The Effect of Health Literacy and Adherence to Medical Treatment on Hypertension Control in the Elderly
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Abstract
Background: Health literacy is an important factor in facilitating disease management among individuals with hypertension. This study aimed to determine the effect of health literacy on adherence to antihypertensive treatment in elderly patients with controlled and uncontrolled hypertension.
Methods: This descriptive and comparative study included 203 elderly patients diagnosed with hypertension for at least 6 months who were on antihypertensive treatment. Data were collected using a patient information form, the Health Literacy Scale (HLS), and the Medication Adherence Self-Efficacy Scale Short Form (MASES-SF).
Results: The mean age of the participants was 69.70±12.49 years. Age, duration of disease, and duration of medication use were higher in patients with uncontrolled hypertension. Moreover, patients with controlled hypertension were more likely to have regular health check-ups, watch health-related programs in the media, and research the accuracy of disease-related information (P<0.05). In addition, patients with controlled hypertension were more likely to use medication once daily, have another chronic disease, and have a family history of hypertension (P<0.05). The mean MASES-SF and HLS scores of patients with controlled hypertension were statistically higher than those of patients with uncontrolled hypertension (P<0.01).
Conclusions: Controlled hypertension showed a positive correlation with health literacy and treatment adherence. Furthermore, the health literacy level was identified as a determinant of medication adherence in elderly patients.
1. Li Y, Cao Y, Ding M, Li G, Han X, Zhou S, et al. Non-pharmacological interventions for older patients with hypertension: a systematic review and network meta-analysis. Geriatr Nurs. 2022;47:71-80.
2. World Health Organization. Hypertension [Internet]. 2021 [cited 2025 Apr 25]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension
3. Benetos A, Bulpitt CJ, Petrovic M, Ungar A, Agabiti Rosei E, Cherubini A, et al. An expert opinion from the European Society of Hypertension-European Union Geriatric Medicine Society Working Group on the management of hypertension in very old, frail subjects. Hypertension. 2016;67(4):820-5.
4. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-20.
5. Yang ZQ, Zhao Q, Jiang P, Zheng SB, Xu B. Prevalence and control of hypertension among a community of elderly population in changning district of shanghai: a cross-sectional study. BMC Geriatr. 2017;17(1):296.
6. Shukuri A, Tewelde T, Shaweno T. Prevalence of old age hypertension and associated factors among older adults in rural Ethiopia. Integr Blood Press Control. 2019;12:23-31.
7. Sousa ALL, Batista SR, Sousa AC, Pacheco JAS, Vitorino PVO, Pagotto V. Hypertension prevalence, treatment and control in older adults in a Brazilian capital city. Arq Bras Cardiol. 2019;112(3):271-8.
8. Alhawassi TM, Krass I, Pont LG. Prevalence, management and control of hypertension in older adults on admission to hospital. Saudi Pharm J. 2017;25(8):1201-7.
9. Sengul S, Akpolat T, Erdem Y, Derici U, Arici M, Sindel S, et al. Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012. J Hypertens. 2016;34(6):1208-17.
10. Lee E, Park E. Self-care behavior and related factors in older patients with uncontrolled hypertension. Contemp Nurse. 2017;53(6):607-21.
11. Aydoğdu S, Güler K, Bayram F, Altun B, Derici Ü, Abacı A, et al. Turkish Hypertension Consensus Report 2019. Turk Kardiyol Dern Ars. 2019;47(6):535-46.
12. Lee YM, Yu HY, You MA, Son YJ. Impact of health literacy on medication adherence in older people with chronic diseases. Collegian. 2017;24(1):11-8.
13. Geboers B, de Winter AF, Spoorenberg SLV, Wynia K, Reijneveld SA. The association between health literacy and self-management abilities in adults aged 75 and older, and its moderators. Qual Life Res. 2016;25(11):2869-77.
14. Banning M. Older people and adherence with medication: a review of the literature. Int J Nurs Stud. 2008;45(10):1550-61.
15. Levinthal BR, Morrow DG, Tu W, Wu J, Murray MD. Cognition and health literacy in patients with hypertension. J Gen Intern Med. 2008;23(8):1172-6.
