

• Poor overall health status.

among individual groups**.**

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newspapers, for health information [16]. These defective sources mostly lead individuals into making erroneous verdicts about their health. The patients should be taught how to seek credible information sources on the media. There should be ever-ready more specific and detailed health information materials to give out to the patients to reference at home *(see appendix 1*).

7.**Inadequate patient education related to medication use -** Research has also shown that medication non-adherence and treatment ineffectiveness can be negatively influenced by the inability to comprehend medication instructions. The problem is not with patients using medications only but also dispensing health practitioners and medication manufacturers. Most of the generally used medication label instructions are unclear, and misunderstanding takes place also in highly educated patients [17]. Poor understanding of medication instructions or misinterpretations could be a cause for patients not using their medications as prescribed. Misinterpretation of medication instructions leads to subprime medication therapy resulting from consuming less than instructed, getting insufficient medication concentrations, or increased risks of adverse effects by overdosing and medication concentration increasing interactions.

It is evident that inadequate health literacy hinders patients' understanding of medication instructions [18]. The instructions also could be written in the clearest and specific manner, however, there is limited evidence supporting the best practices for writing prescription medication instructions to enhance patients' comprehension for proper use of the medication. Therefore, a more specific wording should be used on prescription medication instructions to enhance patients' comprehension [18].
