Health Literacy and Drug Adherence among Diabetes Patients in Ebonyi State: A Cross-Sectional Survey

Health Literacy and Drug Adherence among Diabetes Patients in Ebonyi State: A Cross-Sectional Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Health Literacy and Drug Adherence among Diabetes Patients in Ebonyi State: A Cross-Sectional Survey Ignatius Obilor Nwimo, Benedicta Onyinyechi Nte, Nwamaka Agbe Elom, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8069199/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Health literacy is a phenomenon that empowers patients to navigate the healthcare system, understand medical instructions, and recognize the significance of continuous medication adherence. Purpose The aim of the study was to investigate the relationship between health literacy and drug adherence among diabetes patients in Ebonyi State, Nigeria. Methods This cross-sectional study was carried out on 298 diabetes patients. The study used a researchers-developed 20-item validated Health Literacy and Drug Adherence Questionnaire (HLDAQ). Thirty diabetes patients attending routine out-patient clinic in three government health facilities in Enugu State, Nigeria responded to the research tool for data quality control. The data yielded high Cronbach alpha (Health Literacy Practices α = 0.89; Drug Adherence α = 0.76) reliability coefficients. Spearman Brown correlation coefficient, mean scores, ANOVA, t-test and stepwise multiple regression analysis were used for analysis. Analysis was run with IBM SPSS version 25.0 for windows. Results Overall health literacy (2.60 ± 0.91) indicated that the respondents had a high health literacy level. However, overall drug adherence (2.09 ± 0.49) was low. Differences observed on health literacy were significant in relation age (p = 0.000), sex (p = 0.003), educational level (p = 0.000), and religion (p = 0.000). Similar trend was observed on drug adherence except in sex (p = 0.685). The relationship between health literacy and drug adherence was significantly positive (r = 0.570, p < 0.001). Conclusion The study concluded that the health literacy among the diabetes patients was high, but had low drug adherence. Age, sex, educational level and religion predicted health literacy and drug adherence among the diabetes patients. However, sex was not capable of predicting drug adherence. Healthcare providers should consider addressing complexity of regimen, personal beliefs and attitudes, lifestyle and environmental and psychological factors when developing treatment plans for diabetes patients with higher health literacy. Health Literacy Drug Adherence Diabetes Patients Ebonyi State 1 Introduction Diabetes has been recognized as a significant global health issue. International Diabetes Federation (IDF) reported that there are approximately 425 million individuals living with diabetes globally with nearly 50% of them undiagnosed [ 1 ]. It was noted that diabetes is a risk factor for various complications such as blindness, vascular brain diseases and renal failure. Other complications associated with diabetes include damage to the brain, heart, kidneys and limbs [ 2 ]. In Nigeria, about 3.9 million adults lived with diabetes in 2019 and the number is projected to double by 2045 [ 3 ]. Authors observed that about 29.5% of individuals living with diabetes in Nigeria are unaware of their condition [ 4 ]. However, health literacy has been considered as a determinant in the health-disease process reduction and most of the components of diabetes management rely on the involvement and the ability of patients to adhere, making health literacy an important factor that can influence the management of their disease [ 5 ]. The term literacy (HL) refers to the development of the learning process of reading and writing [ 6 ]. HL is a person’s ability to obtain and understand health information and the basic services available that may favor self-care actions [ 5 ]. HL might also be conceptualized as the ability of an individual to obtain and translate knowledge and information in order to maintain and improve health in a way that is appropriate to the individual and system contexts [ 7 ]. This ability helps people to make appropriate healthcare decisions, understand health risk behaviours, enhance health outcomes and reduce the cost of care in ways that might benefit their health [ 8 ]. In this direction, patients classified as adequate in HL are those who have basic reading, writing and numerical skills, which may favour their participation in the care plan, from planning to the evaluation of the results of the proposed therapeutic actions [ 9 ]. HL has four domains, namely: functional, communicative, critical and numeracy. Functional literacy is the basic level of health literacy that pertains to a patient’s reading and writing skills. Communicative literacy is the advanced level of health literacy that pertains to a patient’s ability to extract and apply information. Critical health literacy refers to a patient’s ability to critically analyze and use information for a greater control over situations [ 10 , 11 ]. Numeracy broadly refers to the ability of a person to understand and use numbers in his or her daily life [ 12 ]. Diabetes-related numeracy specifically refers to the skills needed in the context of diabetes management which can include interpretation of blood glucose, self- monitoring results, administration or intake of diabetes medicines in correct amounts and following nutritional recommendations [ 13 , 14 ]. HL is crucial for effective self-care of chronic conditions and the maintenance of overall health. HL empowers patients by enhancing their ability to navigate the healthcare system, understand medical instructions, and recognize the significance of continuous medication adherence [ 15 ]. It plays a significant role in the healthcare system [ 16 ] as emphasized by the World Health Organization, which recommends health literacy as a tool to achieve several key health improvements in drug adherence targets [ 17 ]. Drug adherence is the process by which patients take the medications as prescribed by the healthcare provider [ 18 ]. It could also be seen as the degree to which a person’s behaviour corresponds with the agreed recommendations from a health care provider [ 19 ]. Empirically, a studies reported high health literacy level among patients with type 2 diabetes [ 20 , 21 ]. On the contrary, another study reported low level of health literacy among diabetes patients [ 22 ]. Many studies affirmed that health literacy has a direct impact on medication adherence. For example, studies conducted across different countries have reported a statistically significant and positive association between health literacy and medication adherence [ 23 , 24 ]. Studies [ 25 – 28 ] further reported a significant positive correlation between health literacy and medication adherence, indicating that higher health literacy could contribute to higher medication adherence levels. Some other studies reported a positive association between health literacy and medication adherence, but did not support a strong association [ 29 , 30 ]. Yet other studies and systematic reviews have reported no direct association between health literacy and medication adherence [ 31 , 32 ]. It was observed that low HL can contribute to the appearance and aggravation of several chronic non-communicable diseases (CNCD), such as diabetes mellitus (DM). Tefera 33 reported an association between health literacy and medication adherence. Further more, Garcia et al. [ 34 ] found no association between health literacy and drug adherence but Thurston et al. [ 35 ] reported a positive relationship between health literacy and ability to remember taking medications only. Significant associations between health literacy and medication adherence were reported [ 36 , 37 ]. Moreover, a study [ 31 ] had found an association between health literacy and medication adherence in patients with type 2 diabetes. The authors noted that patients with higher health literacy levels tended to have better medication adherence and glycemic control. The above studies suggest a relationship between health literacy and adherence to medication among diabetes patients and other sick people. However, according to Krass et al., the correlations between health literacy and drug adherence have been far from perfect, suggesting that not all sick individuals that encounter equivalent or non-adherence to medication share the same risk of susceptibility [ 38 ]. This may, however, be the case of diabetes patients in Ebonyi state. There was need therefore to investigate the association between health literacy and drug adherence among the diabetes patients, at least, to determine their present condition. It is important to note that some socio-demographic variables like age, gender, level of education and religion might play significant role in health literacy and drug adherence. For instance, it was reported that as age increases there is the propensity to encounter low health literacy and drug adherence [ 39 ]. This state of affairs may arise because as age increases, elderly patients’ comprehension, attention, and memory decline to varying degrees, coupled with a greater number of prescribed medications and complex medication regimens, leading to their limited knowledge about medication management. It was reported that significant differences existed in the level of health literacy and drug adherence based on age and the study’s findings provided additional evidence that the younger respondents understood the study’s focus on various aspects of drug use, such as dosage, duration, and timing [ 40 ]. In contrast, Johnson found no significant difference in health literacy in relation to age [ 41 ]. In relation to gender, a study reported differences in the level of health literacy and drug adherence and affirmed that women may experience different challenges compared to men in managing health conditions due to variations in health literacy levels and attributed it to the social and cultural factors that influence how health information acted upon by different genders [ 42 ]. However, a positive correlation was reported between health literacy and medication adherence among Jordanian T2DM patients by gender [ 28 ]. Among Korean adults, it was reported that Korean women had a significantly higher level of health literacy than men in terms of understanding directions on medication bottles. It was noted that the traditional gender expectation provides women with more interactions with the healthcare system, giving them more opportunities to expand their knowledge base and reaching higher levels of health literacy than men [ 43 ]. A research reported low health literacy and drug adherence based on level of education, indicating that people with low levels of education have difficulty understanding treatment regimens during the diagnosis and treatment of disease, do not understand the proper use of medications and are more inclined to have lower levels of medication literacy [ 39 ]. Additionally, a survey found significant differences in the level of health literacy and drug adherence across all educational levels. Radhi and Balat reported that even in highly educated patients the majority of commonly used medication label instructions are unclear, and misunderstanding; may occur leading to low drug adherence [ 44 ]. Dunning reported educational level predict drug literacy and adherence among diabetic persons in UK. It was discovered that high educational attainment significantly associated with a better understanding of health teaching and instructions [ 45 ]. Results [ 46 ] indicated significant different in health literacy among diabetes patients in Cairo Egypt in relation to level of education, that higher education levels correlate with higher overall adequate health literacy. Other studies [ 33 , 47 , 48 ] reported higher educational attainment was associated with better diabetes patients’ health literacy. With regard to religious beliefs and practices, it was reported that patients are always motivated to adhere to their medication regimens while others suggested that certain religious beliefs may conflict with medical recommendations leading to non-adherence. For instance, Kasahun et al. found that religion predicts drug adherence, with patients having strong religious beliefs observing poor medication adherence [ 49 ]. On the other hand, it was found that people who reported high drug adherence perceived that God controls their health and were found to have good adherence to taking their medication [ 50 ]. It is worthy to note that the discrepancies in health literacy and drug adherence relationship may entail inadequate provision of comprehensive information about relevant medications and inability of patients to accurately comprehend. Disregard of information about medication could be a vital factor contributing to low medication literacy. Patients with lower medication literacy may demonstrate inadequate self-administration behaviour in medication therapy, including medication errors, self-medication abuse, and overdose use [ 51 ]. These behaviours could diminish the effectiveness of medication, raise the risk of adverse drug reactions, and ultimately jeopardize the patient’s health. The relationship between health literacy and drug adherence among diabetes patients in Ebonyi State remains unexplored, presenting a significant gap in the existing literature. Given the impact of health literacy on medication adherence, as evidenced in various international contexts, understanding this dynamic within the population at risk could provide important insight for improving treatment outcomes, especially to health professionals and health educators. Therefore, the present study aimed to investigate the relationship between health literacy and drug adherence among diabetes patients in Ebonyi State, Nigeria. 