Loke Yoon K, Hinz Ina, Wang Xia, Salter Charlotte
Norwich Medical School, University of East Anglia, Norwich, UK.
Ann Pharmacother. 2012 Jun;46(6):863-72. doi: 10.1345/aph.1Q718. Epub 2012 Jun 5.
To review the relationship between health literacy and adherence to cardiovascular/diabetes medication.
We searched EMBASE (1974-February 2012) and MEDLINE (1948-February 2012). Search terms included health literacy, numeracy, health education and related terms, health literacy measurement tools, and medication adherence.
English-language articles of all study designs were considered. Articles were included if they had a measurement of health literacy and medication adherence and if participants were older adults taking drugs for cardiovascular illness or diabetes mellitus.
A total of 1310 citations were reviewed, including 9 articles that reported on 7 research studies. Most studies were retrospective, and all were based in the US. Because there was considerable diversity in measurements, participant characteristics, and outcome measures, we conducted a narrative synthesis rather than a meta-analysis. In assessing study validity, we looked at participant selection, method of measuring health literacy and medication adherence, missing data or losses, and adjustment for confounders. Of the 7 included studies, only 1 found a demonstrable association between health literacy and refill adherence. One clinical trial failed to show significant improvements in medication adherence after an intervention to improve health literacy.
The current evidence does not show a definite association between health literacy and medication adherence in older adults with cardiovascular disease or diabetes mellitus. In the absence of a definite link, efforts to develop interventions to improve health literacy would not necessarily improve adherence to cardiovascular medications. There is an urgent need for robust studies outside of the US, with wider, generalized recruitment of participants.
回顾健康素养与心血管疾病/糖尿病药物治疗依从性之间的关系。
我们检索了EMBASE（1974年至2012年2月）和MEDLINE（1948年至2012年2月）。检索词包括健康素养、算术能力、健康教育及相关术语、健康素养测量工具以及药物治疗依从性。
纳入所有研究设计的英文文章。如果文章测量了健康素养和药物治疗依从性，且参与者为服用心血管疾病或糖尿病药物的老年人，则予以纳入。
共检索了1310条引文，其中9篇文章报告了7项研究。大多数研究为回顾性研究，且均在美国开展。由于测量方法、参与者特征和结局指标存在较大差异，我们进行了叙述性综合分析而非荟萃分析。在评估研究的有效性时，我们考察了参与者的选择、健康素养和药物治疗依从性的测量方法、数据缺失或失访情况以及混杂因素的调整。在纳入的7项研究中，只有1项发现健康素养与续方依从性之间存在明显关联。一项临床试验未能显示在进行提高健康素养的干预后药物治疗依从性有显著改善。
目前的证据并未表明健康素养与患有心血管疾病或糖尿病的老年人的药物治疗依从性之间存在明确关联。在缺乏明确联系的情况下，开展旨在提高健康素养的干预措施不一定能改善心血管药物的依从性。迫切需要在美国以外地区开展强有力的研究，并更广泛、普遍地招募参与者。
