Association between health literacy and medication adherence in chronic diseases: A recent systematic review
Abstract
Background Poor medication adherence is a serious barrier to successful chronic disease management. Previous reviews reported that low health literacy could be associated with medication non-adherence but conclusions were uncertain.Aim The aim of this systematic review was to clarify the relationship between health literacy and medication adherence in adults with chronic diseases. A secondary objective was to identify the factors that influence medication adherence.Method Publications analyzing the relationship between health literacy and adherence in adults with chronic diseases were identified through 6 databases between 2015 and 2020. A quality assessment was conducted in order to improve the interpretation of the relationship between health literacy and medication adherence. A narrative synthesis was then performed to describe the relationship between health literacy and medication adherence. The factors influencing medication adherence were then analyzed as a secondary outcome.Results Among the 27 studies, 17 and 10 were considered to be of good and medium methodological quality, respectively. Concerning the relationship between health literacy and adherence, 14 reported a positive relationship, 1 study suggested a negative relationship, 3 found mixed results, and 9 reported not finding a relationship. Patient-related factors such as medication beliefs, self-efficacy, or medication knowledge, as well as demographic factors such as ethnic minority and incomes influence medication adherence.Conclusion The present review confirms an unclear relationship between health literacy and medication adherence. Although health literacy plays a substantial role in medication adherence, other factors must be taken into account when addressing non-adherence.
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Therapeutic adherence is consensually accepted as fundamental for the optimal management of any disease and is interrelated to high levels of health literacy.
“In this context, therapeutic adherence is now consensually accepted as fundamental for the optimal management of any disease and interrelated to high levels of health literacy [13].”
From Therapeutic Adherence of People with Mental Disorders: An Evolutionary Concept Analysis (2023) · cites this paper as [13]
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Beyond health literacy: Addressing epistemic injustice in patient–provider communication
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“To better understand how health literacy affects medication adherence in individuals dealing with chronic conditions, this systematic review set out to do just that [9].”
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Determining global trends in health literacy research using topic modeling
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Rectal treatment in ulcerative colitis; a qualitative study exploring reasons for under utilisation
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Cheng, W. L. S., & Ho, L.-Y. (2026) · Geriatric Nursing · doi:10.1016/j.gerinurse.2026.103831 · Cited by 1 · see citing works
Okuhara, T., Okada, H., & Yokota, R. (2026) · JMIR Research Protocols · doi:10.2196/83451 · Cited by 1 · see citing works
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Rahman, A. A., Ismail, N. H. M. A. R., & Hassan, F. Z. (2024) · Annals of Pharmacy Practice and Pharmacotherapy · doi:10.51847/9n2mpc5emx · Cited by 1 · see citing works
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Mim, M. S., Akib, M. M. H., Pal, B., & Rahaman, L. (2026) · International Journal of Hypertension · doi:10.1155/ijhy/9886514 · Cited by 1 · see citing works
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“In the field of chronic diseases, inadequate health knowledge is considered a significant predictor of treatment failure and hospital read-mission (26).”
Hall, H., Papp, V., & Fitzgerald, M. (2024) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2024.106914 · Cited by 1 · see citing works
“…behaviors and less health promotive behaviors) which are known to influence inflammation and inflammatory diseases (Braveman & Gottlieb, 2014; Hyvert et al., 2023; Lodi-Smith et al., 2010; Miller et al., 2011; Raposa, Bower, Hammen, Najman, & Brennan, 2014; Stormacq, van den Broucke, &…”
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“In recent years, poor adherence with increased hospitalizations of health impact disease progression like diabetes, HIV, AIDS, and hypertension leads to economic burden in medical interventions [1].”
Wrist joint tuberculosis masquerading as traumatic arthritis sequalae
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“For individuals with active TB, lack of attention and adherence to treatment increases the risk of treatment failure by 1.5 times compared to those with good adherence, leading to relapse and even death [34].”
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“44,45 The required acquisition of knowledge to follow homeopathic prescriptions in this context could explain the observed medication adherence.”
BackgroundJunge, T., Pihl, G. T., Bak, C. K., & Skou, S. T. (2024) · Journal of Multimorbidity and Comorbidity · doi:10.1177/26335565241258353
“12 Recent reviews reveal a notable gap in understanding the relationship between health literacy and the social context.”
BackgroundZang, W., Zhang, X., Gu, W., Pan, L., Yu, Z., Wu, Y., Li, T., & Wu, Y. (2024) · Research Square · doi:10.21203/rs.3.rs-4785067/v1
Public Unawareness of Renal Function: A Questionnaire Survey at a Health Promotion Seminar
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Low health literacy impact on headache diagnosis
Pergolizzi, J. V., & LeQuang, J. A. (2025) · Pain Management · doi:10.1080/17581869.2025.2463874
Health Literacy Level During the COVID-19 Pandemic in the Western Region of Iran
Salehi, A. M., Assareh, Z., Jenabi, E., Jiriaei, N., Asadi, R., & Khanlarzadeh, E. (2025) · Coronaviruses · doi:10.2174/0126667975383221250717084800
LETRAMENTO EM SAÚDE COMO FERRAMENTA ESTRATÉGICA DA ENFERMAGEM PARA A RESPOSTA À TUBERCULOSE
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Digital Technology Supporting Medication Adherence
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“Other factors such as patient knowledge and health literacy have been studied for their role in adherence, although the evidence is mixed with regard to their impact on medication-taking behaviors [8, 9].”
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Health literacy research in primary healthcare services – A scoping review
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“Study by Hyvert et al. (40) has demonstrated that the level of medication knowledge serves as a critical mediating variable in fl uencing medication adherence.”
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“Traditional information transmission approaches often fail to ensure long-term self-care, as most patients maintain poor adherence under standard care regimens (Aminuddin et al., 2021; Hyvert et al., 2023; Parmar et al., 2025).”
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“Hyvert et al. (13) in a recent systematic review examined 27 studies, 9 reported no relationship, one study confirmed a negative relationship, 14 revealed a positive relationship, and 3 showed mixed results.”
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“However, no health-literacy or adherence-enhancing intervention was evaluated in the present study; therefore, our findings do not demonstrate that these strategies improve treatment adherence or clinical outcomes [23,24,31,32].”
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- Authors
- Hyvert, S., Yailian, A.-L., Haesebaert, J., Vignot, E., Chapurlat, R., Dussart, C., De Freminville, H., & Janoly-Dumenil, A.
- Affiliations
- Hospices Civils de Lyon (FR)
- Lyon 1 Université (FR)
- Corresponding author
- Hyvert, Sophie
- Venue
- International Journal of Clinical Pharmacy
- Published
- 2022-11-11
- Volume
- 45
- Issue
- 1
- Pages
- 38-51
- ISSN
- 2210-7703 (ISSN-L)
- 2210-7711
- OpenAlex
- W4308834501
- Semantic Scholar
- 902d2f7a0bce7eb2e64076aaa4b8cd73ce4c3f9e
- Cited by
- 102
- References
- 58
- Citations by year
- 2026: 42 · 2025: 27 · 2024: 20 · 2023: 13
- FWCI
- 3.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- International Journal of Clinical Pharmacy (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
- Keywords
- health literacy, medication adherence, chronic disease, medication non-adherence, medication beliefs, self-efficacy, medication knowledge, ethnic minorities, income, factors influencing adherence
- MeSH terms
- Adult, Chronic Disease, Ethnicity, Humans, Minority Groups, Medication Adherence, Health Literacy
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