Association between Health Literacy and Medication Adherence among Pulmonary Tuberculosis Patients Using Four Domains of the Integrated Health Literacy Model in Jember Regency, Indonesia

Document Type : Original Article


1 Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand

2 Department of Family and Community Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand


Background and Objective: Health literacy is one of the factors that can influence tuberculosis medication adherence. Due to inadequate health literacy, patients had not fully used the information received related to tuberculosis in their daily behavior to support recovery. This research analyzes the association between domains of health literacy and medication adherence among pulmonary tuberculosis patients.

Materials and Methods: This retrospective study analyzed the association between health literacy and medication adherence of 150 pulmonary tuberculosis patients in four primary healthcare units in Jember Regency. The participants were composed of; 1) adhere (had no history of interrupt medication > 1 month in 2021) and already recovered and 2) non-adhere (had a history of not taking medication for > 1 month in 2021). The prepared research assistants and health volunteers carried out the data collection. Descriptive statistics and the chi-square test were applied to analyze the data. Collection data held from October-November 2022.

Results: This study found that 128 participants adhered to and 22 did not adhere to tuberculosis medication. Forty-two percent of the participants (63 of 150) had a sufficient health literacy level. There was a significant association between health literacy level and medication adherence (p<.001).  All health literacy domains significantly associated with medication adherence with access (p=0.001), understand (p<0.001), appraise (p<0.001), and apply (p<0.001).

Conclusion: Most participants had sufficient health literacy and good skills in accessing, understanding, appraising, and applying tuberculosis-related information. Health workers can improve tuberculosis patients’ ability to appraise and apply tuberculosis health information by providing continuous health counseling. 


Availability of data and materials: The anonymized datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Conflict of Interest statement: The authors have reported no conflicts of interest.

Consent for Publication; Not applicable

Ethical considerations: This study was carried out in accordance with the Helsinki Declaration. Clinical Ethical permission for the study had been obtained from the office of Khon Kaen University, Ethics Committee for Human Research (ECKKU), Thailand, under record reference number HE652156 with the date of approval 9th September 2022. All participants provided written informed consent.

Funding Statement: This research was supported by the KKU Scholarship for ASEAN and GMS Countries’ (Grant Number 751/220).

Author’s Contributions: Farida Nur Qomariyah,: Development of the concept and study design (proposal development), questionnaire development, ethical submission and approval, data collecting, data analysis, finding report, discussion, and recommendation provision, manuscript preparation. Lukawee Piyabanditkul: Development of the concept and study design (proposal development), questionnaire development, ethical submission and approval, data analysis, finding report, discussion, and recommendation provision, manuscript preparation

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