Effect of Medagogy–Based Medication Literacy Enhancement on Medication Adherence Among Older Persons with Physical Multimorbidity: Randomized Controlled Trial

Authors

  • Wichanee Jaimalai Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Sirirat Panuthai Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Rojanee Chintanawat Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Phanida Juntasopeepun Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.

DOI:

https://doi.org/10.60099/prijnr.2024.263819

Keywords:

Medagogy model, Medication Literacy, Medication Adherence, Older Persons, Physical Multimorbidity

Abstract

Medication non-adherence leads to poor clinical outcomes, particularly in older people with physical multimorbidity. The Medagogy model is a patient education process which enhances medication literacy resulting in medication adherence. This randomized controlled trial examined the effect of the Medagogy-Based Medication Literacy Enhancement Program on medication adherence among older persons with physical multimorbidity. One hundred participants aged 60 and over with two or more physical chronic conditions living in northern Thailand were randomly assigned into either a control group (n = 50) or an experimental group (n = 50). The control group received only usual care, while the experimental group received the Medagogy-Based Medication Literacy Enhancement Program. The program consisted of exchanging information based on the P-pathophysiology, I-indication, T-treatment, and S-specific through transformative learning and the teach-back method, with six sessions, implemented twice a week for three weeks. Medication adherence was measured using the Brief Medication Questionnaire at the 8th week of the program. Data were analyzed using descriptive statistics and Paired and Independent t-tests.

The results showed that after receiving the program, the experimental group had a significantly higher mean score for medication adherence than the control group. The results indicated that enhancing medication literacy through transformative learning resulted in improvement in medication adherence among older persons with physical multimorbidity. Therefore, nurses can use the Medagogy-Based Medication Literacy Enhancement Program to improve medication adherence among this population group. Further testing in other chronic conditions for the generalizability of the program and integrating digital technology or e-Health into the program are suggested.

References

Su Z, Huang L, Zhu J, Cui S. Effects of multimorbidity coexistence on the risk of mortality in the older adult population in China. Front Public Health. 2023;11: 1110876. doi:10.3389/fpubh.2023.1110876. DOI: https://doi.org/10.3389/fpubh.2023.1110876

Willadsen TG, Siersma V, Nicolaisdóttir DR, Køster-Rasmussen R, Jarbøl DE, Reventlow S, et al. Multimorbidity and mortality: a 15-year longitudinal registry-based nationwide Danish population study. J Comorb. 2018;8(1): 2235042X18 804063. doi:10.1177/2235042X18804063. DOI: https://doi.org/10.1177/2235042X18804063

Intarut N, Srihatrai P, Chantawang N. Prevalence of multimorbidity in Thailand: a multilevel analysis of a population-based survey. Int J Community Med Public Health. 2021;8(8):3750-5. doi:10.18203/2394-6040.ijcmph20212760. DOI: https://doi.org/10.18203/2394-6040.ijcmph20212760

Sukchan P, Chemoh W, Payanglee K. Morbidity and multi-morbidity among the elderly population in southernmost Thailand: cox proportional hazards regression model of survival approach. PNUJR. 2019;12(1):89-105.

Vargese SS, Mathew E, Johny V, Kurian N, V GA, Raju AS. Prevalence and pattern of multimorbidity among adults in a primary care rural setting. Clin Epidemiol Global Health. 2020;8(2):482–5. doi:10.1016/j.cegh.2019.10.014. DOI: https://doi.org/10.1016/j.cegh.2019.10.014

Bua-em P, Charoenphitak S, Siri S, Sathitwiphawi P. The prevalence and the risk factors of multimorbidity in the elderly in Sorn District Panburi. In: Proceeding of health literacy for sustainable development goal: Human resource development. Faculty of Public Health, Mahidol University; 2017. p. 254-62.

