Abstract
Background/Aims Low income and inadequate health literacy are independently associated with hospital readmission, a situation exacerbated by factors such as medication errors or non-adherence. The objectives of this study were to describe health literacy in a population of adult patients covered by medical aid programs, to test its impact on medication adherence, and to explore the role of depressive symptoms on adherence.
Methods Ninety patients who had been hospitalized at Scott & White Memorial Hospital participated in the study. Within 15 days of discharge, participants completed an in-person cross-sectional survey, on health literacy (REALM-SF), medication adherence (Morisky 4-item), depressive symptoms (CES-D), demographics, and other psychosocial measures. Chi square was applied to test for differences in medication adherence by health literacy score and by depression score. Health literacy scores were categorized by grade equivalents of ≤grade 6 (0–3 points), 7th–8th grade (4–6 points), and high school or above (7 points). Depressive symptom scores were categorized as below or above a cut-off of 16 points (higher = more symptoms). Medication adherence scores were categorized as low (0–1 points), medium (2–3 points), or high (4 points).
Results The majority of participants were women (62.2%) with a mean age of 50.4 (SD = 13.5). Fifty-four percent scored a grade equivalent of high school or above, thirty percent scored a 7th to 8th grade equivalent, and 15.6% scored equivalent to 6th grade or lower. Medication adherence did not differ across REALM-SF categories (x2 = 4.97, df = 4, P = .29) or by CES-D categories (x2 = 1.79, df = 2, P = .41).
Conclusions Health literacy scores varied in this sample of medical aid program members recently discharged from the hospital; 15% had scores indicating they may struggle with most patient education material. However, health literacy level was not associated with degree of medication adherence after discharge. Planned next steps in this study are to explore the role of motivation and other individual characteristics on medication adherence and other self-care behaviors. Improved understanding of experiences and behaviors following hospital discharge will aid in the tailoring of interventions to reduce avoidable readmissions for persons receiving medical aid.
