HEALTH LITERACY, PERCEIVED MEDICATION BENEFITS,
MEDICATION ADHERENCE AND HEALTH-SEEKING BEHAVIOUR
AND MEDICATION ADHERENCE AMONG PATIENTS WITH
CHRONIC ILLNESSES ATTENDING PRIMARY CARE IN RURAL
COMMUNITIES OF IKENNE LOCAL GOVERNMENT AREA, NIGERIA

INTRODUCTION
Background and Scope of the Study
The main aim of any attempted remediation of a health problem of patients in a health system is to achieve certain desired health outcomes in the patient. These desired outcomes however might not be realizable if the patients are not strictly following prescribed treatment even when the health care professionals have performed their part effectively.
The synergy of the relationship between low literacy, patient decision - making, and compliance with prescribed medication use makes it quite difficult to achieve the desired outcomes in medical therapy (Nutbeam, 2008, Atulomah et al, 2010) of overall increase in health status. Health literacy is defined as the capacity of individuals to obtain, interpret and understand basic health information and services, as well as the competence and motivation to use such information and services in ways that enhance their health (Institute of Medicine, 2004)
Several studies have been have been conducted to evaluate peoples level of literacy and adherence to medication. Health literacy rates in developed countries have been conducted in the United States (USA), United Kingdom (UK), Australia, and Canada to evaluate the rate of health literacy in different diseases and different patient populations. In 1993, the National Adult Literacy Survey reported that about 40 million adult Americans had limited education and English proficiency, many of whom were older adults (Baker et al, 1998). In developing countries these figures are far higher. In 2008, The survey on literacy level in Nigeria was reported to be about 68% (Atulomah, et al, 2012). This is very discouraging especially on the effect that a low literacy would have on patients, especially chronically ill patients who are expected to follow strict adherence to prescription and have high knowledge on the fact that a prescribed therapy would have in improving their general health condition.
Generally, there is a common false conception that most adults can read and write and would be able to understand clinical materials/prescription materials. Most of them cannot understand what they read especially people in the rural areas. Also for clinicians, there is a challenge of cultural and language barrier in the rural areas which contribute to a patient’s ability to understand what the clinician is saying. clinical/prescription materials. For patients in such areas, culture and language forms a major barrier in the administration of any medical treatment. Low health literate people are prone to making uninformed decisions (Atulomah, et al, 2012). Consequences of uninformed decisions can go beyond choices made by patients regarding their own health, but could also include making decisions for their spouses, children and their elderly parents on health decisions. Also, they may not know where to go to seek appropriate care, which measures to take in order to prevent the onset of conditions or how to properly take their prescription drugs. They may forego enrolling in a health insurance plan or may not select the plan best suited for them because they do not understand their options. They may also go further to buy over-the-counter drugs without prior consultation with a physician. Some people with limited health literacy often fail to promptly report poor health and are less likely to live preventive lifestyle which consequently leads to increased health care cost (DeWalt et al, 2004; Wagner et al, 2008); Patients often think that asking questions is disrespectful, Patients are also sick and anxious during the medical interaction, Patients often think that asking questions is disrespectful. Patients are also sick and anxious during the medical interaction.
Health literacy is about finding understanding and using health information and services. For physicians, it should entail learning to listen to all the patient has to say, speaking clearly and bridging cultural barriers that cause misunderstanding and mistakes (Coulter and Ellins, 2007). Patients especially in the rural areas need to be informed; to educate them on the potential dangers posed by chronic disease as well as educate them on preventive lifestyles. When awareness is increased and perceptions corrected through health education, there is a greater likelihood of making informed choices. (Nutbeam, 2008)
This study aims at identifying patterns of low literacy, patients’ compliance to prescribed medication and health-seeking behavior among patients with chronic illnesses attending primary care centres in rural communities of Ikenne Local Government of South-western Nigeria. The data obtained hereinafter would be used as a baseline for any intervention to be conducted in future.