16. Zhang NJ, Terry A, McHorney CA. Impact of health literacy on medication adherence: a systematic review and meta-analysis. Ann Pharmacother. 2014;48(6):741-51.
17. Halladay JR, Donahue KE, Cené CW, Li Q, Cummings DM, Hinderliter AL, et al. The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial. Patient Educ Couns. 2017;100(3):542-9.
18. Wallace LG, Bradway CK, Cacchione PZ. The relationship between sensory loss and health literacy in older adults: a systematic review. Geriatr Nurs. 2022;47:1-12.
19. Wang C, Lang J, Xuan L, Li X, Zhang L. The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study. Int J Equity Health. 2017;16(1):58.
20. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107.
21. Tarı Selçuk K, Mercan Y, Aydın T. Uncontrolled blood pressure in patients with hypertension and associated factors: the role of low health literacy. Erciyes Med J. 2018;40(4):222-7.
22. Powers BJ, Olsen MK, Oddone EZ, Thorpe CT, Bosworth HB. Literacy and blood pressure-do healthcare systems influence this relationship? A cross-sectional study. BMC Health Serv Res. 2008;8:219.
23. Federman AD, Wolf MS, Sofianou A, Martynenko M, O'Connor R, Halm EA, et al. Self-management behaviors in older adults with asthma: associations with health literacy. J Am Geriatr Soc. 2014;62(5):872-9.
24. Krousel-Wood MA, Muntner P, Islam T, Morisky DE, Webber LS. Barriers to and determinants of medication adherence in hypertension management: perspective of the cohort study of medication adherence among older adults. Med Clin North Am. 2009;93(3):753-69.
25. Vatansever Ö, Ünsar S. Determination of medical treatment adherence, self-efficacy levels of patients with essential hypertension and affecting factors. Turk J Card Nurs. 2014;5(8):66-74.
26. Sørensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013;13:948.
27. Tümer A, Baybuğa MS, Dereli F, Uysal DD. The compliance level of treatment of hypertensive patients. J Cardiovasc Nurs. 2016;7(13):105-13.
28. Aras Z, Temel AB. Evaluation of validity and reliability of the Turkish Version of Health Literacy Scale. Florence Nightingale J Nurs. 2017;25(2):85-94.
29. Ogedegbe G, Mancuso CA, Allegrante JP, Charlson ME. Development and evaluation of a medication adherence self-efficacy scale in hypertensive African-American patients. J Clin Epidemiol. 2003;56(6):520-9.
30. Fernandez S, Chaplin W, Schoenthaler AM, Ogedegbe G. Revision and validation of the medication adherence self-efficacy scale (MASES) in hypertensive African Americans. J Behav Med. 2008;31(6):453-62.
31. Hacihasanoglu R, Gözüm S, Çapık C. Validity of the Turkish version of the medication adherence self-efficacy scale-short form in hypertensive patients. Anatol J Cardiol. 2012;12(3):241-8.
32. Kang CD, Tsang PPM, Li WT, Wang HH, Liu KQ, Griffiths SM, et al. Determinants of medication adherence and blood pressure control among hypertensive patients in Hong Kong: a cross-sectional study. Int J Cardiol. 2015;182:250-7.
33. Ruppar TM, Dobbels F, De Geest S. Medication beliefs and antihypertensive adherence among older adults: a pilot study. Geriatr Nurs. 2012;33(2):89-95.
34. Ozdemir Ö, Akyüz A, Doruk H. Compliance with drug treatment in geriatric patients with hypertension. Bakirkoy Med J. 2016;12(4):195-201.
35. Adeseun GA, Bonney CC, Rosas SE. Health literacy associated with blood pressure but not other cardiovascular disease risk factors among dialysis patients. Am J Hypertens. 2012;25(3):348-53.
36. Kressin NR, Wang F, Long J, Bokhour BG, Orner MB, Rothendler J, et al. Hypertensive patients' race, health beliefs, process of care, and medication adherence. J Gen Intern Med. 2007;22(6):768-74.
