Knowledge and health literacy are not associated with osteoporotic medication adherence, however income is, in Arab postmenopausal women

Objective: To investigate the association between adherence with oral bisphosphonate treatment, income, health literacy, knowledge, and receiving instructions from a pharmacist or doctor, among Arab postmenopausal women diagnosed with osteoporosis in Israel. Methods: Arab osteoporotic women treated with oral bisphosphonates were interviewed (303 women). The questionnaire included socio-demographic characteristics, knowledge about osteoporosis and health literacy. Adherence was measured by the Medication Possession Ratio (MPR) according to the number of prescription refills registered in the database of Clalit Health Services. Results: Forty-one percent of the women were adherent according to the MPR. The main predictor of adherence in a multivariate logistic regression was income. Health literacy and knowledge were not associated with adherence after adjustment for income. Neither was the health care provider's counseling regarding the medication. Conclusions: Lower income seems to be a barrier to adherence with osteoporotic medication, over and above other known barriers. Policy makers should take into account that medication funding may be a barrier to treatment. Practical implications Income may be a major barrier to adherance with osteoporosis medication and calls for attention of practiciner.