Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study

Background Previous studies have associated health literacy and social support with medication adherence in hypertension. However, limited evidence exists regarding the mechanisms between the factors and medication adherence. Purpose To explore the prevalence of medication adherence and its determinants in patients with hypertension in Shanghai. Methods A community-based cross-sectional study was conducted containing 1697 participants with hypertension. We collected the characteristics of sociodemographic and clinical, the profiles of health literature and social support, and medication adherence using questionnaires and examined interactions among the factors using a structural equation model. Results The participants contained 654 (38.54%) with low medication adherence, and 1043 (61.46%) with medium/high adherence. Social support influenced adherence directly ( β = 0.165, P < 0.001) and indirectly through health literacy ( β = 0.087, P < 0.001). Health literacy directly influenced adherence ( β = 0.291, P < 0.001). Education indirectly affected adherence through social support ( β = 0.048, P < 0.001) and health literature ( β = 0.080, P < 0.001). Moreover, there was a sequential mediating effect of social support and health literature on the association between education and adherence ( β = 0.025, P < 0.001). After controlling for age and marital status, similar results were also obtained, indicating a good model fit. Conclusions Medication adherence of hypertensive patients needs to improve. Health literacy and social support had direct and/or indirect effects on adherence, which should be more consider as the measures of improving adherence.