Health literacy, medication adherence, and quality-of-life scores in Jordanian adults with chronic diseases: a dual analytical study using the long-term conditions questionnaire and the EuroQol five-dimension three-level questionnaire.
Health literacy and medication adherence are positively associated with quality of life in Jordanian adults with chronic diseases, but these findings should be interpreted with caution due to the study's design.
Where it sits
this study against the rest of the eloralintide corpusSummary and findings
This study examined the association of health literacy and medication adherence with quality-of-life outcomes in Jordanian adults with chronic diseases. A total of 901 participants completed online questionnaires, and significant positive associations were found with both health literacy and medication adherence. The study utilized multiple regression and machine-learning approaches for analysis.
Abstract
<h4>Aims</h4>This study examined the association of health literacy with quality-of-life outcomes among Jordanian adults with chronic diseases using two patient-reported outcome measures, the Long-Term Conditions Questionnaire (LTCQ) and the EuroQol five-dimension, three-level questionnaire (EQ-5D-3L). It also compared conventional regression and machine-learning (ML) approaches for modelling these relationships.<h4>Materials and methods</h4>In this cross-sectional online study, Arabic-language questionnaires were completed by Jordanian adults aged 18 years or older with at least one chronic physical, mental, or neurological condition. The survey, designed to take 10-12 minutes, included the LTCQ, EQ-5D-3L, Medication Adherence Report Scale (MARS-5), and 12-item Health Literacy Scale (HLS-Q12). A total of 901 complete responses were analyzed. Data were split into training (<i>n</i> = 633) and test (<i>n</i> = 268) sets. Multiple linear regression was used for LTCQ, Tobit regression for EQ-5D-3L index scores, and ML models were trained to explore nonlinear associations.<h4>Results</h4>Health literacy and medication adherence were positively associated with both LTCQ (beta = 3.923 and 2.219, respectively; both <i>p</i> < 0.001) and EQ-5D-3L index scores (beta = 0.025, <i>p</i> = 0.001; beta = 0.020, <i>p</i> = 0.009). Number of medications was inversely associated with both outcomes. In 10-fold cross-validation, Extreme Gradient Boosting (XGBoost) showed the lowest average root mean square error (RMSE) for LTCQ (9.18; coefficient of determination [R²] = 0.384) and EQ-5D-3L (0.172; R² = 0.193), although differences between the leading models were modest.<h4>Conclusion</h4>LTCQ and EQ-5D-3L showed overlapping but distinct association patterns. LTCQ was more strongly linked with psychosocial and self-management variables, whereas EQ-5D-3L was more closely aligned with medication burden and clinical comorbidity. These findings should be interpreted as associative rather than causal and as differences in captured dimensions rather than evidence of instrument superiority.
Background
This paper addresses the relationship between health literacy, medication adherence, and quality of life in adults with chronic diseases. Prior research has indicated that health literacy can influence health outcomes, but the specific associations in Jordanian adults had not been thoroughly explored. Understanding these relationships is crucial for improving health interventions and patient education.
Methods
The study employed a cross-sectional design with 901 Jordanian adults aged 18 and older who had at least one chronic condition. Participants completed several questionnaires, including the LTCQ, EQ-5D-3L, and HLS-Q12. The analysis utilized multiple linear regression for LTCQ and Tobit regression for EQ-5D-3L, with data split into training (n=633) and test (n=268) sets.
Results
The primary endpoint showed a positive association between health literacy and LTCQ scores, with a beta of 3.923 (p < 0.001). Medication adherence also positively correlated with LTCQ scores (beta = 2.219, p < 0.001) and EQ-5D-3L index scores (beta = 0.025, p = 0.001). The study reported that the number of medications inversely affected both outcomes.
Interpretation
These findings align with existing literature that suggests health literacy and medication adherence are important for quality of life. However, the effect sizes, while statistically significant, may not be clinically meaningful given the nature of the measures. The study's cross-sectional design and reliance on self-reported data introduce confounding factors that limit the ability to draw definitive conclusions.
Key findings
- beta = 3.923 for health literacy and LTCQ, p < 0.001
- beta = 2.219 for medication adherence and LTCQ, p < 0.001
- beta = 0.025 for health literacy and EQ-5D-3L index scores, p = 0.001
- beta = 0.020 for medication adherence and EQ-5D-3L index scores, p = 0.009
- Average RMSE for LTCQ using XGBoost = 9.18, R² = 0.384
- Average RMSE for EQ-5D-3L using XGBoost = 0.172, R² = 0.193
Limitations
- cross-sectional design limits causal inference
- self-reported measures may introduce bias
- sample may not be representative of the broader population
- short duration of assessment
- no longitudinal follow-up