37. Silva ICD, Nogueira MRDN, Cavalcante TF, Felipe GF, Morais HCC, Moreira RP, et al. Health literacy and adherence to the pharmacological treatment by people with arterial hypertension. Rev Bras Enferm. 2022;75(6):e20220008.
38. Lor M, Koleck TA, Bakken S, Yoon S, Dunn Navarra AM. Association between health literacy and medication adherence among Hispanics with hypertension. J Racial Ethn Health Disparities. 2019;6(3):517-24.
2. World Health Organization. Hypertension [Internet]. 2021 [cited 2025 Apr 25]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension
3. Benetos A, Bulpitt CJ, Petrovic M, Ungar A, Agabiti Rosei E, Cherubini A, et al. An expert opinion from the European Society of Hypertension-European Union Geriatric Medicine Society Working Group on the management of hypertension in very old, frail subjects. Hypertension. 2016;67(4):820-5.
4. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-20.
5. Yang ZQ, Zhao Q, Jiang P, Zheng SB, Xu B. Prevalence and control of hypertension among a community of elderly population in changning district of shanghai: a cross-sectional study. BMC Geriatr. 2017;17(1):296.
6. Shukuri A, Tewelde T, Shaweno T. Prevalence of old age hypertension and associated factors among older adults in rural Ethiopia. Integr Blood Press Control. 2019;12:23-31.
7. Sousa ALL, Batista SR, Sousa AC, Pacheco JAS, Vitorino PVO, Pagotto V. Hypertension prevalence, treatment and control in older adults in a Brazilian capital city. Arq Bras Cardiol. 2019;112(3):271-8.
8. Alhawassi TM, Krass I, Pont LG. Prevalence, management and control of hypertension in older adults on admission to hospital. Saudi Pharm J. 2017;25(8):1201-7.
9. Sengul S, Akpolat T, Erdem Y, Derici U, Arici M, Sindel S, et al. Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012. J Hypertens. 2016;34(6):1208-17.
10. Lee E, Park E. Self-care behavior and related factors in older patients with uncontrolled hypertension. Contemp Nurse. 2017;53(6):607-21.
11. Aydoğdu S, Güler K, Bayram F, Altun B, Derici Ü, Abacı A, et al. Turkish Hypertension Consensus Report 2019. Turk Kardiyol Dern Ars. 2019;47(6):535-46.
12. Lee YM, Yu HY, You MA, Son YJ. Impact of health literacy on medication adherence in older people with chronic diseases. Collegian. 2017;24(1):11-8.
13. Geboers B, de Winter AF, Spoorenberg SLV, Wynia K, Reijneveld SA. The association between health literacy and self-management abilities in adults aged 75 and older, and its moderators. Qual Life Res. 2016;25(11):2869-77.
14. Banning M. Older people and adherence with medication: a review of the literature. Int J Nurs Stud. 2008;45(10):1550-61.
15. Levinthal BR, Morrow DG, Tu W, Wu J, Murray MD. Cognition and health literacy in patients with hypertension. J Gen Intern Med. 2008;23(8):1172-6.
16. Zhang NJ, Terry A, McHorney CA. Impact of health literacy on medication adherence: a systematic review and meta-analysis. Ann Pharmacother. 2014;48(6):741-51.
17. Halladay JR, Donahue KE, Cené CW, Li Q, Cummings DM, Hinderliter AL, et al. The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial. Patient Educ Couns. 2017;100(3):542-9.
18. Wallace LG, Bradway CK, Cacchione PZ. The relationship between sensory loss and health literacy in older adults: a systematic review. Geriatr Nurs. 2022;47:1-12.
19. Wang C, Lang J, Xuan L, Li X, Zhang L. The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study. Int J Equity Health. 2017;16(1):58.
20. Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107.
21. Tarı Selçuk K, Mercan Y, Aydın T. Uncontrolled blood pressure in patients with hypertension and associated factors: the role of low health literacy. Erciyes Med J. 2018;40(4):222-7.
