Health Literacy and Hypertension Medication Adherence: A Systematic Review

Articles in Press

Document Type : Systematic Review

Authors

Universitas Negeri Semarang

Abstract

Background and Objectives : Medication adherence plays a crucial role in the management of hypertension. Low health literacy leads to poor disease management and medication adherence. This study aims to identify the relationship between health literacy and medication adherence in hypertension based on empirical studies conducted over the past ten years. 

Material and Methods: This systematic review employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting criteria and was designed according to the PICO (Participant, Intervention, Comparison, and Outcomes) framework. The study sources were research articles retrieved from two databases PubMed and ScienceDirect covering the period from 2014 to 2024. Of the 62 scientific articles identified, 11 were included in the data synthesis. The review protocol (PROSPERO) registration number CRD420251049123 has been registered in the International Prospective Register of Systematic Reviews. 

Result : Health literacy status was categorized into two or more groups: limited and adequate; limited, marginal, adequate; problematic, inadequate, adequate, and very good. There are five instruments that assess the four domains of health literacy: the Newest Vital Sign, the HL questionnaire by Montazeri et al, the Health Literacy in Hypertension Scale, the European Health Literacy Survey (HLS-EU-Q12M), and the Health Literacy Management Scale (HeLMS). All studies indicated that hypertensive patients with high health literacy tended to have better treatment adherence.

Conclusion : The study findings indicate that health literacy plays a crucial role in improving medication adherence and self-management of hypertension. However, the relationship between health literacy and medication adherence is not always direct. Variations in social and cultural contexts, healthcare systems, family support, and individual characteristics can influence the effectiveness of health literacy in shaping patients’ adherence behaviors.

Keywords

Acknowledgments: Not applicable.


Availability of data and materials: All data generated or analyzed during this study areincluded in this published article.


Conflicts of interest: The authors declare no competing of interest.


Consent for publication: Not applicable.


Ethics approval and consent to participate: This research adhered to the ethical principles outlined in the Declaration of Helsinki .As this is a systematic review, it does not require ethical approval or consent to participate.


Funding: This study did not receive external funding.


Author’s contribution: Conceptualization: Ani NF. Data management: Ani NF. Formal analysis: Ani NF, Siti HB, Evi W. Funding: None. Methodology: Ani NF, Siti HB, Evi W. Drafting: Ani NF, Siti HB, Evi W. Writing, reviewing, and editing: Ani NF.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

  1. 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):1-11. https://doi.org/10.1186/s12939-017-0551-9 PMid:24383432 PMCid:PMC4029464
  2. Kario K, Okura A, Hoshide S, Mogi M. The WHO Global report 2023 on hypertension warning the emerging hypertension burden in globe and its treatment strategy. Hypertens Res. 2024;47(5):1099-102. https://doi.org/10.1038/s41440-024-01622-w PMid:38443614
  3. WHO. Global report on hypertension. Vol. 01, World Health Organization. 2023. 1-7 p.
  4. Sukcharoen P, Sakunpong N, Polruk J, Chumdaeng S. Impact of a transformative health literacy model for Thai older adults with hypertension. BMC Res Notes [Internet]. 2024;17(1):278. Available from: https://doi.org/10.1186/s13104-024-06782-z https://doi.org/10.1186/s13104-024-06782-zPMid:39334268 PMCid:PMC11438067
  5. Konlan KD, Lee H, Choi EK. Hypertension literacy: Concept analysis. Nurs Open. 2023;10(9):6078-90. https://doi.org/10.1002/nop2.1829PMid:37212530 PMCid:PMC10416074
  6. Chajaee F, Pirzadeh A, Hasanzadeh A, Mostafavi F. Relationship between health literacy and knowledge among patients with hypertension in Isfahan province, Iran. Electron physician [Internet]. 2018;10(3):6470-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29765571%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC5942567
  7. Marciano L, Camerini AL, Schulz PJ. The Role of Health Literacy in Diabetes Knowledge, Self-Care, and Glycemic Control: a Meta-analysis. J Gen Intern Med. 2019;34(6):1007-17 https://doi.org/10.1007/s11606-019-04832-yPMid:30877457 PMCid:PMC6544696
  8. Karami M, Ashtarian H, Rajati M, Hamzeh B, Rajati F. The effect of health literacy intervention on adherence to medication of uncontrolled hypertensive patients using the M-health. BMC Med Inform Decis Mak. 2023;23(1):1-10. https://doi.org/10.1186/s12911-023-02393-zPMid:38102648 PMCid:PMC10724893
  9. Tan FCJH, Oka P, Dambha-Miller H, Tan NC. The association between self-efficacy and self-care in essential hypertension: a systematic review. BMC Fam Pract. 2021;22(1):1-12. https://doi.org/10.1186/s12875-021-01391-2PMid:33618661 PMCid:PMC7901221
  10. Lor M, Koleck T, Bakken S, Yoon S, Dunn A. Association Between Health Literacy and Medication Adherence Among Hispanics with Hypertension. J Racial Ethn Health Disparities [revista en Internet] 2019 [acceso 10 de noviembre de 2022] https://doi.org/10.1007/s40615-018-00550-zPMid:30607576 PMCid:PMC6545226

6(3): 517-524. HHS Public Access [Internet]. 2020;6:1-15. Available from: https://pubmed.ncbi.nlm.nih.gov/30607576/

