Assessing the Impact of Compliance and Health Literacy on the Management of Chronic Diseases in the City of Arar, KSA

INTRODUCTION

Long-standing diseases are a burden on patients, healthcare systems, and families throughout the world.^[1] Chronic diseases such as diabetes, high blood pressure, and asthma, need prompt treatment to stop complications and improve outcomes.^[2] One necessary factor that affects the treatment of chronic diseases is compliance and self-care attitude.^[3] Obedience by the patient to the instructions given by healthcare providers regarding strict use of medication, restriction of diet, and physical exercise will bring significant improvement.^[4] Health literacy will enhance the ability of individuals to understand health knowledge and to make wise decisions about health care.^[5] Health literacy is a critical element in public health, defined as “the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health-related decisions.”^[6] Health literacy is not simply about reading skills but encompasses a broader set of abilities to navigate the healthcare system and make informed choices.^[7] Therefore, it is recognized as a key factor influencing health outcomes, especially in the context of chronic disease management.^[8] Health literacy can positively influence the management of chronic diseases. Individuals with strong health literacy skills are better equipped to manage chronic diseases.^[9] This includes understanding their condition, following treatment plans, and making informed healthcare decisions. When patients can understand complex medical information, actively engage with their healthcare providers, and effectively self-manage their condition, they experience improved health outcomes and a greater sense of control over their well-being.^[10]

Health literacy is a complex and multifaceted skill that varies greatly depending on the individual, the specific health information, and the context.^[11] People may easily understand familiar health topics but struggle with unfamiliar medical terms or complex conditions.^[12] For example, someone comfortable with basic health advice might find it difficult to grasp information about a rare disease. The setting also plays a crucial role; individuals may feel more at ease asking questions in a familiar environment like a community health center than a busy hospital.^[13] Importantly, health literacy is not static. It can evolve over time as individuals gain experience, education, and exposure to different health situations.^[14]

Many studies have been done on compliance, health literacy, and chronic disease treatment, and have shown a great effect on these factors in improving patient outcomes. For example, Nutbeam et al.^[7] came to know that low health literacy was associated with poor medication adherence among patients with chronic diseases. Similarly, a systematic review by Saki et al.^[15] explained that low health literacy was connected to bad health outcomes and enhanced healthcare use in those with chronic diseases.

Besides, many researchers have identified the role of compliance in chronic disease treatment. For example, a meta-analysis by Viegi et al.^[16] explained that compliance by the patients with treatment methods was greatly concerned with increased health outcomes in different chronic diseases. Moreover, a systematic literature review by Zeber et al.^[17] showed that if there was noncompliance with drug treatment, there was a great chance of adverse outcomes in patients with high blood pressure and diabetes.^[18]

The purpose of this study is to know the effect of compliance and health literacy on the treatment of chronic diseases in the City of Arar, Kingdom of Saudi Arabia. The findings from this study will be invaluable for healthcare providers, as they will offer insights into the barriers patients face in adhering to treatment plans and comprehending health-related information. This knowledge can guide the development of targeted interventions that aim to bolster patient engagement, ensuring that individuals with chronic illnesses are better equipped to manage their conditions.

MATERIAL AND METHODS

RESULTS

The study included 338 adults with chronic conditions, primarily Saudi nationals living in Arar (99.1%). Most participants were between the ages of 31 and 40 years (34.3%). The group had a higher proportion of men (58.6%) compared to women (41.4%). Educational levels were notably high, with over half (52.7%) holding university degrees. In addition, a significant portion of participants were married (60.7%) [Table 1].

The data highlight the varied levels of confidence and understanding among participants when dealing with medical information. Approximately 35.8% often feel confident filling out medical forms, while only 17.5% feel confident all the time. A considerable portion, 29.0% of the participants, felt confident only occasionally, with 12.7% rarely feeling confident and 5% never feeling confident.

