Association Between Health Literacy and Medication Adherence Among Hispanics with Hypertension
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.
KeywordsMedication adherence Hypertension Dominicans Hispanics Health literacy
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.
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 was obtained from all participants included in the study.
No animal studies were carried out by the authors for this article.
- 2.United States Census Bureau. QuickFacts: UNITED STATES [Internet]. 2017 [cited 2018 Jun 1]. Available from: https://www.census.gov/quickfacts/fact/table/US/PST045217. Accessed 14 May 2018.
- 3.Colby SL, Ortman JM. Projections of the size and composition of the U.S: 2014–2060 [Internet]. 2015; p. 1–13. Available from: https://census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf. Accessed 14 May 2018
- 4.Centers for Disease Control and Prevention, Office of Minority Health and Health Equity. Hispanic Health [Internet]. 2015. Available from: http://www.cdc.gov/vitalsigns/hispanic-health/index.html. Accessed 14 May 2018
- 11.Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–248.CrossRefGoogle Scholar
- 14.World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.Google Scholar
- 32.PROMIS Health Organization. PROMIS® measures are available in languages other than English. [Internet]. [cited 2018 Jun 12]. Available from: http://www.healthmeasures.net/explore-measurement-systems/promis/intro-to-promis/available-translations.
- 33.Health Literacy Tool Shed. Newest Vital Sign Spanish Version - NVS-SP [Internet]. 2005 [cited 2018 Jun 12]. Available from: https://healthliteracy.bu.edu/nvs-sp.
- 34.Weiss BD, Hart G, McGee DL, D’Estelle S. Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills. J Am Board Fam Pract. 1992;5:257–64.Google Scholar
- 39.Institute of Medicine (US) Forum on the Science of Health Care Quality Improvement and Implementation, Institute of Medicine (US) Roundtable on Health Disparities, Institute of Medicine (US) Roundtable on Health Literacy. Toward Health Equity and Patient-Centeredness: Integrating Health Literacy, Disparities Reduction, and Quality Improvement: Workshop Summary [Internet]. Washington (DC): National Academies Press (US); 2009 [cited 2018 May 26]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK37533/.