2 Materials and Methods 2.1 Population and Setting In the month of September 2024 we initiated this cross-sectional study which was completed in the month of March 2025 on a sample of 298 diabetes patients who were attending out-patient clinics at 13 government health facilities; one in each local government area in Ebonyi State, Nigeria. 2.2 Research Tool The study used a researchers-developed 20-item Health Literacy and Drug Adherence Questionnaire (HLDAQ). The items in the questionnaire were gathered from literature on health literacy and drug adherence. The questionnaire consisted of three sections, A, B and C. Section A contained four items on personal data of respondents. Section B contained 14 items that elicited information on health literacy and section C contained six items that elicited information on drug adherence. Five experts from two institutions of higher learning in South East region of Nigeria were used for validating the HLDAQ. Thirty diabetes patients attending routine out patient clinic in three government health facilities in Enugu State, Nigeria responded to the research tool for data quality control. The data yielded high Cronbach alpha (Health Literacy Practices α = 0.89; Drug Adherence α = 0.76) reliability coefficients. The reliability coefficients were higher than a criterion of 0.70 acceptable for good instruments [ 52 ]. The health literacy scale included 14 items which were scored using a 4-point scale (1 = never to 4 = always) with higher scores indicating greater levels of health literacy. For analysis, these items were summed to create an interval scale which could range from 1.0 to 4.0. The drug adherence scale included 6 items which were scored using a 4-point scale (1 = never to 4 = always) with higher scores indicating greater levels of drug adherence. For analysis, these items were summed to create an interval scale which could range from 1.0 to 4.0. Explanatory variables included four personal variables including age, educational level, sex, and religious affiliation. 2.3 Procedure for Data Collection The chief medical directors (CMDs) of the health facilities granted permission to the researchers before data collection. A consent note with the explanation of the research purpose, method of response and assurance of anonymity was attached to each copy of the questionnaire. Consequently 298 copies of the questionnaire were administered on the diabetes patients during out-patient clinic days and were collected immediately after completion. 2.4 Inclusion and Exclusion Criteria Out-patient diabetics who attended clinics from their communities who accepted to participate in the survey were recruited to participate in the study. They read the consent form attached to the questionnaire and willingly accepted to take part. Patients who refused to take part in the study were excluded. Patients who were on admission were also excluded. 2.5 Statistical Analysis Copies of the HLDAQ that had complete information were analyzed. There were 298 copies of the HLDAQ that were administered; however, 290 copies, which represent about 97.3% of the total, were utilized for the analysis of the data. Spearman Brown correlation coefficient and mean scores were used to describe health literacy and drug adherence of the participants. In describing the respondents’ health literacy and drug adherence, a mean score of 2.50 and higher was adjudged high health literacy and high drug adherence and a mean score of less than 2.50 was adjudged the contrary. Standard deviations were used to examine how the responses given by the participants varied. In determining the strength of the relationship, r value of 0.10 to 0.29 was considered low relationship, r value of 0.30 to 0.49 was adjudged moderate relationship, r value of 0.50 to 0.99 was considered high and r value of 1.0 was considered perfect relationship [ 53 ]. Analysis of variance (ANOVA) and t-test were used to determine whether differences observed in mean responses were significant in relation to the participants’ personal characteristics. Stepwise multiple regression analysis was run in order to observe the predictive power of the explanatory variables on health literacy and drug adherence. An alpha level of 0.05 was set for the entire hypotheses. Analysis of data was done with IBM SPSS version 25.0 for windows. 2.6 Ethical approval The procedures involving human participants were done per accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki. The study was approved by Research and Ethics Committee of Ebonyi State Ministry of Health, Abakaliki, Nigeria (Ref. No. EBSU/MOH/ERC/V.54/056/24). Permission was sought and granted by the Chief Medical Directors (CMDs) of the hospitals before data collection. 2.7 Consent to participate Written informed consent to participate was obtained from all subjects before the study. 2.8 Clinical trial Clinical trial number not applicable. 3 Results 3.1 Personal characteristics Out of a total of 290(about 97.3% return rate) diabetes patients who participated in the study returned usable copies of the questionnaire. The mean age of women was 45.5 years with a standard deviation (SD) of ± 2.12 years. One hundred and thirty three (45.9%) belonged to 56 years and above age group. One hundred and fifty nine (54.8%) are males, 104(35.9%) are high education graduates, and 77(26.6%) have no formal education. Furthermore, 239(82.4%) of the respondents are Christians, 33(11.4%) are of African Traditional Religion and only 18(6.2%) are Moslems (Table 1). 3. 2 Health literacy Health literacy of the respondents radiates in the area of understanding the leaflets that come with your drugs, understanding doctor's instruction on how to take prescribed medicine, finding information on healthy activities in case of diabetes type 2, understanding information in the media on how to get healthier, understanding information about your medicine, Understand information relevant on health, understanding information on risk factors and derive meaning from them and differentiating between quacks and authentic health care providers. The overall health literacy (2.60±0.91) indicates that the respondents have a high health literacy level not withstanding areas where the literacy level is low (Table 2). 3.3 Drug adherence Drug adherence among the respondents is shown in the area of forgetting to take your anti-diabetes medicines, stopped taking drugs without telling your doctor, forgetting to bring drugs along while travelling or leaving home, stopped taking drugs when feeling that blood is under control and feeling hassled about sticking to diabetics plan. The overall drug adherence (2.09±0.49) indicates that the respondents’ drug adherence index is low (Table 3). 3.4 Summary of mean, ANOVA and t-test analysis on health literacy Data in Table 4 show the summary of ANOVA and t-test analysis of health literacy in relation to personal characteristics of respondents. The data show that there are significant differences in health literacy in relation to age (F = 14.168, p < 0.05), sex (t = 2.954, p < 0.05), educational level (F = 412.793, p < 0.05), and religion (F = 18.993, p < 0.05). 3.5 Summary of mean, ANOVA and t-test analysis on drug adherence Data in Table 5 show the summary of ANOVA and t-test analysis of drug adherence in relation to personal characteristics of respondents. The data show that there are significant differences in health literacy in relation to age (F = 3.857, p < 0.05), educational level (F = 31.157, p < 0.05), and religion (F = 20.657, p 0.05) appears to be different from other personal characteristics. 3.6 Relationship between health literacy and drug adherence The summary of Pearson correlation of relationship between health literacy and drug adherence is shown in Table 6. The data show positive correlation coefficient score r = 0.570 indicating high relationship. 3.7 Multiple regression analysis of health literacy, drug adherence and personal characteristics diabetes patients Given that the multiple regression (R) value for age is 0.394, which indicates a positive relationship, and that the t-value is 7.283, the p-value is smaller than p = 0.05, which indicates that there is a significant relationship between health literacy and the age of the respondents. Based on the regression weight β value of 0.339, which accounts for 33.9% of the variance in the model, it can be concluded that the predictive value of health literacy in relation to the age of the participants is moderate. There is a tendency for the subjects' sex contributes 31.5% to the model, which indicates that the predictive index of health literacy is often moderate. The fact that there is a significant association between the other characteristics of the participants and their health literacy demonstrates that the personal features of the subjects are capable of predicting their health literacy.The same development appears to hold sway with regard to characteristics of the participants and drug adherence showing that personal characteristics of the subjects could predict drug adherence. An exception is however observed in relation to sex (p = 0.685) which may not have capacity of predicting drug adherence among the subjects (Table 7). 4 Discussion The present study investigated health literacy and drug adherence among diabetes patients in Ebonyi State. The study showed that 133(45.9%) belonged to 56 years and above age group. One hundred and fifty nine (54.8%) are males, 104(35.9%) are high education graduates, and 77(26.6%) have no formal education. Furthermore, 239(82.4%) of the respondents are Christians, 33(11.4%) are of African Traditional Religion and only 18(6.2%) are Moslems. The distribution of these data was not a surprise based on the findings of previous studies that reported majority of DM patients being older than 40 years and those with higher education have a high propensity to be at high risk of DM and could often be seen in the hospital [2, 54]. Results on health literacy showed that the respondents had high health literacy. This result revealed a window for health literacy improvement. The result lent credence to a previous one [28] which reported high health literacy among patients with type 2 diabetes in Jordan. The finding equally corroborates a survey which reported high health literacy level among patients with type 2 diabetes [20]. The high health literacy reported else where [21] is in line with the finding of the present study but contrary to the findings reported in a part of Nigeria that showcased a low level of health literacy among diabetes patients they studied. Therefore, there is need for health professionals to monitor patient’s progress and provide feedback to help them stay on track and provide reminders and tools to patients to assist them when in need [22]. The respondents reported having a low drug adherence. This result was not expected based on the fact that some authorities affirmed the power of high level of health literacy correlate positively with better medication adherence but this observation was different among the group studied [20]. The reason could be that the subjects’ lifestyle might not align with the medication regimen, leading to non-adherence and inadequate patient education coupled with unclear medication instructions. It could also be that most of the subjects are retired civil servants, with little or no income; therefore, most of them cannot afford the drugs and even the young ones among them. This could be the reasons for a lot of life threatening complications that increase the cost management with negative health outcomes. Negative health outcomes may result from a communication gap between a patient’s comprehension ability and a healthcare provider. To combat health illiteracy in diabetes mellitus patients, it is crucial that healthcare professionals and health educators be well-versed in health literacy and have strong communication skills that provide clear, concise and culturally sensitive education about diabetes, medication and adherence by helping the patients develop personalized plans for managing their diabetes and adhering to medication regimens. Data indicated that there are significant differences in health literacy in relation to age (F = 14.168, p < 0.05), sex (t = 2.954, p < 0.05), educational level (F = 412.793, p < 0.05), and religion (F = 18.993, p < 0.05). These findings are in line with a study which reported age and education level differences in health literacy, with younger respondents having greater power of health literacy than other groups. This literacy makes them to understand the various aspects of drug use, such as dosage, duration, and timing compared to older ones [55]. In contrast another study reported no significant difference in health literacy in relation to age [44]. The result on gender corroborates the study which indicated gender differences in health literacy among Korean adults and noted that Korean women had a significantly higher level of health literacy than men in terms of understanding directions on medication bottles. More evidence is shown on other studies that most women report more health problems and use more medical services than men. This might be the result of the conventional role of taking care of sick children and family members. This traditional gender expectation provides women with more interactions with the healthcare system, giving them more opportunities to expand their knowledge base and reaching higher levels of health literacy than men as a consequence [43]. A significant difference in health literacy reported among diabetic persons in UK based on educational level aligns with the report of this study [45]. The author discovered that higher educational attainment significantly associated with a better understanding of health teaching and instructions. Report of this study attest to the finding [46] that significant difference existed in health literacy among diabetes patients in Cairo Egypt in relation to level of education; noting that higher level of education correlate higher overall adequate health literacy. This