title: Knowledge and health literacy are not associated with osteoporotic medication adherence, however income is, in Arab postmenopausal women.
abstract: 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.
authors.affiliation: School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; North District Health Office, Ministry of Health, Israel.
authors.forename: Amal
authors.initials: A
authors.lastname: Shehadeh-Sheeny
authors.forename: Sophia
authors.initials: S
authors.lastname: Eilat-Tsanani
authors.forename: Elias
authors.initials: E
authors.lastname: Bishara
authors.forename: Orna
authors.initials: O
authors.lastname: Baron-Epel
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D018912:Arabs / Q000523:psychology; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000191:economics*; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000008:administration & dosage* / Q000191:economics*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007182:Income; D007557:Israel; D055118:Medication Adherence; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D013689:Telephone
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Adherence; Arab women; Bisphosphonates; Health literacy; Income; Medication Possession Ratio (MPR); Osteoporosis