  1. Moher D, Liberati A, Tetzlaff J, Altman DG, Antes G, Atkins D, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7). https://doi.org/10.1371/journal.pmed.1000097PMid:19621072 PMCid:PMC2707599
  2. Institute JB. Checklist For Systematic Reviews And Research Critical Appraisal Tools for use in JBI Systematic Reviews. JbiGlobal [Internet]. 2020;1-6. Available from: https://jbi.global/sites/default/files/2020-08/Checklist_for_Systematic_Reviews_and_Research_Syntheses.pdf
  3. Persell SD, Karmali KN, Lee JY, Lazar D, Brown T, Friesema EM, et al. Associations between health literacy and medication self-management among community health center patients with uncontrolled hypertension. Patient Prefer Adherence. 2020;14:87-95. https://doi.org/10.2147/PPA.S226619PMid:32021120 PMCid:PMC6970267
  4. Cangussú LR, Sartori Alho EA, Silva AL, Fonsêca DV, Lopes JM, Barbosa RH de A, et al. Low health literacy and quality of life in patients with systemic arterial hypertension. Dialogues Heal. 2022;1:1-7.https://doi.org/10.1016/j.dialog.2022.100036PMid:38515897 PMCid:PMC10953978
  5. Nagarjuna P, Kumar V, Faujdar D, Yadav A. Role of health literacy and primary health-care access in self-care management of hypertension. Indian J Public Health. 2023;67(3):442-7. https://doi.org/10.4103/ijph.ijph_1704_22 PMid:37929388
  6. Gaffari-Fam S, Babazadeh T, Oliaei S, Behboodi L, Daemi A. Adherence to a health literacy and healthy lifestyle with improved blood pressure control in Iran. Patient Prefer Adherence. 2020;14:499-506. https://doi.org/10.2147/PPA.S244820PMid:32184576 PMCid:PMC7061438
  7. Hulya Firat Kilic, Sinem Dag. The Relationship Between Health Literacy and Medication Adherence in a Hypertensive Patient Population. Int J Caring Sci [Internet]. 2020;13(11):1-101. Available from: www.internationaljournalofcaringsciences.org
  8. Doubova S V, Monroy A. Alfabetización en salud y su asociación con el control de hipertensión arterial. Aportación Orig. 2024;62(3).
  9. Liu Y, Jiang F, Zhang M, Niu H, Cao J, Du S, et al. Health literacy and self-management among middle-aged and young hypertensive patients: a parallel mediation effect of illness perception and self-efficacy. Front Psychol. 2024;15(May). https://doi.org/10.3389/fpsyg.2024.1349451PMid:38765827 PMCid:PMC11099212
  10. Lou SP, Han D, Kuczmarski MF, Evans MK, Zonderman AB, Crews DC. Health Literacy, Numeracy, and Dietary Approaches to Stop Hypertension Accordance Among Hypertensive Adults. Heal Educ Behav. 2023;50(1):49-57. https://doi.org/10.1177/10901981221079742PMid:35272527 PMCid:PMC11681931
  11. Fu SN, Dao MC, Wong CKH, Cheung BMY. Knowledge and practice of home blood pressure monitoring 6 months after the risk and assessment management programme: does health literacy matter? Postgrad Med J. 2022;98(1162):610-6. https://doi.org/10.1136/postgradmedj-2020-139329PMid:34039693 PMCid:PMC9340004
  12. Sany SBT, Doosti H, Mahdizadeh M, Orooji A, Peyman N. The health literacy status and its role in interventions in Iran: A systematic and meta-analysis. Int J Environ Res Public Health. 2021;18(8). https://doi.org/10.3390/ijerph18084260PMid:33920508 PMCid:PMC8073744
  13. Sørensen K, Trezona A, Levin-Zamir D, Kosir U, Nutbeam D. Transforming health systems and societies by investing in health literacy policy and strategy. Public Heal Panor. 2019;5(2-3):259-63.
  14. Bröder J, Okan O, Bauer U, Bruland D, Schlupp S, Bollweg TM, et al. Health literacy in childhood and youth: A systematic review of definitions and models. BMC Public Health. 2017;17(1):1-25. https://doi.org/10.1186/s12889-017-4365-xPMid:28441934 PMCid:PMC5405535
  15. IUHPE. Position Statement on Health Literacy : a practical vision for a health literate world. Glob Health Promot. 2018;25(4):79-88. https://doi.org/10.1177/1757975918814421
  16. WHO. Health literacy development for the prevention and control of noncommunicable diseases. In 2022. p. 1-28. Available from: https://apps.who.int/iris/bitstream/handle/10665/364206/9789240055391-eng.pdf?sequence=1
  17. Sørensen K, Van Den Broucke S, Fullam J, Doyle G, Pelikan J, Slonska Z, et al. Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health [Internet]. 2012;12(1):80. https://doi.org/10.1186/1471-2458-12-80 PMid:22276600 PMCid:PMC3292515
  18. Wannasirikul P, Termsirikulchai L, Sujirarat D, Benjakul S TC. HEALTH LITERACY, MEDICATION ADHERENCE, AND BLOOD PRESSURE LEVEL AMONG HYPERTENSIVE OLDER ADULTS TREATED AT PRIMARY HEALTH CARE CENTERS. Southeast Asian J Trop Med Public Heal. 2016;47(1):109-20.
Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 30 May 2026

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