Medication literacy and medication adherence in patients with tuberculosis receiving video-observed therapy: cross-sectional study

Objectives Medication adherence remains a critical challenge in tuberculosis (TB) treatment despite the implementation of video-observed therapy (VOT). Medication literacy may play a crucial role in medication adherence. The aim of this study was to assess medication literacy and medication adherence in patients with TB receiving VOT. Methods A cross-sectional study was conducted from April to November 2025 in Istanbul, Türkiye, involving adults with TB receiving VOT. Medication literacy was assessed using the Medication Literacy Scale for Adults (MELSA) version II (score range 1–9), with higher scores indicating better medication literacy. Medication adherence was measured using the Medication Adherence Report Scale (MARS-5). Patients were non-adherent to medication if the total score of MARS-5 was less than 23. The Single Item Literacy Screener (SILS) was used to assess the reading ability required for health-related materials. Logistic regression was conducted to evaluate factors related to non-adherence to TB medications. Results Participants (n=225) had a mean age of 50.5±16.8 years; 66.7% were male. The mean MELSA score was 6.17±1.46. Despite receiving VOT, 24.0% of patients were non-adherent to medications. Having limited reading ability (OR=0.474, 95% CI 0.240 to 0.939, p=0.032), having comorbidity (OR=0.502, 95% CI 0.270 to 0.933, p=0.029) and a higher number of medications (OR=0.872, 95% CI 0.806 to 0.945, p=0.001) were statistically associated with non-adherence to medications. Conclusions Patients with TB receiving VOT had moderate medication literacy and poor medication adherence. There is a need to assess and improve medication literacy in these patients.