NICE guideline. Multimorbidity: clinical assessment and management [Internet]. 2016 Sept 21[cited 2023 Apr 19]. Available from: https://www.nice.org.uk/guidance/ng56/resourcesmultimorbidity-clinical-assessment-and-management-pdf-1837516654789

World Health Organization. Multimorbidity: technical series on safer primary care [Internet]. 2016 [ cited 2023 Apr 19]:1-28. Available from: https://apps.who.int/iris/bitstream/handle/10665/252275/9789241511650-eng.pdf;jsessionid=C3A27C300C2BBC39045F7BF3B959BB53?sequence =132

Bricca A, Smith SM, Skou ST. Management of multimorbidity. J Multimorb Comorb. 2023; 13:26335565231156693. doi:10.1177/26335565231156693. DOI: https://doi.org/10.1177/26335565231156693

Morris JE, Roderick PJ, Harris S, Yao G, Crowe S, Phillips D, et al. Treatment burden for patients with multimorbidity: cross-sectional study with exploration of a single-item measure. Br J Gen Pract. 2021;71(706):e381-90. doi:10.3399/bjgp.2020.0883. DOI: https://doi.org/10.3399/BJGP.2020.0883

Kim SJ, Kwon OD, Han EB, Lee CM, Oh SW, Joh HK, et al. Impact of number of medications and age on adherence to antihypertensive medications: a nationwide population-based study. Medicine (Baltimore). 2019;98(49):e17825. doi:10.1097/md.0000000000017825. DOI: https://doi.org/10.1097/MD.0000000000017825

Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, et al. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open. 2021; 11(9):e044987. doi:10.1136/bmjopen-2020-044987. DOI: https://doi.org/10.1136/bmjopen-2020-044987

Yan X, Mudiganti S, Husby H, Hudnut A, Gbotoe M, Jones JB. Medication non-adherence and therapeutic inertia independently contribute to poor disease control for cardiometabolic diseases. Sci Rep. 2022;12(1):18936. doi:10.1038/s41598-022-21916-8. DOI: https://doi.org/10.1038/s41598-022-21916-8

Kleinsinger F. The unmet challenge of medication nonadherence. Perm J. 2018;22:18-033. doi: 10.7812/TPP/18-033. DOI: https://doi.org/10.7812/TPP/18-033

Maffoni M, Traversoni S, Costa E, Midão L, Kardas P, Kurczewska-Michalak M, et al. Medication adherence in the older adults with chronic multimorbidity: a systematic review of qualitative studies on patient’s experience. Eur Geriatr Med. 2020;11(3):369–81. doi:10.1007/s41999-020-00313-2. DOI: https://doi.org/10.1007/s41999-020-00313-2

Mairesse J, Panuthai S, Suwankruhasn N. Medication literacy and medication adherence among older persons with multimorbidity [master’s thesis]. [Chiang Mai, Thailand]: Chiang Mai University; 2020.

Guo A, Jin H, Mao J, Zhu W, Zhou Y, Ge X, et al. Impact of health literacy and social support on medication adherence in patients with hypertension: a cross-sectional community-based study. BMC Cardiovasc Disord. 2023;23(1):93. doi:10.1186/s12872-023-03117-x. DOI: https://doi.org/10.1186/s12872-023-03117-x

Walters R, Leslie SJ, Polson R, Cusack T, Gorely T. Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review. BMC Public Health. 2020 Jun 30;20(1):1040. doi:10.1186/s12889-020-08991-0. DOI: https://doi.org/10.1186/s12889-020-08991-0

Kini V, Ho PM. Interventions to Improve medication adherence: a review. JAMA. 2018 Dec 18;320(23): 2461-73. doi:10.1001/jama.2018.19271. DOI: https://doi.org/10.1001/jama.2018.19271

Pouliot A, Vaillancourt R, Stacey D, Suter P. Defining and identifying concepts of medication literacy: an international perspective. Res Social Adm Pharm. 2018;14(9):797- 804. doi:10.1016/j.sapharm.2017.11.005. DOI: https://doi.org/10.1016/j.sapharm.2017.11.005

