Gender Differences in the Associations Between Health Literacy and Medication Adherence in Hypertension: A Population-Based Survey in Heris County, Iran
Received 8 January 2020
Accepted for publication 19 March 2020
Published 23 April 2020 Volume 2020:16 Pages 157—166
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 4
Editor who approved publication: Dr Konstantinos Tziomalos
Haleh Heizomi,1 Zeynab Iraji,2 Rogayeh Vaezi,1 Devender Bhalla,3– 5 Donald E Morisky,6 Haidar Nadrian1,7
1Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran; 2Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran; 3Pôle Universitaire Euclide, Intergovernmental UN Treaty 49006/49007®, Bangui, Central African Republic; 4Iranian Epilepsy Association®, Tehran, Iran; 5Nepal Interest Group of Epilepsy and Neurology (NiGEN), Kathmandu, Nepal; 6Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA; 7Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Correspondence: Haidar Nadrian
Department of Health Education and Promotion, Faulty of Health, Tabriz University of Medical Sciences, Attar-e-Neyshabouri Street, Tabriz, Iran
Objective: We examined the gender-based associations of health literacy (HL) with self-reported medication adherence (MEDA) among patients with primary hypertension (pHTN).
Patients and Methods: The subjects were recruited from the general population through all health centers of the Heris county, east Azarbaijan. They were to be adults (30+ years age), with pHTN of any stage, of any gender, and without comorbid illness. All underwent detailed face-to-face interview. We used valid questionnaires for HL and MEDA. Hierarchical regression was done to establish the association between MEDA, socio-demographic variables, and nine HL domains by gender. Other statistical procedures were also done.
Results: A total of 300 (48.6% males, mean age: 56.7± 9.3) subjects participated; 43.0% were uneducated, 73.0% had moderate socioeconomic status, 68.0% had poor HL, and 7.0% maintained high adherence. Men were better in reading skills (p=0.002), and accessing (p=0.01) and using (p=0.02) health information, but women were better in health knowledge (p=0.004). The average regression estimate (±standard deviation) between HL and MEDA was 0.37± 0.09, lower among men (0.361± 0.11) than women (0.396± 0.08), p=0.003. Upon hierarchical regression, the association between HL and MEDA was significant for communication and decision-making skills alone among both men (34.5%) and women (40.6%), individually.
Conclusion: HL had substantial association with MEDA among those with HTN, for both men and women, particularly the communication and decision-making. With considerations on gender differences, this association should be confirmed through interventional studies to help make HL a formal mitigating strategy for MEDA and other public health goals.
Keywords: medication adherence, health literacy, hypertension, gender
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