finding tends to be in agreement with previous studies [33, 47, 48] which reported higher educational attainment was associated with better diabetes health literacy. This might be due to better access to learning opportunities through courses and social media for those who attended college and universities. Data in showed that there were significant differences in the mean values of drug adherence in relation to personal characteristics of respondents, except in sex (p = 0.685) where no significant difference was reported. That gender was not observed to significantly differentiated in the mean drug adherence values was an interesting revelation because according to popular saying in our culture, ‘what a man can do a woman can do it even better’. Based on this the no significant difference was appreciated. However, this finding ran contrary with a previous study that observed that gender was associated with drug adherence [56]. Data indicated positive correlation coefficient score (r = 0.570) between health literacy and drug adherence which indicating high relationship. This finding showed that high health literacy level could correlate positively with better drug adherence. This finding is consistent with previous research, indicating a significant positive correlation between health literacy and medication adherence, showing that high health literacy contributed to a high medication adherence level [20, 26, 27]. This finding corroborated findings of previous studies [28, 36] which reported a significant correlation between health literacy and medication adherence among diabetes patients else where in Nigeria. Furthermore, the findings aligned with research [33] which reported an association between health literacy and medication adherence. However, other studies [31, 42] reported no significant association between literacy and medication adherence failed to concur with the results of the current study. Data showed that age, sex, educational level and religion were capable of predicting health literacy. The findings are not astonishing based on the fact that, as experience shows, the propensity to do things well increases as one grows old. Therefore, age being a predictor and associated with health literacy [57] was interesting proving the psychology of human development correct [58]. Sex, educational level and religion were observed to be capable of predicting health literacy [59]. These findings were not amazing based on the fact that the area under survey is a male dominated area even the category of the sex that contributed to the prediction was not isolated. Any of the two sexes may have contributed to the prediction. In relation to educational level, secondary and tertiary education levels may have contributed immensely to the predication in agreement with previous reports [55, 60]. Nigeria in general and Ebonyi State in particular, is a Christian dominated society as a result; religion being a predictor of health literacy was not disappointing. Results showed that age, level of education and religion of the subjects could predict drug adherence but an exception is however observed in relation to sex (p = 0.685) which may not have capacity of predicting drug adherence among the subjects. These findings tend to align with report advanced in a previous study confirming the prediction power of gender in drug adherence [56]. However, an earlier study had reported that age predicted drug adherence among diabetes patients else where in Nigeria [61]. In another study, it was reported that age predicted drug adherence and that between 36-93% of diabetes patients studied did not keep to the prescription of diabetes medications therapy for several months because of cost of medication [62]. A previous study’s results showed that age and level of education predicted drug adherence and that inadequate health literacy was more predominant among susceptible people, such as the aged, minorities and illiterates [63]. On the other hand, it was reported else where that religious beliefs predicted drug adherence, that people who reported high drug adherence perceived that God controls their health and were found to have good adherence to taking their medication [50]. Also, yet in another survey it was reported that religion predicted drug adherence but patients with strong religious beliefs had poor medication adherence. This current evidence base presents mixed results regarding the relationship between religiosity and medication adherence [49]. Therefore, more research is needed to understand the mechanisms through which religiosity influences medication adherence and to develop culturally sensitive intervention. 4.1 Study Limitations and Strengths Out of the numerous numbers of hospitals, both government-owned and private-owned in Ebonyi State, the study was delimited one government hospital in each of the 13 local government areas in the state. The in-patient diabetics were not included in study thereby creating a vacuum in the population of diabetes patients in the area under survey. The study used was a paper and pencil survey and as a result the information supplied by the respondents was not monitored, therefore deficiencies suffered by surveys may limit the generalization strength of the findings. The diabetes patients studied might represent a generous number of diabetes patients in Ebonyi State and the information that was gathered would be helpful in establishing treatment protocols for future patients in Nigeria in general and Ebonyi State in particular as well as other third world countries in Africa that would possibly have a culture that is similar to Ebonyi State. 5 Conclusion The present study concluded that the respondents had high health literacy but had low drug adherence. Age, sex, educational level and religion predicted health literacy and drug adherence among the diabetes patients. However, sex was not capable of predicting drug adherence. This could necessitate the implementation of educational campaigns for enhancing medication adherence among patients with diabetes as evidence showed that patients with high health literacy may still experience low adherence. More so, healthcare providers should consider addressing complexity of regimen, personal beliefs and attitudes, lifestyle and environmental and psychological factors when developing treatment plans for diabetes patients with higher health literacy. Declarations Acknowledgements The authors are pleased with the Chief Medical Directors (CMDs) of the government health facilities that provided the setting for the study and the patients who responded to the survey tool. The researchers are very grateful to the authors whose studied are used in this article. The authors are grateful to their colleagues who read through the manuscript and Ruth Eshina Udu, the principal typist of Ave Maria Computer Services, Abakaliki, Nigeria who typed the document. Availability of data and materials Data supporting the findings of the study are available from the corresponding author (ION) upon sensible request. Conflicts of interests No conflicts of interest declared. Consent for publication All the authors agreed to publish the article. Funding The authors did not receive any financial support for this study and publication of the article. Author Contribution ION: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Supervision; Visualization; Writing-original draft; Writing-review and editing; BON: Data curation; Formal analysis; Investigation; Methodology; Supervision; Visualization; Writing-original draft; NAE: Formal analysis; Writing-original draft; Investigation; RNO: Formal analysis; Writing-original draft; Investigation; DNA: Formal analysis; Writing-original draft; Investigation; CIO: Formal analysis; Writing-original draft; Investigation; WOO: Formal analysis; Writing-original draft; Supervision; DCE: Data curation; Writing-original draft; Formal analysis; Methodology; Supervision; Writing-review and editing. All the authors reviewed and edited the final manuscript. 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Usman NO, Muhammad MI, Nwankwo B, Usman OA. Prevalence and determinants of medication adherence in patients with multi-morbidities attending general outpatient clinics in secondary health care facilities in Kaduna State. J Comm Med Pri Health Care. 2022;34(3):140–52. https://dx.doi.org/10.4314/jcmphc.v34i3.11 . Tables Table 1 Personal characteristics Variables Frequency (f) Percentage (%) Age 18–25 9 3.1 26–35 24 8.3 36–45 39 13.4 46–55 85 29.3 56 & above 133 45.9 Sex Male 159 54.8 Female 131 45.2 Educational level Non Formal 77 26.6 Primary 42 14.5 Secondary 67 23.1 Tertiary 104 35.9 Religion Christianity 239 82.4 Islam 18 6.2 African Traditional Religion 33 11.4 Table 2 Health literacy S/N Variables Mean SD Dec. 1. Understanding the leaflets that come with your drugs 2.64 1.16 H 2. Understand doctor's instruction on how to take prescribed medicine 2.99 1.14 H 3. Understand pharmacist's instruction 2.42 0.99 L 4. Follow the instructions on the medications 2.39 1.04 L 5. Find information on healthy activities in case of diabetes type 11 3.41 0.99 H 6. Understand information in the media on how to get healthier 2.56 1.02 H 7. Read written information about your medicine 2.36 0.98 L 8. Understand information about your medicine 2.97 1.29 H 9. Understand information on determinants of health in the social environment 2.17 1.00 L 10. Understand information on determinants of health in physical environment 2.15 0.99 L 11. Understand information relevant on health 2.68 1.08 H 12. Understand medical information and derive meaning from them 1.90 0.94 L 13. Understand information on risk factors and derive meaning from them 2.56 1.04 H 14. Differentiate between quacks and authentic health care providers 3.19 0.97 H Overall 2.60 0.91 H Table 3 Drug adherence S/N Variables Mean SD Dec. 15. Take your anti-diabetic drug 3.84 0.49 H 16. Forget to take your anti-diabetic medicines 1.84 0.82 L 17. Stopped taking your drug without telling your doctor 1.69 0.81 L 18. Forget bringing your drug along while travelling or leaving home 1.64 0.66 L 19. Stopped taking your drug when you feel that your blood is under control 1.36 0.68 L 20. Feel hassled about sticking to your diabetics plan 2.16 0.98 L Overall 2.09 0.49 L Table 4 Summary of mean, ANOVA and t-test analysis on health literacy Variables N Mean SD Obtained value p-value Age (years) 18–25 9 3.34 0.54 26–35 24 3.17 0.45 36–45 39 3.08 0.59 F = 14.168* 0.000 46–55 85 2.70 0.81 56 & above 133 2.24 0.98 Sex Male 159 2.74 0.83 t = 2.954* 0.003 Female 131 2.43 0.98 Educational level Non Formal 77 1.34 0.34 Primary 42 2.36 0.41 F = 412.793* 0.000 Secondary 67 3.03 0.44 Tertiary 104 3.35 0.41 Religion Christianity 239 2.74 0.86 Islam 18 1.87 0.95 F = 18.993* 0.000 ATR 33 1.95 0.85 * Significant at p < 0.05, ATR = African Traditional Religion Table 5 Summary of mean, ANOVA and t-test analysis on drug adherence Variables N Mean SD Obtained value p-value Age (years) 18–25 9 1.72 0.38 26–35 24 1.92 0.38 36–45 39 2.03 0.56 F = 3.857* 0.005 46–55 85 2.05 0.45 56 & above 133 2.19 0.49 Sex Male 159 2.08 0.49 t = 0.406 0.685 Female 131 2.10 0.49 Educational level Non Formal 77 2.41 0.43 Primary 42 2.29 0.40 F = 31.157* 0.000 Secondary 67 1.99 0.50 Tertiary 104 1.84 0.37 Religion Christianity 239 2.01 0.46 Islam 18 2.39 0.42 F = 20.657* 0.000 ATR 33 2.50 0.45 Table 6 Relationship between health literacy and drug adherence Variables Health Literacy Drug Adherence Health Literacy Pearson Correlation 1 0.570** Sig. (2-tailed) p < 0.001 N 290 290 Drug Adherence Pearson Correlation 0.570** 1 Sig. (2-tailed) p < 0.001 N 290 290 ** Correlation is significant at the p < 0.001 level (2-tailed) Table 7 Summary of multiple regression analysis of health literacy, drug adherence and personal characteristics diabetes patients Variables a,b 95% CI for B R R 2 β SE t p Lower Bound Upper Bound Age 0.394 0.156 0.329 0.045 7.283 0.000 0.418 0.240 Sex 0.171 0.029 0.315 0.107 2.954 0.003 0.524 0.105 Educational level 0.882 0.778 0.665 0.021 31.782 0.000 0.624 0.707 Religion 0.320 0.102 0.443 0.077 5.724 0.000 0.596 0.291 Variables c,d Age 0.220 0.048 0.098 0.026 3.822 0.000 0.047 0.148 Sex 0.024 0.001 0.023 0.058 0.406 0.685 0.090 0.137 Educational level 0.492 0.242 0.198 0.021 9.591 0.000 0.238 0.157 Religion 0.349 0.122 0.258 0.041 6.320 0.000 0.178 0.338 a. Personal characteristics (Predictor) b. Health literacy c. Personal characteristics (Predictor) d. Drug adherence Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Ogar","email":"","orcid":"","institution":"Federal University, Birnin Kebbi","correspondingAuthor":false,"prefix":"","firstName":"Walter","middleName":"O.","lastName":"Ogar","suffix":""},{"id":563647842,"identity":"a61b9bbc-a4b9-41ee-80a5-026030234782","order_by":7,"name":"Dom C. Enamhi","email":"","orcid":"","institution":"University of Calabar","correspondingAuthor":false,"prefix":"","firstName":"Dom","middleName":"C.","lastName":"Enamhi","suffix":""}],"badges":[],"createdAt":"2025-11-09 13:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8069199/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8069199/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99307283,"identity":"2bd8c3f7-2983-4d86-a3ef-5b5fc58de338","added_by":"auto","created_at":"2025-12-31 16:05:54","extension":"doc","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":297984,"visible":true,"origin":"","legend":"","description":"","filename":"HealthLiteracyandDrugAdherenceamongDiabetesPatientsinEbonyiState.doc","url":"https://assets-eu.researchsquare.com/files/rs-8069199/v1/9d0bd0ed44867fff18ecc5a3.doc"},{"id":99307213,"identity":"6eb5fbfd-d02b-4060-bf4c-d8d6035491c8","added_by":"auto","created_at":"2025-12-31 16:05:49","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":177664,"visible":true,"origin":"","legend":"","description":"","filename":"Tables17.doc","url":"https://assets-eu.researchsquare.com/files/rs-8069199/v1/e0b1e0177447a87bfc4b7083.doc"},{"id":98813807,"identity":"9da1f261-e84a-4047-a7df-6389eaf76f5b","added_by":"auto","created_at":"2025-12-22 