Horvat N, Kos M. Development, validation and performance of a newly designed tool to evaluate functional medication literacy in Slovenia. Int J Clin Pharm. 2020;42(6):1490– 8. doi:10.1007/s11096020-01138-6. DOI: https://doi.org/10.1007/s11096-020-01138-6

Kamal AK, Khalid W, Zulfiqar M, Muqeet A, Zaidi F, Gowani A, et al. The potential of m-health-based interventions to improve medication literacy and adherence in non-communicable diseases in Pakistan. Int J Stroke. 2019;14(3):NP8-10. doi:10.1177/1747493019827762. DOI: https://doi.org/10.1177/1747493019827762

Smith CA, Chang E, Gallego G, Balneaves LG. An education intervention to improve health literacy and decision making about supporting self-care among older Australians: a study protocol for a randomised controlled trial. Trials. 2017;18(1):441. doi:10.1186/s13063-017-2182-2. DOI: https://doi.org/10.1186/s13063-017-2182-2

Stewart M. The art and science of patient education for health literacy. Philadelphia, PA: Elsevier, Health Sciences Division; 2020.

Cabaniss R. Using transformative learning theory to impact patient care. J Nurs Care. 2014;4(1):223. doi:10.4172/2167-1168.1000 223.

Mezirow J. Transformative learning theory. In: Mezirow J, Taylor EW, editors. Transformative learning in practice: insights from community workplace, and higher education. San Francisco, CA: Jossey-Bass; 2009. pp. 18-32.

Yen PH, Leasure AR. Use and effectiveness of the teach-back method in patient education and health outcomes. Fed Pract. 2019;36(6):284-9.

Talevski J, Wong Shee A, Rasmussen B, Kemp G, Beauchamp A. Teach-back: a systematic review of implementation and impacts. PLoS One. 2020;15(4):e0231350. doi:10.1371/journal.pone.0231350. DOI: https://doi.org/10.1371/journal.pone.0231350

Brega AG, Barnard J, Mabachi NM, Weiss BD, Dewalt DA, Brach C, et al. AHRQ health literacy universal precautions toolkit, 2nd ed [Internet]. 2020 [cited 2023 Apr 19]. Available from: https://www.ahrq.gov/sites/default/files/publications/files/healthlittoolkit2_3.pdf33

Grove SK, Burns N, Gray J. The practice of nursing research: appraisal, synthesis, and generation of evidence. St. Louis, Missouri: Elsevier/Saunders; 2013.

Burns N, Grove S. The practice of nursing research: appraisal, synthesis and generation of evidence. 6th rev. ed. St Louis: Elsevier/Saunders; 2009.

Chiang Mai Public Health Office. The Short Portable Mental Status Questionnaire (SPMSQ) [Internet]. 2018 [cited 2020 Nov 22]. Available from: https://www.chiangmaihealth.go.th/cmpho_web/main_section.php?info_id=4197

Department of Medical Services, Ministry of Public Health, Thailand. Elderly screening/assessment manual [Internet]. 2014 [cited 2020 Nov 22]. Available from: http://203.157.109.15/nont/file_upload/aging/bookGS.pdf

Svarstad BL, Chewning BA, Sleath BL, Claesson C. The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2): 113–24. doi:10.1016/s0738-3991(98)00107-4. DOI: https://doi.org/10.1016/S0738-3991(98)00107-4

Sriwarakorn S, Krittiyanunt S, Sakulbumrungsil R. Sensitivity and specificity of Thai-version Brief Medication Questionnaire. J Health Res [Internet]. 2010 [cited 2023 Apr19];24(3): 129–34. Available from: https://he01.tci-thaijo.org/index.php/jhealthres/article/view/156822

Janchai N, Deoisres W, Chaimongkol N. Improving health literacy using the health education and health empowerment program in Thai adults with uncontrolled hypertension: a randomized controlled trial. Pacific Rim Int J Nurs Res [Internet]. 2021 [cited 2023 Apr 19];25(4):600–13. Available from: https://he02-old.tci-thaijo.org/index.php/PRIJNR/article/view/249238

