Development and validation of a Chinese medication literacy measure

Development and reliability and validity testing of a medication literacy scale for medical college students

BACKGROUND

Irrational drug use has become a global problem threatening human health. As future health professionals, medical college students' medication literacy (ML) is critical. Their mastery of medication-related knowledge will directly affect public medication safety in the future.

METHODS

The initial scale was developed through a literature review and was modified through expert consultation and student interviews to form the initial scale with 14 items. In 2020, a questionnaire survey was conducted among students in a medical college for item analysis, reliability test, validity test and other analyses.

RESULTS

The total Cronbach's α coefficient was 0.826 and split-half reliability was 0.852. The Cronbach's α coefficients for functional medication literacy, communicative medication literacy, and critical medication literacy were 0.901, 0.858, and 0.851, respectively. The item-level content validity index (I-CVI) ranged from 0.833 to 1.000 (≥ 0.78). Factor analysis of 14 items showed that KMO = 0. 852(> 0.7) and Bartlett's spherical test p < 0.001, indicating that the data are very suitable for factor analysis. Three principal axis factors were extracted by principal component analysis, and the total variance interpretation rate was 69.031% (> 40%). The confirmatory factor analysis identified a three-factor model and showed goodness of fit indices for the scale: The χ²/df = 2.623, The Goodness of Fit Index (GFI) = 0.905, The Comparative Fit Index (CFI) = 0.950, Normed Fit Index (NFI) = 0.922, Tucker-Lewis index (TLI) = 0.938, and The Root Mean Square Error of Approximation (RMSEA) = 0.078.

CONCLUSION

A new scale for evaluating the medication literacy of Chinese medical college students was preliminarily developed, demonstrating good reliability and validity. Itcan be used as a preliminary measurement tool for assessing medical students' medication literacy. However, due to the limitations of this study, the practical application of the scale needs to be further examined in a larger sample and should be refined in future studies.

Facilitators and barriers of adherence to rectal interventions by parents of young children with functional constipation: a qualitative study

Background

Functional constipation in children is a worldwide problem that impacts both children's gastrointestinal function and the quality of family life. The treatment of this condition often depends on parental involvement to administer rectal interventions to their children to stimulate defecation. However, adherence to rectal interventions is currently suboptimal. We sought to explore the factors that facilitate and hinder parents from adherence to rectal interventions.

Methods

A descriptive qualitative study was conducted involving semi-structured interviews with parents of infants and young children with functional constipation requiring rectal interventions from March to May 2023. The data were analyzed using content analysis.

Results

Fourteen parents participated in the study. Parents reported the main facilitators of adherence to prescribed rectal interventions as recognition of illness severity, support from family and friends, and medical resource support and e-health literacy. Parents reported the primary barriers as information barriers, family conflict, cognitive misalignment, and difficulties in accessing healthcare services.

Conclusion

Rectal interventions are often essential in managing constipation in young children, with parental compliance being crucial for effective treatment. Healthcare providers must consider the psychosocial aspects of parents' perceptions, adhere to guidelines to standardize communication, and ensure comprehensive education to improve medication literacy.

Development, Reliability and Validity of the Medication Literacy Scale for Parents of Children with Epilepsy

Purpose

This study aimed to develop a medication literacy scale for parents of children with epilepsy (MLSPCE) and to test the reliability and validity of the scale.

Patients and Methods

The pilot scale was formulated based on the concept of medication literacy, the knowledge-attitude-practice model, and relevant literature reviews. It was formed through two rounds of expert consultations using the Delphi method. A survey of 657 parents of children with epilepsy, who were admitted to the neurology department or examined in the neuro-electrophysiological outpatient department of Guangzhou Women and Children Medical Center, using the pilot scale was conducted from October 2021 to January 2022 to test the reliability and validity of the scale questionnaire. The content validity of the scale questionnaire was assessed by consulting 20 neurology nursing, neurology clinician, and nursing education experts. Numbers, percentages, t-test, correlation analysis, Cronbach's alpha reliability coefficient and factor analysis were used for data analysis.