15:58:14","extension":"json","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":10405,"visible":true,"origin":"","legend":"","description":"","filename":"fe158d5826ba4bf38d06d525429b1528.json","url":"https://assets-eu.researchsquare.com/files/rs-8069199/v1/8d55c5d1b401ea4227d04afd.json"},{"id":99307254,"identity":"8a465cbb-893b-4c87-8fbd-41c52cde4f93","added_by":"auto","created_at":"2025-12-31 16:05:53","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":231599,"visible":true,"origin":"","legend":"","description":"","filename":"fe158d5826ba4bf38d06d525429b15281enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8069199/v1/5dc4fa3c829a17ca99df09da.xml"},{"id":98813811,"identity":"1d51f536-9280-43f2-bb86-759ab3dc0968","added_by":"auto","created_at":"2025-12-22 15:58:14","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":228349,"visible":true,"origin":"","legend":"","description":"","filename":"fe158d5826ba4bf38d06d525429b15281structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8069199/v1/8d4c1b637d91fc36ee3f2281.xml"},{"id":98813809,"identity":"e034d9df-aec0-4611-a9cd-cfd8bdb39e22","added_by":"auto","created_at":"2025-12-22 15:58:14","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":245341,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8069199/v1/3f1c0a01a0d252f21a9832c6.html"},{"id":104531974,"identity":"5316462f-f95c-4b75-b153-0afdc1896338","added_by":"auto","created_at":"2026-03-13 02:25:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1225201,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8069199/v1/9e8db30a-247a-4944-b989-a2bc1ed5436c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Health Literacy and Drug Adherence among Diabetes Patients in Ebonyi State: A Cross-Sectional Survey","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eDiabetes has been recognized as a significant global health issue. International Diabetes Federation (IDF) reported that there are approximately 425\u0026nbsp;million individuals living with diabetes globally with nearly 50% of them undiagnosed [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It was noted that diabetes is a risk factor for various complications such as blindness, vascular brain diseases and renal failure. Other complications associated with diabetes include damage to the brain, heart, kidneys and limbs [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In Nigeria, about 3.9\u0026nbsp;million adults lived with diabetes in 2019 and the number is projected to double by 2045 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Authors observed that about 29.5% of individuals living with diabetes in Nigeria are unaware of their condition [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, health literacy has been considered as a determinant in the health-disease process reduction and most of the components of diabetes management rely on the involvement and the ability of patients to adhere, making health literacy an important factor that can influence the management of their disease [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe term literacy (HL) refers to the development of the learning process of reading and writing [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. HL is a person\u0026rsquo;s ability to obtain and understand health information and the basic services available that may favor self-care actions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. HL might also be conceptualized as the ability of an individual to obtain and translate knowledge and information in order to maintain and improve health in a way that is appropriate to the individual and system contexts [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This ability helps people to make appropriate healthcare decisions, understand health risk behaviours, enhance health outcomes and reduce the cost of care in ways that might benefit their health [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In this direction, patients classified as adequate in HL are those who have basic reading, writing and numerical skills, which may favour their participation in the care plan, from planning to the evaluation of the results of the proposed therapeutic actions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. HL has four domains, namely: functional, communicative, critical and numeracy. Functional literacy is the basic level of health literacy that pertains to a patient\u0026rsquo;s reading and writing skills. Communicative literacy is the advanced level of health literacy that pertains to a patient\u0026rsquo;s ability to extract and apply information. Critical health literacy refers to a patient\u0026rsquo;s ability to critically analyze and use information for a greater control over situations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Numeracy broadly refers to the ability of a person to understand and use numbers in his or her daily life [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Diabetes-related numeracy specifically refers to the skills needed in the context of diabetes management which can include interpretation of blood glucose, self- monitoring results, administration or intake of diabetes medicines in correct amounts and following nutritional recommendations [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHL is crucial for effective self-care of chronic conditions and the maintenance of overall health. HL empowers patients by enhancing their ability to navigate the healthcare system, understand medical instructions, and recognize the significance of continuous medication adherence [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It plays a significant role in the healthcare system [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] as emphasized by the World Health Organization, which recommends health literacy as a tool to achieve several key health improvements in drug adherence targets [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Drug adherence is the process by which patients take the medications as prescribed by the healthcare provider [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. It could also be seen as the degree to which a person\u0026rsquo;s behaviour corresponds with the agreed recommendations from a health care provider [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEmpirically, a studies reported high health literacy level among patients with type 2 diabetes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. On the contrary, another study reported low level of health literacy among diabetes patients [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Many studies affirmed that health literacy has a direct impact on medication adherence. For example, studies conducted across different countries have reported a statistically significant and positive association between health literacy and medication adherence [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Studies [\u003cspan additionalcitationids=\"CR26 CR27\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] further reported a significant positive correlation between health literacy and medication adherence, indicating that higher health literacy could contribute to higher medication adherence levels. Some other studies reported a positive association between health literacy and medication adherence, but did not support a strong association [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Yet other studies and systematic reviews have reported no direct association between health literacy and medication adherence [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt was observed that low HL can contribute to the appearance and aggravation of several chronic non-communicable diseases (CNCD), such as diabetes mellitus (DM). Tefera\u003csup\u003e33\u003c/sup\u003e reported an association between health literacy and medication adherence. Further more, Garcia et al. [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] found no association between health literacy and drug adherence but Thurston et al. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] reported a positive relationship between health literacy and ability to remember taking medications only. Significant associations between health literacy and medication adherence were reported [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Moreover, a study [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] had found an association between health literacy and medication adherence in patients with type 2 diabetes. The authors noted that patients with higher health literacy levels tended to have better medication adherence and glycemic control.\u003c/p\u003e \u003cp\u003eThe above studies suggest a relationship between health literacy and adherence to medication among diabetes patients and other sick people. However, according to Krass et al., the correlations between health literacy and drug adherence have been far from perfect, suggesting that not all sick individuals that encounter equivalent or non-adherence to medication share the same risk of susceptibility [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. This may, however, be the case of diabetes patients in Ebonyi state. There was need therefore to investigate the association between health literacy and drug adherence among the diabetes patients, at least, to determine their present condition.\u003c/p\u003e \u003cp\u003eIt is important to note that some socio-demographic variables like age, gender, level of education and religion might play significant role in health literacy and drug adherence. For instance, it was reported that as age increases there is the propensity to encounter low health literacy and drug adherence [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This state of affairs may arise because as age increases, elderly patients\u0026rsquo; comprehension, attention, and memory decline to varying degrees, coupled with a greater number of prescribed medications and complex medication regimens, leading to their limited knowledge about medication management. It was reported that significant differences existed in the level of health literacy and drug adherence based on age and the study\u0026rsquo;s findings provided additional evidence that the younger respondents understood the study\u0026rsquo;s focus on various aspects of drug use, such as dosage, duration, and timing [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. In contrast, Johnson found no significant difference in health literacy in relation to age [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn relation to gender, a study reported differences in the level of health literacy and drug adherence and affirmed that women may experience different challenges compared to men in managing health conditions due to variations in health literacy levels and attributed it to the social and cultural factors that influence how health information acted upon by different genders [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. However, a positive correlation was reported between health literacy and medication adherence among Jordanian T2DM patients by gender [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Among Korean adults, it was reported that Korean women had a significantly higher level of health literacy than men in terms of understanding directions on medication bottles. It was noted that the traditional gender expectation provides women with more interactions with the healthcare system, giving them more opportunities to expand their knowledge base and reaching higher levels of health literacy than men [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA research reported low health literacy and drug adherence based on level of education, indicating that people with low levels of education have difficulty understanding treatment regimens during the diagnosis and treatment of disease, do not understand the proper use of medications and are more inclined to have lower levels of medication literacy [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Additionally, a survey found significant differences in the level of health literacy and drug adherence across all educational levels. Radhi and Balat reported that even in highly educated patients the majority of commonly used medication label instructions are unclear, and misunderstanding; may occur leading to low drug adherence [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Dunning reported educational level predict drug literacy and adherence among diabetic persons in UK. It was discovered that high educational attainment significantly associated with a better understanding of health teaching and instructions [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Results [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] indicated significant different in health literacy among diabetes patients in Cairo Egypt in relation to level of education, that higher education levels correlate with higher overall adequate health literacy. Other studies [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e] reported higher educational attainment was associated with better diabetes patients\u0026rsquo; health literacy.