Medication literacy is low among patients with cardiovascular diseases, meta-analysis findsMedication literacy low in heart disease patients, review finds

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).