Results

The MLSPCE included 34 items in four dimensions. Ten factors were drawn from the explorative factor analysis, with a cumulative variance contribution rate of 62.32%. The content validity index of each item on the 34-item scale was between 0.81 and 1.0, and the scale-content validity index/ average was 0.97. The correlation coefficient between each item and its dimension was between 0.399 and 0.760, the correlation coefficients between dimensions were between 0.150 and 0.382, and the correlation coefficients between each dimension and the total scale were between 0.390 and 0.845. Differences for all comparisons were statistically significant (P < 0.05). Cronbach's alpha coefficient for the total scale was 0.864, and the split-half reliability of the total scale was 0.923.

Conclusion

All the statistical procedures performed in the validity and reliability stages of the study showed that MLSPCE is a valid and reliable tool for measuring medication literacy among Chinese parents of children with epilepsy.

Factors affecting the medication literacy of older adults and targeted initiatives for improvement: a cross-sectional study in central China

Introduction

This study explored the state of rational drug use among older adults in central China, aiming to unveil factors influencing their medication literacy and proposing targeted improvement measures.

Methods

A cross-sectional study involving 454 participants aged 60 and above was conducted in Hubei province between February 1 and May 30, 2023, with data collected through face-to-face interviews by pharmacists. Multiple logistic regression analysis was conducted to determine factors that affected medication literacy.

Results

Of the 412 valid questionnaires, findings revealed inadequate knowledge of rational drug use among older adults in central China. Those who fully understood (105, 25.49%, OR = 9.349, p < 0.001, 95%CI = 3.884-22.502) or partially understood (228, 55.34%, OR = 3.295, p = 0.002, 95%CI = 1.548-7.013) drug instructions exhibited significantly higher medication literacy than those who did not understand (79, 19.17%). Subsequent research revealed a lack of awareness in reading drug instructions or difficulty in understanding them. Most older adults seldom heard of but exhibited high acceptance of medication guidance services.

Discussion

In conclusion, the ability to comprehend drug instructions significantly influenced the medication literacy of older adults. Initiatives such as revising age-appropriate drug instructions could effectively enhance rational drug use among this demographic.

Development and content validation of the medication literacy test for older adults (TELUMI)

OBJECTIVES

Medication literacy comprises the skills needed to access, understand, and act on medication information. Low medication literacy is frequent among older adults, making them more susceptible to negative health outcomes. The aim of this study was to develop and evaluate the content validity of an instrument to measure medication literacy in this population.

METHOD

Multistage methodological study. Items were generated according to a conceptual model and a literature review. The instrument was submitted to a panel of experts to assess item's relevance, clarity, and theoretical classification. Subsequently, the instrument was applied to the target population to assess its comprehensibility.

RESULTS

Content Validity Index results indicated excellent agreement among experts on the instrument's relevance (0.98) and clarity (0.91). Overall agreement between experts regarding the theoretical subdimensions was moderate [Fleiss' kappa=0.57 (p = 0.00)]. Items were reported to be fully understood by most representatives of the target population. The final version of the instrument had 33 items divided into eight scenarios of medication use.

CONCLUSION

The instrument seems to have adequate content validity and good suitability for the target population. Therefore, it can help health professionals to identify older adults with low medication literacy, aiming to improve their medication use skills.

Psychometric properties and validation of the revised Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP-R)

Background

Medication literacy is one of the key indicators that can affect the self-management of medications and medication safety. This study aimed to revise the Chinese Medication Literacy Scale for hypertensive patients (C-MLSHP) and test the reliability and validity of the revised scale.

Methods

We revised the C-MLSHP by several methods, i.e., focus group discussion, expert consultation, patient interview, and pilot study, based on the established evaluation index system of medication literacy for hypertensive patients. Then, a formal survey using the revised Chinese Medication Literacy Scale for hypertensive patients (C-MLSHP-R) was carried out on hypertensive patients from hospitals and community healthcare centers in Changsha city of China to test its reliability and validity. The reliability was evaluated with Cronbach's α coefficient, split-half reliability, and test–retest reliability. The validity was evaluated with content validity, construct validity, convergent validity, discriminant validity, and criterion-related validity.