\u003c/p\u003e \u003cp\u003eWith regard to religious beliefs and practices, it was reported that patients are always motivated to adhere to their medication regimens while others suggested that certain religious beliefs may conflict with medical recommendations leading to non-adherence. For instance, Kasahun et al. found that religion predicts drug adherence, with patients having strong religious beliefs observing poor medication adherence [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. On the other hand, it was found that people who reported high drug adherence perceived that God controls their health and were found to have good adherence to taking their medication [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is worthy to note that the discrepancies in health literacy and drug adherence relationship may entail inadequate provision of comprehensive information about relevant medications and inability of patients to accurately comprehend. Disregard of information about medication could be a vital factor contributing to low medication literacy. Patients with lower medication literacy may demonstrate inadequate self-administration behaviour in medication therapy, including medication errors, self-medication abuse, and overdose use [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. These behaviours could diminish the effectiveness of medication, raise the risk of adverse drug reactions, and ultimately jeopardize the patient\u0026rsquo;s health.\u003c/p\u003e \u003cp\u003eThe relationship between health literacy and drug adherence among diabetes patients in Ebonyi State remains unexplored, presenting a significant gap in the existing literature. Given the impact of health literacy on medication adherence, as evidenced in various international contexts, understanding this dynamic within the population at risk could provide important insight for improving treatment outcomes, especially to health professionals and health educators. Therefore, the present study aimed to investigate the relationship between health literacy and drug adherence among diabetes patients in Ebonyi State, Nigeria.\u003c/p\u003e"},{"header":"2 Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Population and Setting\u003c/h2\u003e \u003cp\u003e In the month of September 2024 we initiated this cross-sectional study which was completed in the month of March 2025 on a sample of 298 diabetes patients who were attending out-patient clinics at 13 government health facilities; one in each local government area in Ebonyi State, Nigeria.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 \u003cb\u003eResearch Tool\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe study used a researchers-developed 20-item Health Literacy and Drug Adherence Questionnaire (HLDAQ). The items in the questionnaire were gathered from literature on health literacy and drug adherence. The questionnaire consisted of three sections, A, B and C. Section A contained four items on personal data of respondents. Section B contained 14 items that elicited information on health literacy and section C contained six items that elicited information on drug adherence. Five experts from two institutions of higher learning in South East region of Nigeria were used for validating the HLDAQ. Thirty diabetes patients attending routine out patient clinic in three government health facilities in Enugu State, Nigeria responded to the research tool for data quality control. The data yielded high Cronbach alpha (Health Literacy Practices α\u0026thinsp;=\u0026thinsp;0.89; Drug Adherence α\u0026thinsp;=\u0026thinsp;0.76) reliability coefficients. The reliability coefficients were higher than a criterion of 0.70 acceptable for good instruments [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe health literacy scale included 14 items which were scored using a 4-point scale (1\u0026thinsp;=\u0026thinsp;never to 4\u0026thinsp;=\u0026thinsp;always) with higher scores indicating greater levels of health literacy. For analysis, these items were summed to create an interval scale which could range from 1.0 to 4.0.\u003c/p\u003e \u003cp\u003eThe drug adherence scale included 6 items which were scored using a 4-point scale (1\u0026thinsp;=\u0026thinsp;never to 4\u0026thinsp;=\u0026thinsp;always) with higher scores indicating greater levels of drug adherence. For analysis, these items were summed to create an interval scale which could range from 1.0 to 4.0. Explanatory variables included four personal variables including age, educational level, sex, and religious affiliation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Procedure for Data Collection\u003c/h2\u003e \u003cp\u003eThe chief medical directors (CMDs) of the health facilities granted permission to the researchers before data collection. A consent note with the explanation of the research purpose, method of response and assurance of anonymity was attached to each copy of the questionnaire. Consequently 298 copies of the questionnaire were administered on the diabetes patients during out-patient clinic days and were collected immediately after completion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Inclusion and Exclusion Criteria\u003c/h2\u003e \u003cp\u003eOut-patient diabetics who attended clinics from their communities who accepted to participate in the survey were recruited to participate in the study. They read the consent form attached to the questionnaire and willingly accepted to take part. Patients who refused to take part in the study were excluded. Patients who were on admission were also excluded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical Analysis\u003c/h2\u003e \u003cp\u003eCopies of the HLDAQ that had complete information were analyzed. There were 298 copies of the HLDAQ that were administered; however, 290 copies, which represent about 97.3% of the total, were utilized for the analysis of the data. Spearman Brown correlation coefficient and mean scores were used to describe health literacy and drug adherence of the participants. In describing the respondents\u0026rsquo; health literacy and drug adherence, a mean score of 2.50 and higher was adjudged high health literacy and high drug adherence and a mean score of less than 2.50 was adjudged the contrary. Standard deviations were used to examine how the responses given by the participants varied. In determining the strength of the relationship, r value of 0.10 to 0.29 was considered low relationship, r value of 0.30 to 0.49 was adjudged moderate relationship, r value of 0.50 to 0.99 was considered high and r value of 1.0 was considered perfect relationship [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Analysis of variance (ANOVA) and t-test were used to determine whether differences observed in mean responses were significant in relation to the participants\u0026rsquo; personal characteristics. Stepwise multiple regression analysis was run in order to observe the predictive power of the explanatory variables on health literacy and drug adherence. An alpha level of 0.05 was set for the entire hypotheses. Analysis of data was done with IBM SPSS version 25.0 for windows.\u003c/p\u003e \u003c/div\u003e\n\u003ch2\u003e2.6 Ethical approval \u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe procedures involving human participants were done per accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki. The study was approved by Research and Ethics Committee of Ebonyi State Ministry of Health, Abakaliki, Nigeria (Ref. No. EBSU/MOH/ERC/V.54/056/24). Permission was sought and granted by the Chief Medical Directors (CMDs) of the hospitals before data collection.\u003c/p\u003e\n\u003ch2\u003e2.7 Consent to participate\u003c/h2\u003e\n\u003cp\u003eWritten informed consent to participate was obtained from all subjects before the study.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e2.8 Clinical trial\u003c/h2\u003e\n\u003cp\u003eClinical trial number not applicable.\u003c/p\u003e"},{"header":"3 Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Personal characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of a total of 290(about 97.3% return rate) diabetes patients who participated in the study returned usable copies of the questionnaire. The mean age of women was 45.5 years with a standard deviation (SD) of \u0026plusmn; 2.12 years. One hundred and thirty three (45.9%) belonged to 56 years and above age group. One hundred and fifty nine (54.8%) are males, 104(35.9%) are high education graduates, and 77(26.6%) have no formal education. Furthermore, 239(82.4%) of the respondents are Christians, 33(11.4%) are of African Traditional Religion and only 18(6.2%) are Moslems (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.\u003c/strong\u003e2 \u003cstrong\u003eHealth literacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth literacy of the respondents radiates in the area of understanding the leaflets that come with your drugs, understanding doctor\u0026apos;s instruction on how to take prescribed medicine, finding information on healthy activities in case of diabetes type 2, understanding information in the media on how to get healthier, understanding information about your medicine, Understand information relevant on health, understanding information on risk factors and derive meaning from them and differentiating between quacks and authentic health care providers. The overall health literacy (2.60\u0026plusmn;0.91) indicates that the respondents have a high health literacy level not withstanding areas where the literacy level is low (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Drug adherence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDrug adherence among the respondents is shown in the area of forgetting to take your anti-diabetes medicines, stopped taking drugs without telling your doctor, forgetting to \u0026nbsp;bring drugs along while travelling or leaving home, stopped taking drugs when feeling that blood is under control and feeling hassled about sticking to diabetics plan. The overall drug adherence (2.09\u0026plusmn;0.49) indicates that the respondents\u0026rsquo; drug adherence index is low (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Summary of mean, ANOVA and t-test analysis on health literacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData in Table 4 show the summary of ANOVA and t-test analysis of health literacy in relation to personal characteristics of respondents. The data show that there are significant differences in health literacy in relation to age (F = 14.168, p \u0026lt; 0.05), sex (t = 2.954, p \u0026lt; 0.05), educational level (F = 412.793, p \u0026lt; 0.05), and religion (F = 18.993, p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Summary of mean, ANOVA and t-test analysis on drug adherence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData in Table 5 show the summary of ANOVA and t-test analysis of drug adherence in relation to personal characteristics of respondents. The data show that there are significant differences in health literacy in relation to age (F = 3.857, p \u0026lt; 0.05), educational level (F = 31.157, p \u0026lt; 0.05), and religion (F = 20.657, p \u0026lt; 0.05). However, sex (t = 0.406, p \u0026gt; 0.05) appears to be different from other personal characteristics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.6 Relationship between health literacy and drug adherence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe summary of Pearson correlation of relationship between health literacy and drug adherence is shown in Table 6. The data show positive correlation coefficient score r = 0.570 indicating high relationship.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.7 \u0026nbsp;Multiple regression analysis of health literacy, drug adherence and personal characteristics diabetes patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGiven that the multiple regression (R) value for age is 0.394, which indicates a positive relationship, and that the t-value is 7.283, the p-value is smaller than p = 0.05, which indicates that there is a significant relationship between health literacy and the age of the respondents. Based on the regression weight \u0026beta; value of 0.339, which accounts for 33.9% of the variance in the model, it can be concluded that the predictive value of health literacy in relation to the age of the participants is moderate. There is a tendency for the subjects\u0026apos; sex contributes 31.5% to the model, which indicates that the predictive index of health literacy is often moderate. The fact that there is a significant association between the other characteristics of the participants and their health literacy demonstrates that the personal features of the subjects are capable of predicting their health literacy.The same development appears to hold sway with regard to characteristics of the participants and drug adherence showing that personal characteristics of the subjects could predict drug adherence. An exception is however observed in relation to sex (p = 0.685) which may not have capacity of predicting drug adherence among the subjects (Table 7).\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThe present study investigated health literacy and drug adherence among diabetes patients in Ebonyi State. The study showed that 133(45.9%) belonged to 56 years and above age group. One hundred and fifty nine (54.8%) are males, 104(35.9%) are high education graduates, and 77(26.6%) have no formal education. Furthermore, 239(82.4%) of the respondents are Christians, 33(11.4%) are of African Traditional Religion and only 18(6.2%) are Moslems. The distribution of these data was not a surprise based on the findings of previous studies that reported majority of DM patients being older than 40 years and those with higher education have a high propensity to be at high risk of DM and could often be seen in the hospital [2, 54].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults on health literacy showed that the respondents had high health literacy. This result revealed a window for health literacy improvement. The result lent credence to a previous one [28] which reported high health literacy among patients with type 2 diabetes in Jordan. The finding equally corroborates a survey which reported high health literacy level among patients with type 2 diabetes [20]. The high health literacy reported else where [21] is in line with the finding of the present study but contrary to the findings reported in a part of Nigeria that showcased a low level of health literacy among diabetes patients they studied. Therefore, there is need for health professionals to monitor patient\u0026rsquo;s progress and provide feedback to help them stay on track and provide reminders and tools to patients to assist them when in need [22].