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

Patricia Quinlan DNSc, MPA
Hospital for Special Surgery, New York, NY

Kwanza O. Price MPH
Hospital for Special Surgery, New York, NY

Steven K. Magid, MD
Attending Physician, Hospital for Special Surgery
Professor of Clinical Medicine, Weill Cornell Medical College

Stephen Lyman PhD
Hospital for Special Surgery, New York, NY

Lisa A. Mandl, MD
Assistant Attending Physician, Hospital for Special Surgery
Assistant Professor of Medicine, Weill Cornell Medical College
Assistant Professor of Public Health, Weill Cornell Medical College

Patricia W. Stone PhD, MPH
Center for Health Policy, Columbia University School of Nursing, New York, NY



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.

This article appears in HSS Journal: Volume 9, Number 1.
View the full article at

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


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