Results

The C-MLSHP-R contained 18 items within four domains, i.e., the knowledge domain included four items, the attitude domain had three items, the skill domain involved seven items, and the practice domain included four items. A total of 339 hypertensive patients participated in the formal survey. The results showed that the Cronbach's α coefficient of C-MLSHP-R was 0.802, and for each domain ranged from 0.639 to 0.815. The split-half reliability coefficient of C-MLSHP-R was 0.709, and for each domain ranged from 0.648 to 0.792. The test–retest reliability coefficient of C-MLSHP-R was 0.851, and for each domain ranged from 0.655 to 0.857. The I-CVI of each item ranged from 0.833 to 1.000, the S-CVI/Ave of C-MLSHP-R was 0.981, the S-CVI/UA was 0.889, and for each domain ranged from 0.958 to 1.000. Confirmatory factor analysis results showed that the model fitted well. The convergent validity of C-MLSHP-R was acceptable, and the discriminant validity was good. The criterion coefficient between C-MLSHP-R and C-MLSHP was 0.797, and for each domain ranged from 0.609 to 0.755.

Conclusion

Compared with C-MLSHP, the C-MLSHP-R with 18 items was much shorter for measuring, and had decreased reliability within the acceptable range and better validity, which was more appropriate and time-saving to assess the medication literacy level for hypertensive patients scientifically and conveniently.

Status of medication literacy and its related factors among undergraduate students in Shanxi Province, China: A cross-sectional study

WHAT IS KNOWN AND OBJECTIVE

Medication safety problem has always been the focus of healthcare providers and public health community scholars. As the backbone of the future society, the mastery of college students' knowledge to use medicine will directly affect the level of medication literacy (ML) of the public in the future. The purpose of this study was to investigate the current ML of college students in Shanxi Province and to identify its related factors.

METHODS

A cluster random sampling method was utilized to select 800 college students from 10 universities in Shanxi province as participants from 21 March to 10 April 2020. After quality control, 763 valid questionnaires were collected (effective rate 95.4%). This study applied the ML scale adapted from the 14-item health literacy scale (HLS-14) to estimate ML, which contains functional ML, communicative ML and critical ML dimensions to estimate the ML situation. Then, we used structural equation modelling (SEM) to test the hypothesized relationship among three dimensions of ML, self-evaluated health status and safety medication science popularization activities on campus.

RESULTS AND DISCUSSION

The results showed that the reliability and validity of the ML scale were good. The average score of ML level of college students in Shanxi Province was 44 points, and the interquartile range was 40-48 points (full score is 65 points). The proportion of high ML level was estimated at as low as 26.7%. 73.1% participants had an average level, and only 1 participant (0.1%) had a low level of ML. Univariate analysis showed that the ML level was significantly influenced by gender, universities, field of study, academic performance and ethnic group (p < 0.05). SEM showed that functional ML (λ = 0.01) and communicative ML (λ = 0.75) had a direct positive association with critical ML. Meanwhile, the model also had a mediating effect. Functional ML had an indirect positive association with critical ML through the mediating effect of communicative ML (λ = 0.11). In addition, both self-evaluated health status and safety medication science popularization activities on campus had an indirect positive association with critical ML through the mediating effect of functional ML and communicative ML.

WHAT IS NEW AND CONCLUSION

The study revealed that the ML of most college students in Shanxi Province was at the average level. Among them, medical college student (including pharmacy, nursing, public health, preventive medicine, basic medicine and clinical medicine students), the Han nationality students (the students of China's majority ethnic group), students of good self-evaluated health status, and students who were more exposed to safety medication science popularization activities had a relatively higher ML level. Moreover, it highlighted the importance of self-evaluated health status and safety medication science popularization activities on campus to ML.

Web-based education of the elderly improves drug utilization literacy: A randomized controlled trial

The aim of this study was to explore the effects of web-based education in the field of drug utilization on elderly individuals' knowledge of, concerns about and self-assessed understanding of drug utilization. The 260 included participants were randomized to a control group or an intervention group. To assess drug utilization literacy, we used a questionnaire containing 20 multiple-choice questions on drug utilization and ten statements about drug utilization (to which participants graded their response using a Likert scale: two about common concerns and eight about their self-assessed understanding of drug utilization). The Beliefs about Medicines Questionnaire-General was also used. The intervention group scored higher on the knowledge questions (p < 0.001) and on six of the eight statements about self-assessed understanding of drug utilization at the first check after 2 weeks (p < 0.05). At a second check 6 months later, the difference remained for the knowledge questions, but there was no difference in self-assessed understanding of drug utilization between the groups. There were no differences in the concerns about drug utilization or beliefs about medication at any time. We conclude that a web-based education can improve drug utilization literacy in elderly individuals and might contribute to the safer use of medications.