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe respondents reported having a low drug adherence. This result was not expected based on the fact that some authorities affirmed the power of high level of health literacy correlate positively with better medication adherence but this observation was different among the group studied [20]. The reason could be that the subjects\u0026rsquo; lifestyle might not align with the medication regimen, leading to non-adherence and inadequate patient education coupled with unclear medication instructions. It could also be that most of the subjects are retired civil servants, with little or no income; therefore, most of them cannot afford the drugs and even the young ones among them. This could be the reasons for a lot of life threatening complications that increase the cost management with negative health outcomes. Negative health outcomes may result from a communication gap between a patient\u0026rsquo;s comprehension ability and a healthcare provider. To combat health illiteracy in diabetes mellitus patients, it is crucial that healthcare professionals and health educators be well-versed in health literacy and have strong communication skills that provide clear, concise and culturally sensitive education about diabetes, medication and adherence by helping the patients develop personalized plans for managing their diabetes and adhering to medication regimens.\u003c/p\u003e\n\u003cp\u003eData indicated that there are significant differences in health literacy in relation to age (F = 14.168, p \u0026lt; 0.05), sex (t = 2.954, p \u0026lt; 0.05), educational level (F = 412.793, p \u0026lt; 0.05), and religion (F = 18.993, p \u0026lt; 0.05). These findings are in line with a study which reported age and education level differences in health literacy, with younger respondents having greater power of health literacy than other groups. This literacy makes them to understand the various aspects of drug use, such as dosage, duration, and timing compared to older ones [55]. In contrast another study reported no significant difference in health literacy in relation to age [44].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe result on gender corroborates the study which indicated gender differences in health literacy among Korean adults and noted that Korean women had a significantly higher level of health literacy than men in terms of understanding directions on medication bottles. More evidence is shown on other studies that most women report more health problems and use more medical services than men. This might be the result of the conventional role of taking care of sick children and family members. This traditional gender expectation provides women with more interactions with the healthcare system, giving them more opportunities to expand their knowledge base and reaching higher levels of health literacy than men as a consequence [43].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA significant difference in health literacy reported among diabetic persons in UK based on educational level aligns with the report of this study [45]. The author discovered that higher educational attainment significantly associated with a better understanding of health teaching and instructions. Report of this study attest to the finding [46] that significant difference existed in health literacy among diabetes patients in Cairo Egypt \u0026nbsp; in relation to level of education; noting that higher level of education correlate higher overall adequate health literacy. This finding tends to be in agreement with previous studies [33, 47, 48] which reported higher educational attainment was associated with better diabetes health literacy. This might be due to better access to learning opportunities through courses and social media for those who attended college and universities.\u003c/p\u003e\n\u003cp\u003eData in showed that there were significant differences in the mean values of drug adherence in relation to personal characteristics of respondents, except in sex (p = 0.685) where no significant difference was reported. That gender was not observed to significantly differentiated in the mean drug adherence values was an interesting revelation because according to popular saying in our culture, \u0026lsquo;what a man can do a woman can do it even better\u0026rsquo;. Based on this the no significant difference was appreciated. However, this finding ran contrary with a previous study that observed that gender was associated with drug adherence [56].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData indicated positive correlation coefficient score (r = 0.570) between health literacy and drug adherence which indicating high relationship. This finding showed that high health literacy level could correlate positively with better drug adherence. This finding is consistent with previous research, indicating a significant positive correlation between health literacy and medication adherence, showing that high health literacy contributed to a high medication adherence level [20, 26, 27]. This finding corroborated findings of previous studies [28, 36] which reported a significant correlation between health literacy and medication adherence among diabetes patients else where in Nigeria. Furthermore, the findings aligned with research [33] which reported an association between health literacy and medication adherence. However, other studies [31, 42] reported no significant association between literacy and medication adherence failed to concur with the results of the current study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData showed that age, sex, educational level and religion were capable of predicting health literacy. The findings are not astonishing based on the fact that, as experience shows, the propensity to do things well increases as one grows old. Therefore, age being a predictor and associated with health literacy [57] was interesting proving the psychology of human development correct [58]. Sex, educational level and religion were observed to be capable of predicting health literacy [59]. These findings were not amazing based on the fact that the area under survey is a male dominated area even the category of the sex that contributed to the prediction was not isolated. Any of the two sexes may have contributed to the prediction. In relation to educational level, secondary and tertiary education levels may have contributed immensely to the predication in agreement with previous reports [55, 60]. Nigeria in general and Ebonyi State in particular, is a Christian dominated society as a result; religion being a predictor of health literacy was not disappointing. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults showed that age, level of education and religion \u0026nbsp;of the subjects could predict drug adherence but an exception is however observed in relation to sex (p = 0.685) which may not have capacity of predicting drug adherence among the subjects. These findings tend to align with report advanced in a previous study confirming the prediction power of gender in drug adherence [56]. However, an earlier study had reported that age\u0026nbsp;predicted drug adherence among diabetes patients else where in Nigeria [61]. In another study, it was reported that age predicted drug adherence and that between 36-93% of diabetes patients studied did not keep to the prescription of diabetes medications therapy for several months because of cost of medication [62]. A previous study\u0026rsquo;s results showed that age and level of education predicted drug adherence and that inadequate health literacy was more predominant among susceptible people, such as the aged, minorities and illiterates [63].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn the other hand, it was reported else where that religious beliefs predicted drug adherence, that people who reported high drug adherence perceived that God controls their health and were found to have good adherence to taking their medication [50]. Also, yet in another survey it was reported that religion predicted drug adherence but patients with strong religious beliefs had poor medication adherence. This current evidence base presents mixed results regarding the relationship between religiosity and medication adherence [49]. Therefore, more research is needed to understand the mechanisms through which religiosity influences medication adherence and to develop culturally sensitive intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 Study Limitations and Strengths\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the numerous numbers of hospitals, both government-owned and private-owned in Ebonyi State, the study was delimited one government hospital in each of the 13 local government areas in the state. The in-patient diabetics were not included in study thereby creating a vacuum in the population of diabetes patients in the area under survey. The study used was a paper and pencil survey and as a result the information supplied by the respondents was not monitored, therefore deficiencies suffered by surveys may limit the generalization strength of the findings. The diabetes patients studied might represent a generous number of diabetes patients in Ebonyi State and the information that was gathered would be helpful in establishing treatment protocols for future patients in Nigeria in general and Ebonyi State in particular as well as other third world countries in Africa that would possibly have a culture that is similar to Ebonyi State.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThe present study concluded that the respondents had high health literacy but had low drug adherence. Age, sex, educational level and religion predicted health literacy and drug adherence among the diabetes patients. However, sex was not capable of predicting drug adherence. This could necessitate the implementation of educational campaigns for enhancing medication adherence among patients with diabetes as evidence showed that patients with high health literacy may still experience low adherence. More so, healthcare providers should consider addressing complexity of regimen, personal beliefs and attitudes, lifestyle and environmental and psychological factors when developing treatment plans for diabetes patients with higher health literacy.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are pleased with the Chief Medical Directors (CMDs) of the government health facilities that provided the setting for the study and the patients who responded to the survey tool. The researchers are very grateful to the authors whose studied are used in this article. The authors are grateful to their colleagues who read through the manuscript and Ruth Eshina Udu, the principal typist of Ave Maria Computer Services, Abakaliki, Nigeria who typed the document.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData supporting the findings of the study are available from the corresponding author (ION) upon sensible request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflicts of interest declared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors agreed to publish the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any financial support for this study and publication of the article.\u003c/p\u003e\n\u003cp\u003e\u003cb\u003eAuthor Contribution\u003c/b\u003e\u003c/p\u003e\u003cp\u003eION: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Resources; Supervision; Visualization; Writing-original draft; Writing-review and editing; BON: Data curation; Formal analysis; Investigation; Methodology; Supervision; Visualization; Writing-original draft; NAE: Formal analysis; Writing-original draft; Investigation; RNO: Formal analysis; Writing-original draft; Investigation; DNA: Formal analysis; Writing-original draft; Investigation; CIO: Formal analysis; Writing-original draft; Investigation; WOO: Formal analysis; Writing-original draft; Supervision; DCE: Data curation; Writing-original draft; Formal analysis; Methodology; Supervision; Writing-review and editing. 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Health Lit Res Pract. 2022;6(3):e191\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3928/24748307-20220718-02\u003c/span\u003e\u003cspan address=\"10.3928/24748307-20220718-02\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReshma AS, Chandrasekhar T, Paul B, Arpita D. A cross-sectional study on health literacy and its associated factors among adults of a rural area of Hooghly District, West Bengal. J Health Lit Autumn. 2024;9(3):95\u0026ndash;105. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22038/jhl.2024.79591.1566\u003c/span\u003e\u003cspan address=\"10.22038/jhl.2024.79591.1566\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLacasse M, Douville F, Gagnon J, Simard C, C\u0026ocirc;t\u0026eacute; L. Theories and models in health sciences education - a literature review. Can J Scholar Teach Learn. 2019;10(3). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5206/cjsotl-rcacea.2019.3.9477\u003c/span\u003e\u003cspan address=\"10.5206/cjsotl-rcacea.2019.3.9477\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuyinu YA, Femi-Adebayo TT, Adebayo BI, Abdurraheem-Salami I, Odusanya OO. Health literacy: Prevalence and determinants in Lagos State, Nigeria. PLoS ONE. 2020;15(8):e0237813. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0237813\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0237813\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHulya FK, Sinem D. The relationship between health literacy and medication adherence in a hypertensive patient population. Int J Caring Sci. 2020;13(1):101\u0026ndash;7. www.internationaljournalofcaringsciences.org.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShiyanbola O, Unni E, Huang YM, Lanier C. The association of health literacy with illness perceptions, medication beliefs and medication adherence among individuals with type 2 diabetes. Res Soc Adm Pharm. 