Medication literacy is low among patients with cardiovascular diseases, meta-analysis finds

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Frontiers in Medicine Published June 3, 2026 Medically reviewed June 3, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider that medication literacy is low in CVD patients; tailored education and standardized assessments are needed.

This systematic review and meta-analysis assessed medication literacy levels among patients with cardiovascular diseases (CVDs). The analysis included 9,599 patients and used three validated instruments: the Medication Literacy Questionnaire (MLQ), the Medication Literacy Scale in Spanish and English (MedLitRxSE), and the Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP).

Pooled mean scores were 4.56 (95% CI 4.36 to 4.77; I²=95.7%) for MLQ, 7.49 (95% CI 6.46 to 8.52; I²=97.7%) for MedLitRxSE, and 24.09 (95% CI 23.72 to 24.45; I²=64.2%) for C-MLSHP. These scores indicate low medication literacy across populations.

The authors note substantial heterogeneity across all instrument subgroups, which limits the generalizability of the pooled estimates. They call for future large-scale, longitudinal studies using standardized assessment tools to elucidate causal relationships, underlying mechanisms, and sources of heterogeneity.

Clinically, the findings underscore the need for individualized patient education, standardized counseling protocols, community-based services, and healthcare provider training. Multilevel interventions grounded in the Health Ecological Model may help improve medication use and inform policy, but causality cannot be inferred from these data.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

BackgroundAs an important domain of health literacy, medication literacy plays a critical role in ensuring the safe and effective use of medicines, especially among individuals with Cardiovascular Diseases (CVDs). Nevertheless, evidence regarding the overall level of medication literacy and the factors influencing it in this population remains limited. This study aimed to systematically evaluate medication literacy levels among patients with CVDs and to identify associated factors based on the Health Ecological Model (HEM).MethodsThis systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We systematically searched PubMed, Web of Science, the Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and the Vertically Integrated Projects database (VIP) for studies published in English or Chinese from database inception to 30 December 2025. Two reviewers independently performed study selection, quality assessment, data extraction, and analysis. Mean medication literacy scores and corresponding effect sizes were pooled using meta-analysis in Stata 18.0. Random-effects models were applied for all analyses due to substantial heterogeneity across studies. Heterogeneity was assessed using the I2 test. Sensitivity analyses and publication bias were also assessed.ResultsA total of 34 studies involving 9,599 patients were included. Of these, 30 studies reported medication literacy levels. Given the substantial heterogeneity observed across all instrument subgroups, random-effects models were applied for pooling. The pooled mean scores were as follows: the Medication Literacy Questionnaire (MLQ): 4.56 [95% CI (4.36, 4.77), I2 = 95.7%]; the Medication Literacy Scale in Spanish and English (MedLitRxSE): 7.49 [95% CI (6.46, 8.52), I2 = 97.7%]; and the Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP): 24.09 [95% CI (23.72, 24.45), I2 = 64.2%]. Twenty-four studies reported factors associated with medication literacy. Significant factors included age, department of hospitalization, comorbid hypertension, and number of discharge medications (personal traits); self-efficacy (psychological and behavioral characteristics); social support (social networking); income level and educational attainment (work and living conditions); and receipt of medication education (policy and environmental factors).ConclusionMedication literacy among patients with CVDs remains suboptimal and is influenced by multidimensional factors. Individualized patient education, standardized counseling protocols, community-based services, and healthcare provider training are urgently needed. Multilevel interventions grounded in the HEM hold promise for improving medication use and informing policy development. Future large-scale, longitudinal studies employing standardized assessment tools are needed to elucidate causal relationships, underlying mechanisms, and sources of heterogeneity.Systematic Review RegistrationThe protocol for this systematic review has been registered in PROSPERO (CRD420251208289, available at: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251208289).