Medication literacy: A conceptual model

BACKGROUND

Medication literacy reflects the specific literacy skills necessary to act on medication-related information. A comprehensive and clear conceptual model that reflects medication literacy is lacking. Conceptual models describe the components that represent a construct, allowing for its understanding and providing a rationale for its measurement.

OBJECTIVES

To propose a conceptual model to support the development of an instrument to measure medication literacy.

METHODS

This is a three-phase methodological study. A literature review was conducted to identify the components that should be part of the preliminary conceptual model. Subsequently, the importance of its components was judged on a Likert-5 scale. Then, the model was refined, and the dimensions and subdimensions of medication literacy were defined.

RESULTS

Forty-five experts were included, with a mean age of 39.9 (SD = 10.5) years, most of them females (86.7%) and pharmacists (80%). All components of the preliminary conceptual model were considered important to extremely important by most experts. "Dosing information", "medication name", and "processing the information received about their medication and acting upon medication instructions" were the components considered most important. In the refinement phase, we identified that the construct has four dimensions - functional literacy, communicative literacy, critical literacy, and numeracy, which include the subdimensions to access, understand, evaluate, calculate, and communicate medication-related information.

CONCLUSIONS

The conceptual model allowed identifying the components that represent medication literacy, which will support the development of an instrument for measuring the construct in Brazil.

Ideal instruments used to measure health literacy related to medication use: A systematic review

BACKGROUND

Prior studies showed the association between inadequate health literacy (HL) and poor medication-related skills, while none of the published studies have reviewed and compared the existing instruments used to measure medication-related HL. This systematic review comprehensively summarizes the existing instruments that assess medication-related HL.

OBJECTIVES

To identify appropriate HL instruments related to medication use as screening tools for enhancing patients' ability to use medications correctly.

METHODS

This review retrieved medication-related HL instruments that were published between 2000 and 2019 from three databases (i.e., PubMed, Scopus, EMBASE) and by hand-searching. The PRISMA procedure was followed as well as the SURGE guideline to assess the quality of studies. Psychometric properties, HL dimensions, and types of medication information gleaned from the items in three types of HL instruments (i.e., general, disease-specific, medication-specific) were compared to identify appropriate medication-related HL instruments.

RESULT

Forty-eight instruments were identified from 44 studies, whereas 70.8% instruments were either disease- or medication-specific HL instruments. Most instruments with different sample sizes showed certain an extent of reliability and validity. The distributions of HL dimensions and types of medication information among the relevant items were varied across different types of instruments. The five instruments (named as the 16SQ, AKQ-CQ, DHLKI, AKT, and ChMLM) were identified as the most appropriate instruments for three types of medication-related HL, respectively. These appropriate instruments consistently covered items related to HL dimensions of literacy and comprehension and medication-related information regarding dosing, treatment indication, and side effects/precautions.

CONCLUSION

Of 48 identified instruments mainly derived from disease- or medication-specific studies, the five most appropriate medication-related HL instruments were identified to support clinicians in facilitating patients' correct medication use. Further confirmation to explore the usefulness among these instruments are needed.

Instruments assessing medication literacy in adult recipients of care: A systematic review of measurement properties

OBJECTIVES

The assessment of medication literacy in patients is an important step in assisting clinicians to plan for education, prescription simplification, assistance and/or medication aids. There have been several attempts to develop a standardised, objective measure of medication literacy. The objectives of this systematic review were to critically appraise, compare and summarise the measurement properties of existing instruments that assess medication literacy in adult recipients of care.

DESIGN

A systematic review was performed.

SEARCH METHODS

Structured searches were conducted in Embase, MEDLINE PubMed, CINAHL, APA PsycINFO and Web of Science Core Collection in March 2020. Additional searches were performed in ProQuest Dissertations and Theses, DART Europe, and Google Scholar, followed by citation tracking of included studies.

