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.

中文翻译：

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健康素养对美国成年人糖尿病患者服药的影响：系统评价

目的

本系统综述的目的是评估美国成年人糖尿病患者的健康素养与药物使用（以前称为药物依从性）之间的关系。

方法

从每个数据库开始到2020年4月，在PubMed，Ovid Medline，CINAHL，Embase，PsycInfo和Scopus中进行文献检索。如果研究符合以下所有条件，则包括在内：（1）在美国进行，（ 2）感兴趣的人群是诊断为1型或2型糖尿病的18岁以上成年人，（3）用药是结果变量，（4）评估了健康素养和用药之间的直接关系而非中介关系，（5）报告了一种量化的关联度量，并且（6）可获得全文期刊文章或论文。根据适合所确定的各个研究设计的乔安娜·布里格斯研究所的关键评估清单对公开证据的质量进行分级。

结果

该评价保留了11项独特研究的13篇文章，其中大多数使用了横断面设计。11项研究中有4项发现健康素养与药物投入之间存在直接的正相关。4项阳性结果的研究中有2项在方法学上存在重大缺陷。

结论

有一些证据表明，在美国，健康素养与成年人中服用药物有关。需要进行适当设计和执行的纵向研究，以更好地阐明成人糖尿病患者的健康素养与药物使用之间的关系。