Demian Maryam N, Shapiro R Jean, Thornton Wendy Loken
Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Clin Kidney J. 2016 Dec;9(6):858-865. doi: 10.1093/ckj/sfw076. Epub 2016 Aug 31.
There is a high prevalence of non-adherence to immunosuppressants in kidney transplant recipients. Although limited health literacy is common in kidney recipients and is linked to adverse outcomes in other medical populations, its effect on medication adherence in kidney transplant recipients remains poorly understood. The objective was to investigate the effect of lower health literacy on immunosuppressant adherence.
Kidney recipients who were at least 6 months post-transplant and outpatients of Vancouver General Hospital in B.C., Canada were recruited through invitation letters. A total of 96 recipients completed the Health Literacy Questionnaire, which provides a multifactorial profile of self-reported health literacy and the Transplant Effects Questionnaire-Adherence subscale measuring self-reported immunosuppressant adherence. Hierarchical linear regression was used to analyze the association between health literacy and adherence after controlling for identified risk factors of non-adherence.
Our sample was on average 53 years old, 56% male and 9 years post-transplant. Kidney recipients reported low levels of health literacy on scales measuring active health management and critical appraisal of information and 75% reported non-perfect adherence. Worse adherence was associated with poorer overall health literacy (Δ = 0.08, P = 0.004) and lower scores on six of nine of the health literacy factors.
Poorer health literacy is associated with lower immunosuppressant adherence in adult kidney transplant recipients suggesting the importance of considering a recipient's level of health literacy in research and clinical contexts. Medication adherence interventions can target the six factors of health literacy identified as being risk factors for lower medication adherence.
肾移植受者中免疫抑制剂治疗依从性差的情况很普遍。虽然肾移植受者普遍存在健康素养有限的问题，且这与其他医疗人群的不良结局相关，但其对肾移植受者药物治疗依从性的影响仍知之甚少。本研究的目的是调查健康素养较低对免疫抑制剂依从性的影响。
通过邀请函招募了加拿大不列颠哥伦比亚省温哥华总医院的肾移植受者，这些受者移植后至少已过去6个月。共有96名受者完成了健康素养问卷，该问卷提供了自我报告的健康素养的多因素概况，以及测量自我报告的免疫抑制剂依从性的移植影响问卷-依从性子量表。在控制已确定的不依从风险因素后，采用分层线性回归分析健康素养与依从性之间的关联。
我们的样本平均年龄为53岁，男性占56%，移植后9年。肾移植受者在积极健康管理和信息批判性评估量表上报告的健康素养水平较低，75%的受者报告依从性不理想。依从性较差与总体健康素养较差（Δ = 0.08，P = 0.004）以及九个健康素养因素中的六个得分较低相关。
健康素养较差与成年肾移植受者较低的免疫抑制剂依从性相关，这表明在研究和临床环境中考虑受者的健康素养水平很重要。药物治疗依从性干预措施可以针对被确定为药物治疗依从性较低风险因素的六个健康素养因素。