REVIEW METHODS

Two researchers independently identified eligible studies. Two researchers then assessed the methodological quality of the studies and quality of measurement properties, using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) guidelines. A best-evidence synthesis for each instrument was performed.

RESULTS

From the 5035 citations, 17 studies were included that concerned 13 instruments using different administration methods (i.e., performancebased or self-report), medication type (i.e., prescribed or nonprescribed) and context of use (i.e., clinical or community settings). Very low- to moderate-quality evidence supported satisfactory content validity regarding relevance and comprehensibility, while comprehensiveness remained inconsistent. Other measurement properties were less frequently examined and were supported by moderate-quality evidence (i.e., structural validity) to low- or very low-quality evidence (i.e., internal consistency, reliability, construct validity). The bestvalidated instrument is the unidimensional 14-item Medication Literacy in Spanish and English assessment tool (MedLitRxSE), based on direct testing of participant performance regarding four hypothetical scenarios on medication use. Nine instruments have the potential to be recommended but require additional research, while for others, their psychometric soundness is too limited and they require content revisions.

CONCLUSION

This is the first systematic review to identify instruments for medication literacy. None of the identified instruments had all measurement properties properly assessed and none reported measurement invariance, measurement error and responsiveness of the instrument. Further research is necessary for a better theoretical understanding of medication literacy in order to assist health professionals in identifying patient needs for education, regimen simplification, assistance and/or medication aids. Such research will help conceptualise new instruments that not only cover relevant domains dedicated to specific populations (e.g., polymorbid and/or older individuals), but also exhibit satisfactory measurement properties.

Conceptualization, Development and Psychometric Evaluations of a New Medication-Related Health Literacy Instrument: The Chinese Medication Literacy Measurement

There is a need for valid and reliable instruments to focus on medication aspects of health literacy and help healthcare professionals address patients’ barriers to medication use. This cross-sectional study describes the conceptualization, development, and psychometric properties of the first Chinese Medication Literacy Measurement (ChMLM) to assess the level of health literacy on medication use. The 17-item ChMLM (ChMLM-17) and its short form, 13-item ChMLM (ChMLM-13), consist of four sections (vocabulary, over-the-counter labels, prescription labels, and advertisements) to cover six domains of medication-related health literacy. Multistage stratified quota sampling was attempted to recruit a representative sample in Taiwan. Receiver operating characteristic curves were used to identify the cut-off point for differentiating high and low medication literacy. Psychometric analyses were performed (n = 1410) to assess the reliability and validity separately on all samples and sociodemographic subgroups. The 17- and 13-item versions both had high construct validity among all patients and patients with low medication literacy. The developed ChMLM-17 and ChMLM-13 is expected to help healthcare providers and researchers to accurately measure medication-related health literacy and improve medication use in the real-world practice.

Development, validation and performance of a newly designed tool to evaluate functional medication literacy in Slovenia

Background Medication literacy refers to the ability of individuals to safely and appropriately access, understand and act on basic medication information. It is vital for correctly and safely using medications. General health literacy measures do not adequately address specific skills for medication literacy, and there are no general, self-administered, performance-based instruments for assessing patients' medication literacy. Objective The aim was to develop and validate a self-administered performance-based questionnaire measuring functional medication literacy and to evaluate functional medication literacy among the Slovenian general population. Setting A random sample of adult Slovenian residents received the questionnaires at their home addresses. Method The initial content was derived from medication counselling literature. Thirteen patients and 14 healthcare professionals provided feedback about its comprehensibility, comprehensiveness, and difficulty thus supporting content and face validity. The developed questionnaire, comprising 30 items divided into 5 categories (dosage, adverse effects, interactions, precautions, and other information), was sent to a random sample of 1500 adult Slovenian residents. The overall validity of the questionnaire was assessed via reliability, criterion and discriminant validity using the Kuder-Richardson Formula 20, multiple linear regression and Mann-Whitney test. Descriptive statistics were used to evaluate medication literacy. Main outcome measure The psychometric properties of the questionnaire (reliability, content, face, criterion, and discriminant validity); level of functional medication literacy. Results A total of 402 residents returned eligible questionnaires (26.8% response rate). The Kuder-Richardson Formula 20 reliability coefficient for the whole questionnaire was 0.823. One item that did not demonstrate discriminant validity was deleted. Criterion validity was supported by a significant association between age and medication literacy (β = - 0.303). Income (β = 0.243) and current self-perceived health (β = 0.187) also were associated with medication literacy. The median of medication literacy score was 24 out of 29 points. Dosage-related items requiring understanding of long text instructions and the use of numeracy skills received the most incorrect answers. Conclusion A performance-based questionnaire measuring functional medication literacy among a general population with supported validity was developed. Slovenian residents encountered difficulties when dealing with items requiring prose literacy and numeracy skills, especially related to dosing. Special attention should be paid to low-income elderly with poor self-perceived health.