2018;14(9):824\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.sapharm.2017.12.005\u003c/span\u003e\u003cspan address=\"10.1016/j.sapharm.2017.12.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(9):1218\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2337/diacare.27.9.2284\u003c/span\u003e\u003cspan address=\"10.2337/diacare.27.9.2284\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUsman NO, Muhammad MI, Nwankwo B, Usman OA. Prevalence and determinants of medication adherence in patients with multi-morbidities attending general outpatient clinics in secondary health care facilities in Kaduna State. J Comm Med Pri Health Care. 2022;34(3):140\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dx.doi.org/10.4314/jcmphc.v34i3.11\u003c/span\u003e\u003cspan address=\"10.4314/jcmphc.v34i3.11\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePersonal characteristics\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariables\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFrequency (f)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ePercentage (%)\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e18\u0026ndash;25\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.1\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e26\u0026ndash;35\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.3\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e36\u0026ndash;45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e39\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e13.4\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e46\u0026ndash;55\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e85\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e29.3\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e56 \u0026amp; above\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e133\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e45.9\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSex\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e159\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e54.8\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e131\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e45.2\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEducational level\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNon Formal\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e77\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e26.6\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrimary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e14.5\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSecondary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e67\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e23.1\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTertiary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e104\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e35.9\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eReligion\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eChristianity\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e239\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e82.4\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIslam\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e18\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e6.2\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAfrican Traditional Religion\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.4\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHealth literacy\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eS/N\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariables\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eMean\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eSD\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eDec.\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnderstanding the leaflets that come with your drugs\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.64\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.16\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eH\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnderstand doctor's instruction on how to take prescribed medicine\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.14\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eH\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnderstand pharmacist's instruction\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e4.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFollow the instructions on the medications\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.39\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.04\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFind information on healthy activities in case of diabetes type 11\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.41\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eH\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e6.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnderstand information in the media on how to get healthier\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.56\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.02\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eH\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eRead written information about your medicine\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.36\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.98\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnderstand information about your medicine\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.97\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.29\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eH\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnderstand information on determinants of health in the social environment\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.17\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.00\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e10.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnderstand information on determinants of health in physical environment\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.15\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnderstand information relevant on health\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.68\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.08\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eH\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnderstand medical information and derive meaning from them\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.94\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e13.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnderstand information on risk factors and derive meaning from them\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.56\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.04\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eH\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e14.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eDifferentiate between quacks and authentic health care providers\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.19\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.97\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eH\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eOverall\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.60\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.91\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eH\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eDrug adherence\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eS/N\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariables\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eMean\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eSD\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eDec.\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e15.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eTake your anti-diabetic drug\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.84\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.49\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eH\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e16.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eForget to take your anti-diabetic medicines\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.84\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.82\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e17.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eStopped taking your drug without telling your doctor\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.69\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.81\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e18.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eForget bringing your drug along while travelling or leaving home\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.64\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.66\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e19.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eStopped taking your drug when you feel that your blood is under control\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.36\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.68\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e20.\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eFeel hassled about sticking to your diabetics plan\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.16\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.98\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eOverall\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.09\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.49\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eL\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSummary of mean, ANOVA and t-test analysis on health literacy\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariables\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eN\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eMean\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eSD\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eObtained value\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003ep-value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge (years)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e18\u0026ndash;25\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.34\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.54\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e26\u0026ndash;35\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.17\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e36\u0026ndash;45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e39\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.08\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.59\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eF\u0026thinsp;=\u0026thinsp;14.168*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e46\u0026ndash;55\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e85\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.70\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.81\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e56 \u0026amp; above\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e133\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.98\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSex\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e159\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.74\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.83\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003et\u0026thinsp;=\u0026thinsp;2.954*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.003\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e131\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.43\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.98\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEducational level\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNon Formal\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e77\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.34\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.34\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrimary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.36\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.41\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eF\u0026thinsp;=\u0026thinsp;412.793*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSecondary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e67\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.03\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTertiary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e104\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.35\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.41\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eReligion\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eChristianity\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e239\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.74\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.86\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIslam\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e18\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.87\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.95\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eF\u0026thinsp;=\u0026thinsp;18.993*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eATR\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.95\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.85\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ATR\u0026thinsp;=\u0026thinsp;African Traditional Religion\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSummary