Purpose The purpose of this systematic review is to assess evidence of a relationship between health literacy and medication engagement (formerly referred to as medication adherence) among adults with diabetes mellitus in the United States. Methods Literature searches were conducted in PubMed, Ovid Medline, CINAHL, Embase, PsycInfo, and Scopus from the inception of each database to April 2020. Studies were included if they met all of the following criteria: (1) conducted in the United States, (2) the population of interest was adults ≥18 years with a diagnosis of type 1 or type 2 diabetes, (3) medication engagement was an outcome variable, (4) a direct and not a mediating relationship between health literacy and medication engagement was assessed, (5) a quantifiable measure of association was reported, and (6) a full-text journal article or dissertation was available. Quality of published evidence was graded according to Joanna Briggs Institute Critical Appraisal Checklists appropriate for the respective study designs identified. Results Thirteen articles from 11 unique studies were retained in the review, most of which used a cross-sectional design. Four out of 11 studies found a direct positive association between health literacy and medication engagement. Two of the 4 studies with positive findings had significant methodological shortcomings. Conclusions There is some evidence that health literacy is associated with medication engagement among adults with diabetes in the United States. Properly designed and executed longitudinal studies are needed to better elucidate the relationship between health literacy and medication engagement among adults with diabetes.

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健康素养对美国成人糖尿病患者用药参与的影响：系统评价

目的 本系统评价的目的是评估美国成人糖尿病患者的健康素养和药物参与（以前称为药物依从性）之间关系的证据。方法 从每个数据库建立到 2020 年 4 月，在 PubMed、Ovid Medline、CINAHL、Embase、PsycInfo 和 Scopus 中进行文献检索。如果研究满足以下所有条件，则纳入：（1）在美国进行， (2) 感兴趣的人群是 18 岁以上诊断为 1 型或 2 型糖尿病的成年人，(3) 药物参与是一个结果变量，(4) 健康素养和药物参与之间存在直接而非中介关系评估，（5）报告了可量化的关联度量，(6) 有全文期刊文章或论文。已发表证据的质量根据适用于确定的各个研究设计的 Joanna Briggs 研究所批判性评估清单进行分级。结果 评价中保留了来自 11 项独特研究的 13 篇文章，其中大部分使用了横断面设计。11 项研究中有 4 项发现健康素养与药物参与之间存在直接的正相关。4 项具有阳性结果的研究中有两项存在明显的方法学缺陷。结论 有一些证据表明，健康素养与美国成人糖尿病患者的药物治疗相关。