The Development and Psychometric Assessment of Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP)

OBJECTIVE

To develop the medication literacy scale for patients with hypertension, and to test the reliability and validity of the scale.

METHODS

The initial draft of the scale was formulated based on the operationalization of medication literacy with four core elements of knowledge, attitude, skill, and practice, and was developed through procedures of literature review, interviews to hypertensive patients, and research group discussion. Expert panel meeting, interviews, and pre-test on the initial draft of the scale to 10 hypertensive patients, as well as a two iterations of expert feedback were used to form a primary medication literacy scale for pilot investigation and item selection. In this study, 260 patients with hypertension in Changsha city of China were purposively selected to conduct a pilot survey using the primary medication literacy scale. After item selection by a series of statistical analysis method and item re-wording according to patients' feedback, the scale was revised to form a formal investigation scale with four domains and 37 items. A formal investigation was carried out on 650 patients with hypertension selected purposively in a tertiary general hospital and two community health service centers in Changsha city of China. The reliability and validity of the scale were analyzed.

RESULTS

Finally, the formal scale consists of four domains on knowledge, attitude, practice and skills, 11 sub-factors and 37 items in total. The scale-level content validity index (S-CVI/Ave) of this scale was 0.968, and the I-CVI for each item ranged from 0.833 to 1.000, indicating a good and acceptable content and face validity. The Cronbach's α coefficient was 0.849 for the overall scale and ranged from 0.744 to 0.783 for domains. The Pearson's correlation coefficients between domains and the total scale were ranging from 0.530 to 0.799. Besides, the Pearson's correlation coefficient among domains of the scale ranged from 0.157 to 0.439. The Spearman-Brown split-half reliability coefficient was 0.893 for the total scale and ranged from 0.793 to 0.872 for domains. The test-retest reliability coefficient of the total scale was 0.968 and ranged from 0.880 to 0.959 for domains. Four domains of knowledge, attitude, skill, and practice were identified through the exploratory factor analysis and confirmatory factor analysis from each domain. The total explained variation of domains for the overall scale was 51.420%. Eleven sub-factors for domains were extracted through respective exploratory factor analysis from each domain, and the total explained variation of sub-factors for its belonging domain were ranging from 56.111 to 64.419%. The confirmatory factor analysis showed the fit indices of the four-domain model were as follows (χ2/df=2.629, GFI=0.804, AGFI=0.777, RMR=0.012, IFI=0.746, RMSEA=0.066, PNFI=0.599, PCFI=0.689), which indicated an acceptable model fit.

CONCLUSIONS

The medication literacy scale for hypertensive patients has good reliability and acceptable validity, which is suitable and acceptable for evaluating the medication literacy level of hypertension patients in China. In the future, further construct and model fit validation and English translation with appropriate adaptation of this whole scale are required, so that this scale can be further validated and applied worldwide.

The status of medication literacy and associated factors of hypertensive patients in China: a cross-sectional study

The adverse consequence of low medication literacy is a major problem that threatens patients' health. The number of people with hypertension is increasing in China. We described the current situation of medication literacy of patients with hypertension in China and its related influencing factor. We conducted a cross-sectional study, which contains 590 hypertensive patients. Stratified sampling was adopted according to the hospital level in China. To determine the factors related to medication literacy, multiple linear regression analysis was used to determine associations between medication literacy of hypertensive patients and other factors. Among 590 respondents, results showed that they have poor medication literacy. Multiple linear regression analysis showed that level of education, annual income, occupation status, and type of medical insurance were significantly associated with medication literacy level of hypertensive patients. In addition, our study also demonstrates that we can identify the medication literacy level of hypertensive patients using the Chinese version Medication Literacy Scale for Hypertensive Patients. High medication literacy is an important factor for hypertensive patients to improve medication adherence, so as to better control blood pressure. We should pay attention to the improvement of medication literacy and take corresponding measures.

