Table 58Effect of mixed interventions on adherence

Author, Date of Publication, QualityStudy DesignControl GroupInterventionSample Size% population with Limited LiteracyOutcomeDifference
Bosworth et al., 2005201
RCTUsual careTailored Adherence Intervention58838% low literacyaChange in % reporting agreement to any question in Morisky adherence scaleOverall change (unadjusted): 0.007% (95% CI, -0.62%-0.076%)
Change among those initially adherent (unadjusted): -2%, (P = 0.68)
Change among those initially non-adherent (unadjusted): +12%, (P = 0.08)
Kim et al., 2004197
Quasi-(pre-post)NoneDiabetes Self-Management Intervention9223% S-TOFHLA < 22 (Inadequate or marginal)
(15% inadequate on TOFHLA)
# days of Medication adherence in last weekOverall: +0.7b, NR
Adeq. vs. Inadequate HL (adjusted): NR, (P = 0.751)
Murray et al., 2007182
RCTUsual CareCHF Adherence Intervention31429% “not literate” on S-TOFHLA (NOS)% of prescribed medication taken (according to MEMS cap)% of prescribed medication taken:
During intervention (unadjusted): +10.9% (95% CI, 5%-16.7%)
Post Intervention (unadjusted): +3.9% (-2.8%-10.7%)
Paasche-Orlow et al., 200579
Quasi-(pre-post)NAAsthma Self-Management Intervention7322% S-TOFHLA Inadequate% with adherence less than 50% for inhalers or meds (according to Doser CT or MEMS cap)Poor adherence, by literacy subgroups (adjusted):
NR, p for interaction: (P = 0.45)
Rudd et al., 2009209
RCTArthritis Management Intervention (arthritis pamphlet, medicine calendar, hospital map)Arthritis Management Intervention + Individual Counseling12719% REALM < high schoolMean score on Levine medication adherence assessment (range 0-3, 3 best)Mean percent change in medication adherence (unadjusted):
6 mo: -5.01%, p 0.33
12 mo: -9.09%, p 0.10

Determined through personal communication with author;


Calculated by team

Adeq.=adequate; CHF=congestive heart failure; CI=confidence interval; HL=health literacy; meds=medications; MEMS cap=Medication Event Monitoring System cap; NA=not applicable; NOS=not otherwise specified; NR=not reported; Quasi-=quasi-experimental study; RCT=randomized controlled trial; S-TOFHLA=short form Test of Functional Health Literacy in Adults; TOFHLA=Test of Functional Health Literacy in Adults; vs.=versus.

From: The Effect of Interventions To Mitigate the Effects of Low Health Literacy

Cover of Health Literacy Interventions and Outcomes: An Updated Systematic Review
Health Literacy Interventions and Outcomes: An Updated Systematic Review.
Evidence Reports/Technology Assessments, No. 199.
Berkman ND, Sheridan SL, Donahue KE, et al.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.