Health literacy and medication adherence in psoriasis patients: a survey in Iran

Springer Science and Business Media LLC - 2022
Yasaman Avazeh1, Soheila Rezaei2, Peivand Bastani3, Gholamhossein Mehralian4
1Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
2Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3Research Fellow, Faculty of Health and Behavioral Sciences, School of Dentistry, University of Queensland, Brisbane, QLD, 4072, Australia
4Nottingham Business School, Nottingham Trent University, Nottingham, UK

Tóm tắt

Abstract Background Medication adherence among Psoriasis patients is often inadequate identified as a significant problem in Psoriasis symptoms management. Poor medication adherence could necessitate stronger and more expensive medications, which could place a significant burden on the healthcare system. Moreover, the importance of health literacy assessment as a factor influencing adherence in psoriasis patients cannot be overstated. This study aimed to evaluate the medication adherence level of Iranian Psoriasis patients and its relationship with the patients’ health literacy level and demographic conditions. Methods This is a cross-sectional study among Iranian psoriasis patients conducted through a web-based questionnaire survey between 26 July 2020 and 5 January 2021 and a total of 575 samples were collected. The questionnaire consisted of 3 sections: First, demographic information and disease characteristics were evaluated. Second, the medication adherence was evaluated by using valid Morisky Medication Adherence Scale-8 (MMAS-8), and, finally, the health literacy was evaluated by using Health Literacy for Iranian Adults (HELIA). Data were analyzed using SPSS software, version 22 with descriptive statistics; Chi-square and Kruskal–Wallis tests. Stepwise multiple linear regression was also used to evaluate the impact of independent variables related on medication adherence score. Results Results showed that the mean health literacy score in the study population was 74.3 ± 14.23, and the mean medication adherence score was 4.1 ± 2.18. Out of the total participants, 28.8% had high health literacy, 67.1% had adequate health literacy, and 4% had inadequate health literacy. The majority of the participants (70.7%) reported low adherence, while 24.1% reported moderate and 5.2% reported high adherence. The results of the Chi-square test showed a significant relationship between age, comorbidities, type of treatment, satisfaction with treatment, the experience of adverse effects, and health literacy with medication adherence (P < 0.05 for all). The final constructed model of stepwise multiple linear regression was highly statistically significant. The highest beta coefficient in the final model belonged to the total health literacy score. Conclusions. Based on the results, medication adherence among Iranian psoriasis patients is low. Health literacy correlates most strongly with medication adherence and is the best variable to determine it. Improving the access to the internet and the ICTs to enhance the patients` health literacy along with developing the patient education approaches and techniques should be considered by health policymakers.

Từ khóa


Tài liệu tham khảo

Belinchón I, Rivera R, Blanch C, Comellas M, Lizán L. Adherence, satisfaction and preferences for treatment in patients with psoriasis in the European Union: a systematic review of the literature. Patient Prefer Adherence. 2016;10:2357–67.

Takeshita J, Grewal S, Langan SM, Mehta NN, Ogdie A, Van Voorhees AS, et al. Psoriasis and comorbid diseases: epidemiology. J Am Acad Dermatol. 2017;76(3):377–90.

Augustin M, Alvaro-Gracia JM, Bagot M, Hillmann O, van de Kerkhof PC, Kobelt G, et al. A framework for improving the quality of care for people with psoriasis. J Eur Acad Dermatol Venereol. 2012;26(Suppl 4):1–16.

Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol. 2017;31(2):205–12.

World Health O. Global report on psoriasis. Geneva: World Health Organization; 2016.

Strober BE, van der Walt JM, Armstrong AW, Bourcier M, Carvalho AVE, Chouela E, et al. Clinical goals and barriers to effective psoriasis care. Dermatol Ther. 2019;9(1):5–18.

Kwan Z, Bong YB, Tan LL, Lim SX, Yong ASW, Ch’ng CC, et al. Determinants of quality of life and psychological status in adults with psoriasis. Arch Dermatol Res. 2018;310(5):443–51.

Armstrong AW, Schupp C, Wu J, Bebo B. Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003–2011. PLoS ONE. 2012;7(12):e52935.

Zschocke I, Mrowietz U, Karakasili E, Reich K. Non-adherence and measures to improve adherence in the topical treatment of psoriasis. J Eur Acad Dermatol Venereol. 2014;28(Suppl 2):4–9.

Boehncke WH, Schön MP. Psoriasis. Lancet. 2015;386(9997):983–94.

NajafiGhezeljeh TSK, Hoseini A-F. The effect of self-management education on the quality of life and severity of the disease in patients with severe psoriasis: a non-randomized clinical trial. NPT. 2018;5(1):243–55.

Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377–85.

