Journal of Health Literacy

Journal of Health Literacy

Relationship between Health Literacy and Medication Adherence in Patients with Hypertension in Gonabad, Iran

Articles in Press

Document Type : Original Article

Authors
Akram Bakhtiari Shahri 1
Mohammad Saleh Hadadi 2
Mitra Tavakolizadeh 3
Mahdi Moshki 4
1 Assistant Professor of Internal Medicine, Faculty of Medicine, Clinical Research Development Unit, Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran.
2 Clinical Research Development Unit, Bohlool Hospital, Gonabad University of Medical Sciences, Gonabad, Iran.
3 Ph.D. Student of Nursing, Students Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran.
4 Professor, Department of Health Education and Health Promotion, School of Health AND Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
10.22038/jhl.2026.98404.2039
Abstract
Background and Objective: Hypertension is a major modifiable risk factor for cardiovascular diseases. Despite effective therapies, poor medication adherence remains a significant barrier to blood pressure control. This study aimed to determine the levels of health literacy and medication adherence and examine their relationship among hypertensive patients in Gonabad, Iran.

Materials and Methods: In this analytical cross-sectional study, 350 hypertensive patients attending urban and rural health centers in Gonabad in 2023 were enrolled using stratified proportional sampling. Data were collected using a demographic questionnaire, the 8-item Morisky Medication Adherence Scale (MMAS-8), and the Health Literacy for Iranian Adults (HELIA) questionnaire. Data analysis was performed using SPSS version 24, utilizing Spearman correlation, Mann-Whitney U, and Kruskal-Wallis tests. The significance level was set at p<0.05. Ethical approval was obtained (IR.GMU.REC.1401.195). Response rate: 96%. Cronbach’s alpha across the five HELIA domain scores in the present sample was 0.88.

Results: The mean age of participants was 56.71 ± 7.20 years, and 51.7% were female. Regarding medication adherence, 38.0% had poor adherence, 50.0% had moderate adherence, and 12.0% demonstrated full adherence. For health literacy, 31.4% of participants had inadequate health literacy, 24.0% had marginally adequate, 30.9% had adequate, and 13.7% had excellent health literacy. Spearman correlation revealed a statistically significant positive relationship between health literacy and medication adherence (r=0.11, p=0.033).

Conclusion: The majority of hypertensive patients in Gonabad exhibited suboptimal medication adherence and insufficient health literacy. The significant positive correlation indicates that higher health literacy is associated with better adherence. These findings highlight the need for targeted health literacy interventions to improve medication-taking behavior and blood pressure management in this population. Limitations include the cross-sectional design, self-reported measures, and convenience sampling within strata.
Keywords
Hypertension
Health Literacy
Medication Adherence
MMAS-8
HELIA

Acknowledgments: The authors would like to acknowledge and thank the Clinical Research Development Unit of Bohlool hospital in Gonabad University of Medical Sciences for their contribution to this research. The authors also acknowledge the staff of Gonabad University of Medical Sciences health centers and all patients who participated in this study.


Availability of data and materials:  The data supporting the findings of this study are available from the corresponding author upon reasonable request.


Conflict of interest: The authors declare no conflicts of interest.


Consent for publication: Not applicable.


Ethics approval and consent to participate: The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Consent forms were filled out prior to participation in the study, and the treatment of those who did not participate was not altered. The researcher also explained this study's steps and process to all of the participants and that their anonymity and data confidentiality will be maintained throughout the study. The study was approved by the Ethics Committee of Gonabad University of Medical Sciences (Ethical Code: IR.GMU.REC.1401.195). Data were anonymized and stored securely, accessible only to the research team.


Funding: None.


Author contributions: A.Bakhtiari, M. Moshki construct and supervised this study.  M.S. Hadadi implemented the project and collected the data. M. Tavakolizadeh provided statistical consultation and analysis. A.Bakhtiari served as the clinical advisor. A.Bakhtiari and M. Tavakolizadeh drafted and revised the manuscript. All authors reviewed and approved the final version of the manuscript.

 

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 license, visit https://creativecommons.org/licenses/by/4.0/

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Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 31 October 2026