Pathways linking health literacy, health beliefs, and cognition to medication adherence in older adults with asthma - 19/04/17
, Jenny L. Lin, MD, MPH b, Michael S. Wolf, PhD, MPH c, Rachel O'Conor, MPH c, Melissa Martynenko, MPH, MPP b, Juan P. Wisnivesky, MD, DrPh b, d, Alex D. Federman, MD, MPH bAbstract |
Background |
Limited health literacy is associated with low adherence to asthma controller medications among older adults.
Objective |
We sought to describe the causal pathway linking health literacy to medication adherence by modeling asthma illness and medication beliefs as mediators.
Methods |
We recruited adults aged 60 years and older with asthma from hospital and community practices in New York, New York, and Chicago, Illinois. We measured health literacy and medication adherence using the Short Test of Functional Health Literacy in Adults and the Medication Adherence Rating Scale, respectively. We used validated instruments to assess asthma illness and medication beliefs. We assessed cognition using a cognitive battery. Using structural equation modeling, we modeled illness and medication beliefs as mediators of the relationship between health literacy and adherence while controlling for cognition.
Results |
Our study included 433 patients with a mean age of 67 ± 6.8 years. The sample had 84% women, 31% non-Hispanic blacks, and 39% Hispanics. The 36% of patients with limited health literacy were more likely to have misconceptions about asthma (P < .001) and asthma medications (P < .001). Health literacy had a direct effect (β = 0.089; P < .001) as well as an indirect effect on adherence mediated by medications concerns (β = 0.033; P = .002). Neither medication necessity (β = 0.044; P = .138) nor illness beliefs (β = 0.007; P = .143) demonstrated a mediational role between health literacy and adherence.
Conclusions |
Interventions designed to improve asthma controller medication adherence in older adults may be enhanced by addressing concerns about medications in addition to using communication strategies appropriate for populations with limited health literacy and cognitive impairments.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, elderly, health literacy, adherence, medication beliefs, illness beliefs, cognition
Abbreviations used : B-IPQ, BMQ, MARS, S-TOFHLA, WMS-immediate, Trails B
Plan
| This work was supported by a grant from the National Heart, Lung, and Blood Institute (grant no. 5R01HL096612-04), which played no role in the design or conduct of the study or the interpretation of its findings. |
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| Disclosure of Potential Conflict of Interest: J. L. Lin has received a grant from the National Cancer Institute. M. S. Wolf has received a grant from the National Heart, Lung, and Blood Institute, Merck, Eli Lilly, AbbVie, and United Healthcare and has consultant arrangements with Luto, Merck, Amgen, Adler Design, Imbev, Medlearning Group, CVS Caremark, and UAMS. R. O'Conor has received a grant from the National Heart, Lung, and Blood Institute. J. P. Wisnivesky has received a grant from the National Institutes of Health, Sanofi, and Quorum; is a board member for EHE International; and has consultant arrangements with Merck and Quintiles. A. D. Federman has received a grant from the National Institutes of Health. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 139 - N° 3
P. 804-809 - mars 2017 Retour au numéro
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