Brezinski EA, Dhillon JS, Armstrong AW. Economic burden of psoriasis in the United States: a systematic review. JAMA Dermatol. 2015;151(6):651–8.

Haidari W, Quan EY, Cline A, Feldman SR. Adherence in Psoriasis. In: Feldman SR, Cline A, Pona A, Kolli SS, editors. Treatment adherence in dermatology. Cham: Springer International Publishing; 2020. p. 59–74.

Feldman SR, Vrijens B, Gieler U, Piaserico S, Puig L, van de Kerkhof P. Treatment adherence intervention studies in dermatology and guidance on how to support adherence. Am J Clin Dermatol. 2017;18(2):253–71.

Thorneloe RJ, Bundy C, Griffiths CE, Ashcroft DM, Cordingley L. Adherence to medication in patients with psoriasis: a systematic literature review. Br J Dermatol. 2013;168(1):20–31.

Ahn CS, Culp L, Huang WW, Davis SA, Feldman SR. Adherence in dermatology. J Dermatolog Treat. 2017;28(2):94–103.

World Health O. Adherence to long-term therapies : evidence for action / [edited by Eduardo Sabaté]. Geneva: World Health Organization; 2003.

Lam WY, Fresco P. Medication Adherence measures: an overview. Biomed Res Int. 2015;2015:217047.

Larsen MH, Strumse YAS, Borge CR, Osborne R, Andersen MH, Wahl AK. Health literacy: a new piece of the puzzle in psoriasis care? A cross-sectional study. Br J Dermatol. 2019;180(6):1506–16.

Pona A, Cline A, Feldman SR. Reasons for Nonadherence. In: Feldman SR, Cline A, Pona A, Kolli SS, editors. Treatment adherence in dermatology. Cham: Springer International Publishing; 2020. p. 1–11.

Zarei E, Gholamhosseini A, Ghandi N. Estimation of direct and indirect costs of one year treatment for psoriasis outpatients in Iran: a study in Razi Hospital in 2017–2018. Dermatol Cosmet. 2021;12(3):164–79.

Laghousi D, Rezaie F, Alizadeh M, Asghari JM. The eight-item Morisky medication adherence scale: validation of its Persian version in diabetic adults. Caspian J Intern Med. 2021;12(1):77–83.

Behnood-Rod A, Rabbanifar O, Pourzargar P, Rai A, Saadat Z, Saadat H, et al. Adherence to antihypertensive medications in iranian patients. Int J Hypertens. 2016;2016:1508752.

Moharamzad Y, Saadat H, NakhjavanShahraki B, Rai A, Saadat Z, Aerab-Sheibani H, et al. Validation of the Persian version of the 8-Item Morisky Medication Adherence Scale (MMAS-8) in Iranian hypertensive patients. Glob J Health Sci. 2015;7(4):173–83.

Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens. 2008;10(5):348–54.

Montazeri AL, Tavousi M, Rakhshani FA, Azin SA, Jahangiri K, Ebadi M, et al. Health Literacy for Iranian Adults (HELIA): development and psychometric properties. Health Mon J Iran Inst Health Sci Res. 2014;13(5):589–99.

Wang Q, Luo Y, Lv C, Zheng X, Zhu W, Chen X, et al. Nonadherence to treatment and patient-reported outcomes of psoriasis during the COVID-19 epidemic: a web-based survey. Patient Prefer Adherence. 2020;14:1403–9.

Wang W, Qiu Y, Zhao F, Zhang F. Poor medication adherence in patients with psoriasis and a successful intervention. J Dermatolog Treat. 2019;30(6):525–8.

Alsubeeh NA, Alsharafi AA, Ahamed SS, Alajlan A. Treatment adherence among patients with five dermatological diseases and four treatment types - a cross-sectional study. Patient Prefer Adherence. 2019;13:2029–38.

Saeki H, Imafuku S, Abe M, Shintani Y, Onozuka D, Hagihara A, et al. Poor adherence to medication as assessed by the Morisky Medication Adherence Scale-8 and low satisfaction with treatment in 237 psoriasis patients. J Dermatol. 2015;42(4):367–72.

Svendsen MT, Andersen F, Hansen J, Johannessen H, Andersen KE. Medical adherence to topical corticosteroid preparations prescribed for psoriasis: a systematic review. J Dermatolog Treat. 2017;28(1):32–9.

Ostini R, Kairuz T. Investigating the association between health literacy and non-adherence. Int J Clin Pharm. 2014;36(1):36–44.

Rasmussen GS, Maindal HT, Lomborg K. Self-management in daily life with psoriasis: an integrative review of patient needs for structured education. Nutr Res Pract. 2012;2012:890860.

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Thông tin tác giả