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HSS J. 2013 Feb;9(1):42-9. doi: 10.1007/s11420-012-9308-6. Epub 2012 Dec 11.

The relationship among health literacy, health knowledge, and adherence to treatment in patients with rheumatoid arthritis.

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  • 1Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
  • 2Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA ; Weill Cornell University Medical College, New York, NY USA.
  • 3Center for Health Policy, Columbia University School of Nursing, New York, NY USA.



Patients with poor health literacy often lack the knowledge needed to manage their treatment.


The aim of this cross-sectional study is to determine whether health literacy is a predictor of health knowledge and/or adherence to medication treatment in patients with rheumatoid arthritis.


The study was completed in an urban, outpatient rheumatology setting. Health literacy was measured using the Test of Functional Health Literacy in Adults. The Arthritis Knowledge Questionnaire was modified to measure medication specific health knowledge, and the Morisky Medication Adherence scale was used to measure adherence. Researchers used regression analyses to determine if health literacy was a predicator of knowledge and/or adherence.


Participants (Nā€‰=ā€‰125) had high mean health literacy scores. The average medication knowledge score was 0.73. Adherence to medication regimen was 0.84. Controlling for patient covariates, health literacy was positively associated with education, race, and age. In adjusted analyses, health literacy was a significant predictor of health knowledge but not adherence. Race, neighborhood income, and confidence with contacting provider about medications were predictors of adherence.


Study findings indicate that health literacy is independently associated with medication knowledge but not medication adherence in patients with rheumatoid arthritis. These results provide useful information for planning initiatives to support individuals with disease self-management.


adherence to treatment; health knowledge; health literacy

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