HSS Journal ®

, Volume 9, Issue 1, pp 42–49

The Relationship Among Health Literacy, Health Knowledge, and Adherence to Treatment in Patients with Rheumatoid Arthritis


    • Hospital for Special Surgery
  • Kwanza O. Price
    • Hospital for Special Surgery
  • Steven K. Magid
    • Hospital for Special Surgery
    • Weill Cornell University Medical College
  • Stephen Lyman
    • Hospital for Special Surgery
  • Lisa A. Mandl
    • Hospital for Special Surgery
    • Weill Cornell University Medical College
  • Patricia W. Stone
    • Center for Health PolicyColumbia University School of Nursing
Original Article

DOI: 10.1007/s11420-012-9308-6

Cite this article as:
Quinlan, P., Price, K.O., Magid, S.K. et al. HSS Jrnl (2013) 9: 42. doi:10.1007/s11420-012-9308-6



Patients with poor health literacy often lack the knowledge needed to manage their treatment.


The aim of this cross-sectional study is to determine whether health literacy is a predictor of health knowledge and/or adherence to medication treatment in patients with rheumatoid arthritis.


The study was completed in an urban, outpatient rheumatology setting. Health literacy was measured using the Test of Functional Health Literacy in Adults. The Arthritis Knowledge Questionnaire was modified to measure medication specific health knowledge, and the Morisky Medication Adherence scale was used to measure adherence. Researchers used regression analyses to determine if health literacy was a predicator of knowledge and/or adherence.


Participants (N = 125) had high mean health literacy scores. The average medication knowledge score was 0.73. Adherence to medication regimen was 0.84. Controlling for patient covariates, health literacy was positively associated with education, race, and age. In adjusted analyses, health literacy was a significant predictor of health knowledge but not adherence. Race, neighborhood income, and confidence with contacting provider about medications were predictors of adherence.


Study findings indicate that health literacy is independently associated with medication knowledge but not medication adherence in patients with rheumatoid arthritis. These results provide useful information for planning initiatives to support individuals with disease self-management.


health literacyhealth knowledgeadherence to treatment

Copyright information

© Hospital for Special Surgery 2012