22. Powers BJ, Olsen MK, Oddone EZ, Thorpe CT, Bosworth HB. Literacy and blood pressure-do healthcare systems influence this relationship? A cross-sectional study. BMC Health Serv Res. 2008;8:219.
23. Federman AD, Wolf MS, Sofianou A, Martynenko M, O'Connor R, Halm EA, et al. Self-management behaviors in older adults with asthma: associations with health literacy. J Am Geriatr Soc. 2014;62(5):872-9.
24. Krousel-Wood MA, Muntner P, Islam T, Morisky DE, Webber LS. Barriers to and determinants of medication adherence in hypertension management: perspective of the cohort study of medication adherence among older adults. Med Clin North Am. 2009;93(3):753-69.
25. Vatansever Ö, Ünsar S. Determination of medical treatment adherence, self-efficacy levels of patients with essential hypertension and affecting factors. Turk J Card Nurs. 2014;5(8):66-74.
26. Sørensen K, Van den Broucke S, Pelikan JM, Fullam J, Doyle G, Slonska Z, et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health. 2013;13:948.
27. Tümer A, Baybuğa MS, Dereli F, Uysal DD. The compliance level of treatment of hypertensive patients. J Cardiovasc Nurs. 2016;7(13):105-13.
28. Aras Z, Temel AB. Evaluation of validity and reliability of the Turkish Version of Health Literacy Scale. Florence Nightingale J Nurs. 2017;25(2):85-94.
29. Ogedegbe G, Mancuso CA, Allegrante JP, Charlson ME. Development and evaluation of a medication adherence self-efficacy scale in hypertensive African-American patients. J Clin Epidemiol. 2003;56(6):520-9.
30. Fernandez S, Chaplin W, Schoenthaler AM, Ogedegbe G. Revision and validation of the medication adherence self-efficacy scale (MASES) in hypertensive African Americans. J Behav Med. 2008;31(6):453-62.
31. Hacihasanoglu R, Gözüm S, Çapık C. Validity of the Turkish version of the medication adherence self-efficacy scale-short form in hypertensive patients. Anatol J Cardiol. 2012;12(3):241-8.
32. Kang CD, Tsang PPM, Li WT, Wang HH, Liu KQ, Griffiths SM, et al. Determinants of medication adherence and blood pressure control among hypertensive patients in Hong Kong: a cross-sectional study. Int J Cardiol. 2015;182:250-7.
33. Ruppar TM, Dobbels F, De Geest S. Medication beliefs and antihypertensive adherence among older adults: a pilot study. Geriatr Nurs. 2012;33(2):89-95.
34. Ozdemir Ö, Akyüz A, Doruk H. Compliance with drug treatment in geriatric patients with hypertension. Bakirkoy Med J. 2016;12(4):195-201.
35. Adeseun GA, Bonney CC, Rosas SE. Health literacy associated with blood pressure but not other cardiovascular disease risk factors among dialysis patients. Am J Hypertens. 2012;25(3):348-53.
36. Kressin NR, Wang F, Long J, Bokhour BG, Orner MB, Rothendler J, et al. Hypertensive patients' race, health beliefs, process of care, and medication adherence. J Gen Intern Med. 2007;22(6):768-74.
37. Silva ICD, Nogueira MRDN, Cavalcante TF, Felipe GF, Morais HCC, Moreira RP, et al. Health literacy and adherence to the pharmacological treatment by people with arterial hypertension. Rev Bras Enferm. 2022;75(6):e20220008.
38. Lor M, Koleck TA, Bakken S, Yoon S, Dunn Navarra AM. Association between health literacy and medication adherence among Hispanics with hypertension. J Racial Ethn Health Disparities. 2019;6(3):517-24.
| Files | ||
| Issue | Vol 20 No 2 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v20i2.19703 | |
| Keywords | ||
| Adherence to Treatment Health Literacy Hypertension Elderly | ||
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How to Cite
1.
Taskin Yilmaz F, Sabanciogullari S, Turesin AK, Copur S. The Effect of Health Literacy and Adherence to Medical Treatment on Hypertension Control in the Elderly. Res Heart Yield Transl Med. 2025;20(2):79-88.