Qvarfordt M, Throfast V, Petersson G, Hammar T, Hellström L. Web-based education of the elderly improves drug utilization literacy: a randomized controlled trial. Health Informatics J. 2021;27(1):1460458220977585. doi:10.1177/1460458220977585. DOI: https://doi.org/10.1177/1460458220977585

Ampofo AG, Khan E, Ibitoye MB. Understanding the role of educational interventions on medication adherence in hypertension: a systematic review and meta-analysis. Heart Lung. 2020;49(5):537–47. doi:10.1016/j.hrtlng.2020.02.039. DOI: https://doi.org/10.1016/j.hrtlng.2020.02.039

Delavar F, Pashaeypoor S, Negarandeh R. The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: a randomized controlled trial. Patient Educ Couns. 2020;103(2):336–42. doi:10.1016/j.pec.2019.08.028. DOI: https://doi.org/10.1016/j.pec.2019.08.028

Tan JP, Cheng KK, Siah RC. A systematic review and meta‐analysis on the effectiveness of education on medication adherence for patients with hypertension, hyperlipidaemia and diabetes. J Adv Nurs. 2019;75(11): 2478–94. doi:10.1111/jan.14025. DOI: https://doi.org/10.1111/jan.14025

Wu JR, Mark B, Knafl GJ, Dunbar SB, Chang PP, DeWalt DA. A multi-component, family-focused and literacy-sensitive intervention to improve medication adherence in patients with heart failure–a randomized controlled trial. Heart Lung. 2019;48(6):507–14. doi:10.1016/j.hrtlng.2019.05.011. DOI: https://doi.org/10.1016/j.hrtlng.2019.05.011

Chiangkhong A, Intarakamhang U, Duangchan P, Macaskill A. Effectiveness of health literacy through transformative learning on glycemic control behavior in adult diabetes patients: a mixed methods approach. J Behav Sci [Internet]. 2019 [cited 2023 Apr 19];14(3):49–61. Available from: https://so06.tci-thaijo.org/index.php/IJBS/article/view/172168

Ongkulna K, Pothiban L, Panuthai S, Chintanawat R. Enhancing self-management through geragogy-based education in older adults with uncontrolled hypertension: a randomized controlled trial. Pacific Rim Int J Nurs Res [Internet]. 2022 [cited 2023 Aug 16];26(4):690–705. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/259276

Sriklo M, Tamdee D, Aungwattana S, Kaewthummanukul T. Effects of enhance health literacy through transformative learning program on self-management and hemoglobin A1C level among adults with uncontrolled type 2 diabetes: a randomized controlled trial. Pacific Rim Int J Nurs Res [Internet]. 2023 [cited 2023 Aug 16];27(2):317–33. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/262041 DOI: https://doi.org/10.60099/prijnr.2023.262041

Mahajan M, Hogewoning JA, Zewald JJA, Kerkmeer M, Feitsma M, van Rijssel DA. The impact of teach-back on patient recall and understanding of discharge information in the emergency department: the emergency teach-back (EM-TeBa) study. Int J Emerg Med [Internet]. 2020;13(1):49. Available from: http://dx.doi.org/10.1186/s12245-020-00306-9 DOI: https://doi.org/10.1186/s12245-020-00306-9

Wannasirikul P, Termsirikulchai L, Sujirarat D, Benjakul S, Tanasugarn C. Health literacy, medication adherence, and blood pressure level among hypertensive older adults treated at primary health care centers. Southeast Asian J Trop Med Public Health. 2016;47(1):109–20.

Downloads

Published

2023-11-27

How to Cite

1.
Jaimalai W, Panuthai S, Chintanawat R, Juntasopeepun P. Effect of Medagogy–Based Medication Literacy Enhancement on Medication Adherence Among Older Persons with Physical Multimorbidity: Randomized Controlled Trial. PRIJNR [Internet]. 2023 Nov. 27 [cited 2024 Oct. 6];28(1):21-37. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/263819