Demographic characteristics
A total of 400 community pharmacy users, including 264 females (66%) and 136 males (34%) were analyzed in this study (Table 1a, Fig. 1). The median age of total cohort was 49.65 ± 16.62 (years ± SD). All age groups analyzed were equally represented and no significant differences were found (P=0.090). Individuals under 50 years represented 53.5% while individuals over or equal to 51 years were 46.5%. The analysis of school level showed significant differences between the analyzed groups (X2=0.003) because a 42.5% had only primay school level or any study, while a 57.5% had a middle and high school levels (32.3% and 25.2%, respectively).
A 41% of the surveys were conducted by users of rural community pharmacies, while 59% were conducted in urban areas. It should be noted that there were no significant differences in terms of gender, age or school level. The analysis of medicine consumption in community pharmacy showed that 44.8% were performed by patients with chronic disease while 37.7% did not have any type of chronic disease. The chronic diseases present in these patients were metabolic syndrome (32.9%), hypertension (30.1%), hyperlipemia (16.1%), depression (12.5%) and diabetes (8.4%). Finally, with respect to the reading of medicine leaflets, it was observed that 47% stated to read them, while 24.8% never and sometimes 28.2% of respondents (X2=0.0001).
Analysis of total literacy medication
It should be noted that only 19% and 15% respond adequately to 13 and 14 questions respectively in the MedLiTRxSE tool. On the other hands, adequate- and inadequate-ML and the sociodemographic characteristics were analyzed (Table 1a). The results showed that only a 34% (n=136) had an adequate-ML respect to inadequate-ML (66%; n=264). Respect to gender, women were a high frequency of inadequate literacy respect to men (70.1% and 29.9%, respectively; P=0.019, OR=0.592, 95% CI: 0.385-0.910). Similarly, the analysis of the different age groups showed statistically significant differences regarding medication and literacy (P<0.001; OR=0.312; 95% CI: 0.195-0.499). The groups between 51-65 and ˃65 years showed a high frequency of inadequate-ML (76.5% and 92.9%, respectively) compared with the rest of age groups. The school level was also analyzed, and a statistically significant increase in ML was observed with the academic level was increased (P <0.001; OR=15.403; 95% CI: 8.109-29.257).
Besides, any different in inadequate-ML were observed in different community pharmacy, rural or urban areas (61.0% and 69.5% respectively, P=0.086). However, with regard to the consumption of medications, an inadequate literacy was observed in chronic patients group (75.1%) compared to non-chronic patients (51%; P<0.001; OR=0.345; 95% CI: 0.225-0.530). No significant statistical difference was found respect to reading information leaflet (P=0.180).
Finally, the total correct answers obtained in total-ML depending on the different sociodemographic characteristics were analyzed (Table 1b). The mean number of correct answers for total-ML was 10.30±3.41 (mean points ± SD; range: 0-14 points). No difference between both sexes was observed, obtaining both a similar and high percentage of correct answers (P=0.075). On the contrary, a gradual decrease in the number of correct answers was observed when age was increased (P<0.001). On the other hand, high school level showed the highest number of correct answers (12.67±1.46, mean±SD). The location of the pharmacy (rural or urban) not showed significant differences (P=0.083). However, a decrease in correct responses was observed in users with chronic diseases (P<0.001) respect to user without chronic diseases and those who never read leaflet information (P<0.001).
Analysis of total literacy medication in patients with chronic disease
Adequate- and inadequate-ML in patients with chronic disease and their relationships with sociodemographic characteristics were analyzed (Table 2, Fig. 2). The results showed a low adequate-ML in both men and women, there being no significant differences between both groups of patients (X2=0.874). Our result showed that the only variables that influenced ML were the patient's age and school level (P<0.001). It should be noted that patients with an age ≥ 51years showed a high frequency of inadequate-ML compared with the rest of age groups analyzed. Patients with high school level also showed high adequate-ML (68.3%) and only 31.7% showed inadequate-ML. Finally, the influence of reading information leaflet was also analyzed and no statistically significant influence was observed (X2 = 0.973)
Analysis of documental medication literacy
It should be noted that 21% and 16% respond correctly to a total of 9 and 10 questions respectively in the documental MedLiTRxSE tool. The analysis of the 10 questions that reflect the documentary literacy showed an average of correct answers of 7.06 ± 2.51 (mean ± SD) in the total population analyzed (Table 1b). The analysis of la influence de las different sociodemographic characteristics when the number of correct answers between men and women was compared showed significant differences according to gender (P=0.008). A decrease in the number of correct answers was observed in individuals over 65 years compared with the rest of ages analyzed (P <0.001). On the other hand, a greater number of correct answers was observed in individuals with high school level (8.79±1.28, mean ± SD) respect to others groups. No influence was observed between rural or urban area of the community pharmacy (P = 0.069). Also a smaller number of correct answers were observed in users with chronic diseases respect to users without chronic diseases (P = 0.002).
Finally, the different scenarios in the MedLiTRxSE tool for documental-ML were also analyzed. The identification of Doctor prescription medicine (scenario # 5) showed the high frequency of correct answers (96%) junto con la identification of name of medicine (93%; scenario # 5). On the contrary, the identification of the parts of the body to inject the medicine (45%, scenario # 3) and the correct identification of doses per day for syrup (54%; scenario # 8) were the scenarios with the greatest difficulty to answer adequately.
Analysis of numeracy medication literacy
The percentage of each MedLiTRxSE question correctly answered for numeracy-ML questions were analyzed. It is observed as a 43% answered adequately ≤3 questions and 57% answered adequately four questions.
The analysis of the four questions of numerical literacy in medicines showed an average of corrected answers of 3.23±1.09 (mean ±DS) in the total study cohort (Table 1b). The analysis of numeracy-ML on different sociodemographic characteristics did not show differences according to gender (P=0.268) or according to the location of the community pharmacy (P=0.154), however, statistically significant differences were found in function of age (P <0.001), observing a decrease in numeracy-ML as the patient's age increased. This association was confirmed and improved when multivariable analysis was applied (P<0.0001; Table 3). Similarly, statistically significant differences were found in school level (P <0.001). The individuals with primary studies or without studies showed a low numerical literacy (1.86±1.17; mean±DS) compared with individuals with a high school education (3.88±0.35; mean ± SD), this association was confirmed and improved when multivariable analysis was applied (P<0.0001; Table 3).
On the other hand, chronic patients obtained lower values of numeracy-ML (2.86 ± 1.34; mean ± DS) than patients without chronic disease (3.36±1.01; mean±DS), being statistically significant (P=0.002). This association was confirmed and improved when multivariable analysis was applied (P=0.001). Finally, differences were also observed between individuals who never read the leaflet information and those who always read it (P=0.002).
Frequency of correct answers in the MedLiTRxSE tool for numeracy-ML were also analyzed (Fig. 2). It should be noted that the numerical calculation of units of injectable medicine for diabetes (scenario #1) was the one that presented the lowest frequency of correct answers (62%), with respect to the rest of the questions whose frequency of success was 87% in all of them.