Treatment adherence and health literacy in multiple sclerosis: Equity implications

Abstract

Abstract Background Treatment adherence in multiple sclerosis (MS) is critical for long-term disease management, yet its determinants remain poorly understood. The objective of this study is to examine the role of health literacy in adherence, disease severity, duration, and socioeconomic factors, which are often linked with health inequalities. Methods The study included 166 people diagnosed with MS (75.3% women; mean age: 40.9±11.3 years, disease duration: 11.6±7.1 years). Adherence was measured using the adherence subscale of the Multiple Sclerosis Self-Management Scale (MSSM), while health literacy was assessed by the MS knowledge and information subscale of MSSM. Sociodemographic and clinical data were obtained during neurological examination. Linear regression was used for data analysis. Results Statistical analyses showed that income was significantly associated with adherence (ß=0.19, p ≤ 0.05) in models with socioeconomic and clinical variables. This association attenuated after adding health literacy into final model. Health literacy remained the only significant predictor (ß=0.36, p ≤ 0.001) of adherence, while other variables, including education, did not show a significant contribution. The final model explained 11.6% of the overall variance. Conclusions Health literacy, rather than formal education, appears to be a key determinant of treatment adherence in MS. Health literacy remained significant even after adjusting for socioeconomic factors like income or educational attainment, and clinical factors such as disease severity and duration, highlighting its role as a key variable. These results suggest that improving health literacy may represent a modifiable pathway to enhance adherence and promote more equitable health outcomes in people with MS, independent of education level. These findings underscore the importance of implementing literacy-sensitive approaches by healthcare providers in patient education and healthcare communication. Grant support: APVV-22-0587 Key messages • Health literacy is associated with treatment adherence in MS, independent of education and income, highlighting a modifiable pathway to improve health outcomes. • Improving health literacy may enhance MS treatment adherence across all educational levels, enhancing equity between people from different sociodemographic backgrounds.