Association Between Health Literacy and Medication Adherence Among Hispanics with Hypertension

  • Maichou Lor
  • Theresa A. Koleck
  • Suzanne Bakken
  • Sunmoo Yoon
  • Ann-Margaret Dunn NavarraEmail author



Poor adherence to prescribed antihypertensive medication is a major contributor to disparities in effective blood pressure control among Hispanics. The purpose of this study was to investigate the association between health literacy level and adherence to antihypertensive medications among Hispanic adults, who self-reported hypertension, controlling for potential covariates of adherence and/or health literacy.


We conducted a cross-sectional survey of 1355 Hispanic adults, primarily Dominicans, who self-reported hypertension. Antihypertensive medication adherence and health literacy were evaluated along with covariates, including sociodemographic characteristics, depression, anxiety, and sleep disturbance. Linear regression models were created for health literacy, each covariate, and adherence. Factors found to be significantly associated with adherence in the individual regression models at a p value of < 0.20 were included in a hierarchical multiple linear regression model.


Overall, the majority of participants had low adherence levels to antihypertensive medications (88.4%; n = 1026) and inadequate health literacy (84.9%; n = 1151). When controlling for age, sex, birth country, education level, recruitment location, depression, anxiety, and sleep disturbance, having adequate as compared to inadequate health literacy was associated with a higher adherence score (b = 0.378, p = 0.043). The full model explained 13.6% of the variance in medication adherence (p value < 0.001), but the unique contribution of health literacy to the model was minimal (R2 change = 0.003).


Tailored interventions considering health literacy are needed to support medication adherence in order to improve hypertension outcomes of Hispanics. Additional studies are needed to identify and prioritize factors in the development of targeted and effective adherence interventions for Hispanics with hypertension.


Medication adherence Hypertension Dominicans Hispanics Health literacy 


Funding Information

The Washington Heights/Inwood Informatics Infrastructure for Comparative Effectiveness Research was supported by R01HS019853 and R01HS022961. The analysis and manuscript preparation were supported by the Reducing Health Disparities Through Informatics training grant (T32NR007969) and the Precision in Symptom Self-Management (PriSSM) Center (P30NR016587). Dr. Koleck is also supported by K99NR017651 and Dr. Navarra by K23 NR015970.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

The study received IRB approval from the Columbia University Medical Center’s Institutional Review Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all participants included in the study.

Animal Studies

No animal studies were carried out by the authors for this article.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  • Maichou Lor
    • 1
  • Theresa A. Koleck
    • 1
  • Suzanne Bakken
    • 1
    • 2
    • 3
  • Sunmoo Yoon
    • 1
  • Ann-Margaret Dunn Navarra
    • 4
    Email author
  1. 1.School of NursingColumbia UniversityNew York CityUSA
  2. 2.Biomedical InformaticsColumbia UniversityNew York CityUSA
  3. 3.Data Science InstituteColumbia UniversityNew York CityUSA
  4. 4.Rory Meyers College of NursingNew York UniversityNew York CityUSA

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