HSS Journal ®

, Volume 9, Issue 1, pp 42–49 | Cite as

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

  • Patricia QuinlanEmail author
  • Kwanza O. Price
  • Steven K. Magid
  • Stephen Lyman
  • Lisa A. Mandl
  • Patricia W. Stone
Original Article



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 literacy health knowledge adherence to treatment 



Dr. Quinlan’s effort was supported by the REDcap Database of the Cornell Clinical and Translational Science Center—Grant UL11RR024996.


Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participating in the study was obtained


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Copyright information

© Hospital for Special Surgery 2012

Authors and Affiliations

  • Patricia Quinlan
    • 1
    Email author
  • Kwanza O. Price
    • 1
  • Steven K. Magid
    • 1
    • 2
  • Stephen Lyman
    • 1
  • Lisa A. Mandl
    • 1
    • 2
  • Patricia W. Stone
    • 3
  1. 1.Hospital for Special SurgeryNew YorkUSA
  2. 2.Weill Cornell University Medical CollegeNew YorkUSA
  3. 3.Center for Health PolicyColumbia University School of NursingNew YorkUSA

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