Relationship Between Medication Literacy and Medication Adherence in Inpatients With Coronary Heart Disease in Changsha, China

Background: Medication literacy may be associated with medication safety, and medication adherence is critical in treating coronary heart disease. Few studies have explored the association between medication literacy and medication adherence in patients with coronary heart disease. The aim was to investigate the status of medication literacy and medication adherence among Chinese inpatients with coronary heart disease, and explore the association between medication literacy and medication adherence.

Methods: The study was a cross-sectional survey. Four hundred seventy inpatients with coronary heart disease were recruited from hospitals in Changsha, Hunan, China. Participants’ demographic and clinical data were retrieved from hospital charts. Medication adherence was assessed using the four-item Morisky Medication Adherence Scale. Medication literacy was assessed using the Chinese Version of the Medication Literacy Scale. For univariate analysis, potential factors influencing medication adherence were tested by T-tests, analysis of variance, and the Kruskal–Wallis H test. Binary logistic regression model was conducted with medication adherence as the outcome variable in order to analyze the association between medication literacy and medication adherence in inpatients with coronary heart disease.

Results: Among 512 participants, 470 (91.8%) produced valid responses for the survey. Mean (SD) of medication adherence score was 2.26 (13.6); only 13.6% had optimal medication adherence. Mean (SD) of medication literacy score was 7.52 (4.09); participants with adequate medication literacy was 30.2% (142). Binary logistic regression analysis indicated that medication literacy was an independent predictor associated with medication adherence. Participants with adequate medication literacy were more likely to have optimal medication adherence (OR 1.461 [95% CI: 0.114, 0.643]; P = 0.005), and participants with a high level of education (OR 0.613 [95% CI: 0.284, 0.694]; P< 0.001), a fewer number of medicines (OR 1.514 [95% CI: -0.631, -0.198]; P < 0.001), having medical insurance (OR 0.770 [95% CI: -1.769, 0.059]; P = 0.043), and single inpatients were more likely to be adherent (OR 1.655 [95% CI:-0.858, -0.149]; P = 0.005).

Conclusions: The study indicates a significant association between medication literacy and medication adherence in patients with coronary heart disease. These results suggest that medication literacy is an important consideration in the development, implementation, and evaluation of medication adherence interventions.

Development and validation of a Chinese medication literacy measure

Background

Despite the impact of medication literacy (ML) on patients’ safe use of medications, existing instruments are mostly for general health literacy measurement or designed for specific disease populations, with few specifically designed for ML.

Objective

To develop and validate the first Chinese medication literacy measure (ChMLM).

Methods

The ChMLM was developed by a multidisciplinary and bilingual expert panel and subsequently pilot‐tested. The final version had 17 questions in four sections: vocabulary, non‐prescription drug, prescription drug and drug advertisement. Face‐to‐face interviews were administered in a convenience sample of adults with diverse sociodemographic characteristics. Internal consistency was assessed by Cronbach's alpha. Content validity was confirmed by the expert panel, and hypothesis testing was performed to assess construct validity.

Results

A total of 634 adults were interviewed. The mean (SD) total ChMLM score was 13.0 (2.8). The internal validity was acceptable (Cronbach's alpha=0.72). Nine of the ten a priori hypotheses were fulfilled. Younger age, higher income and higher education levels were significantly associated with a higher ChMLM score. Furthermore, higher scores on the ChMLM were associated with higher confidence or less difficulty in writing, reading, speaking and listening abilities in a health‐care encounter. No association was found between ChMLM total scores and frequency of doctor's visits.

Conclusion

The ChMLM is a valid and reliable ML measure. It may help pharmacists and other health‐care providers to target patients and problem areas that need interventions with the ultimate goal of preventing medication errors and harm.