of mean, ANOVA and t-test analysis on drug adherence\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariables\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eN\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eMean\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eSD\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eObtained value\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003ep-value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge (years)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e18\u0026ndash;25\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.72\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.38\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e26\u0026ndash;35\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.92\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.38\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e36\u0026ndash;45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e39\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.03\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.56\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eF\u0026thinsp;=\u0026thinsp;3.857*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.005\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e46\u0026ndash;55\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e85\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.05\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e56 \u0026amp; above\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e133\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.19\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.49\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSex\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e159\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.08\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.49\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003et\u0026thinsp;=\u0026thinsp;0.406\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.685\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e131\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.10\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.49\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEducational level\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNon Formal\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e77\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.41\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.43\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePrimary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.29\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.40\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eF\u0026thinsp;=\u0026thinsp;31.157*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSecondary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e67\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.50\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTertiary\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e104\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.84\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.37\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eReligion\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eChristianity\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e239\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.01\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.46\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eIslam\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e18\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.39\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eF\u0026thinsp;=\u0026thinsp;20.657*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eATR\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e33\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.50\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eRelationship between health literacy and drug adherence\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariables\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eHealth Literacy\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eDrug Adherence\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHealth Literacy\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003ePearson Correlation\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.570**\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSig. (2-tailed)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eN\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e290\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e290\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDrug Adherence\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003ePearson Correlation\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.570**\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSig. (2-tailed)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eN\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e290\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e290\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e** Correlation is significant at the p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 level (2-tailed)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSummary of multiple regression analysis of health literacy, drug adherence and personal characteristics diabetes patients\u003c/span\u003e\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariables \u003csup\u003ea,b\u003c/sup\u003e\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e95% CI for B\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eR\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eβ\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eSE\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003et\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003ep\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003eLower Bound\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003eUpper\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eBound\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.394\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.156\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.329\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.045\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.283\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.418\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.240\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSex\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.171\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.029\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.315\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.107\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.954\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.003\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.524\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.105\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eEducational level\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.882\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.778\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.665\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.021\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e31.782\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.624\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.707\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eReligion\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.320\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.102\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.443\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.077\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.724\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.596\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.291\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eVariables\u003c/span\u003e \u003csup\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ec,d\u003c/span\u003e\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.220\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.048\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.098\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.026\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.822\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.047\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.148\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSex\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.024\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.023\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.058\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.406\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.685\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.090\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.137\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eEducational level\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.492\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.242\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.198\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.021\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.591\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.238\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.157\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eReligion\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.349\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.122\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.258\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.041\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e6.320\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.000\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.178\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.338\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ea. \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePersonal characteristics (Predictor)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eb. \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHealth literacy\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ec. \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePersonal characteristics (Predictor)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ed. \u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eDrug adherence\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e "}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health Literacy, Drug Adherence, Diabetes Patients, Ebonyi State","lastPublishedDoi":"10.21203/rs.3.rs-8069199/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8069199/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealth literacy is a phenomenon that empowers patients to navigate the healthcare system, understand medical instructions, and recognize the significance of continuous medication adherence.\u003c/p\u003e\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThe aim of the study was to investigate the relationship between health literacy and drug adherence among diabetes patients in Ebonyi State, Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was carried out on 298 diabetes patients. The study used a researchers-developed 20-item validated Health Literacy and Drug Adherence Questionnaire (HLDAQ). Thirty diabetes patients attending routine out-patient clinic in three government health facilities in Enugu State, Nigeria responded to the research tool for data quality control. The data yielded high Cronbach alpha (Health Literacy Practices α\u0026thinsp;=\u0026thinsp;0.89; Drug Adherence α\u0026thinsp;=\u0026thinsp;0.76) reliability coefficients. Spearman Brown correlation coefficient, mean scores, ANOVA, t-test and stepwise multiple regression analysis were used for analysis. Analysis was run with IBM SPSS version 25.0 for windows.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall health literacy (2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91) indicated that the respondents had a high health literacy level. However, overall drug adherence (2.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49) was low. Differences observed on health literacy were significant in relation age (p\u0026thinsp;=\u0026thinsp;0.000), sex (p\u0026thinsp;=\u0026thinsp;0.003), educational level (p\u0026thinsp;=\u0026thinsp;0.000), and religion (p\u0026thinsp;=\u0026thinsp;0.000). Similar trend was observed on drug adherence except in sex (p\u0026thinsp;=\u0026thinsp;0.685). The relationship between health literacy and drug adherence was significantly positive (r\u0026thinsp;=\u0026thinsp;0.570, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study concluded that the health literacy among the diabetes patients was high, but had low drug adherence. Age, sex, educational level and religion predicted health literacy and drug adherence among the diabetes patients. However, sex was not capable of predicting drug adherence. Healthcare providers should consider addressing complexity of regimen, personal beliefs and attitudes, lifestyle and environmental and psychological factors when developing treatment plans for diabetes patients with higher health literacy.\u003c/p\u003e","manuscriptTitle":"Health Literacy and Drug Adherence among Diabetes Patients in Ebonyi State: A Cross-Sectional Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 15:58:05","doi":"10.21203/rs.3.rs-8069199/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"185facf3-bb5f-400a-a202-23be82fa2513","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-13T02:24:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 15:58:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8069199","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8069199","identity":"rs-8069199","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}