The role of health literacy in medication adherence: Evidence from a greater western Sydney study of Indian migrants living with type 2 diabetes mellitus.

BACKGROUND: Type 2 Diabetes Mellitus (T2DM) presents a major public health challenge globally, disproportionately affecting Indian migrants who are vulnerable to diabetes-related complications due to cultural, linguistic and systemic barriers that can limit access to timely and effective care. Health literacy is a key determinant of T2DM management, yet its association with medication adherence in this population remains underexplored.

OBJECTIVE: This study investigates the association between performance-based (objectively assessed) and self-reported (subjectively assessed) health literacy and medication adherence among Indian migrants with T2DM, while accounting for a range of demographic, socioeconomic and health-specific factors.

METHODS: A cross-sectional study design was employed. Participants (n = 309) were recruited through multicultural health services, and hospital diabetes clinics across Greater Western Sydney, a socioeconomically and culturally diverse area of Sydney, NSW, Australia. Eligible participants self-identified as Indian, were aged 18 years or older, had been diagnosed with T2DM for at least one year, and were currently prescribed diabetes medication. Data were collected via a structured survey and analysed using multivariate logistic regression.

RESULTS: Low health literacy was prevalent among Indian migrants, with over 67.6% demonstrating low performance-based health literacy and 62.5% reporting low self-reported health literacy. Approximately 68.9% of participants had low medication adherence. Lower medication adherence was significantly and positively associated with lower health literacy, both performance-based (adjOR=9.14, 95%CI: 4.24-19.72; p = <0.001) and self-reported (adjOR=12.45, 95%CI: 4.55-34.10; p = <0.001). Key predictors of medication adherence included health literacy, private health insurance, BMI, glucose level, comorbidities and social support. Models differed slightly depending on the type of health literacy assessed.

CONCLUSION: Health literacy plays an important role in diabetes self-management for Indian migrants. These findings highlight the need for culturally tailored interventions that address both health literacy support - such as improving understanding of medical information and navigating healthcare systems - and social or family support systems that influence health behaviours and decision-making.