Many participants also faced challenges in understanding written medical information. Around 35.2% sometimes struggled and 25.4% often encountered difficulties. On the other hand, 20.7% say they rarely had trouble, and 7.7% d no issues at all. However, 10.9% consistently found it challenging to understand medical information [Table 2].

The findings indicate the varying levels of adherence to prescribed treatment plans among participants. About 34.0% of the participants reported following their treatment plans often, while 19.5% always adhered, and 26.0% followed them only sometimes. Fewer participants reported adhering to plans (5.3%) rarely and (15.1%) never adhering to plans. A significant insight is that over half (53.6%) agreed to missing doses of medication due to misunderstanding of instructions.

Regarding routine checkups for managing chronic conditions, 28.7% of the participants visited healthcare providers often, 12.7% always attended, and 33.7% went sometimes. Others reported attending rarely (16.3%) or not at all (8.6%) [Table 3].

The responses reveal that health literacy significantly influences participants’ ability to manage their chronic conditions. Only a small portion, 6.2% of participants, felt unaffected by their health literacy, while 15.7% thought it has a slight effect on them. Meanwhile, a larger share of participants –28.4% and 23.4% – reported that health literacy impacts them very much and extremely, respectively, with another 26.3% of participants finding it moderately impactful. There is a clear consensus on the importance of understanding chronic illnesses and treatment plans for effective management. Just 4.7% believe it is not important at all, and 13.3% view it as only slightly important. On the other hand, a strong majority recognize its significance, with 31.7% describing it as extremely important and 26.9% as very important. In addition, 23.4% of the participants see it as moderately important. Finally, the data show that most participants (89.1%) have not faced negative outcomes due to misunderstandings or noncompliance with their chronic disease management plans. However, 10.9% have experienced adverse effects [Table 4].

The analysis of confidence levels in independently completing medical forms highlights significant differences across age and educational backgrounds. Age was found to be notably linked to confidence (P = 0.028), with individuals aged 31–40 and 41–50 years more frequently expressing confidence, especially within the “sometimes” to “always” range. In contrast, those over 60 mostly reported lower confidence levels. Gender, however, showed no meaningful impact on confidence (P = 0.866). Conversely, education level had a strong association with confidence (P = 0.000); those with university or postgraduate education were the most confident, commonly falling in the “often” and “always” categories [Table 5].

The analysis shows notable links between age (P = 0.013) and education level (P = 0.001) when it comes to challenges in understanding written medical information. In terms of age, individuals aged 31–40 and 41–50 years reported experiencing these challenges more often, mostly within the “sometimes” to “always” range. On the other hand, younger individuals (20–30) and those over 60 years reported fewer difficulties overall. Considering education levels, people with primary or intermediate education levels faced more frequent challenges, whereas those with higher education – particularly those with university or postgraduate degrees – tended to report fewer difficulties [Table 6].

The data analysis indicates that, among various demographic factors related to adherence to treatment plans, only education level shows a meaningful connection, with a very high level of statistical significance (P < 0.001). Other factors such as age (P = 0.645), gender (P = 0.244), and marital status (P = 0.887) did not display any significant association with adherence. Specifically, individuals with higher levels of education, such as those holding university or postgraduate degrees, tend to adhere to treatment plans more consistently, falling mostly within the “often” and “always” adherence categories. In contrast, those with lower educational backgrounds, including primary and intermediate levels, exhibit lower adherence rates [Table 7].

DISCUSSION

This study investigated how the ability of patients to comprehend health information (health literacy) and follow the advice given to them (compliance) affects the management of chronic diseases among patients in Arar, Kingdom of Saudi Arabia. The results indicate that both health literacy and compliance in a more comprehensive manner are important in the management of chronic diseases that require long-term treatment and care.

The study indicated that the majority of participants are of Saudi nationals (99.1%), which reflects the study’s regional focus, while the age distribution was primarily adults aged 31–40 years (34.3%) aligning with a population that may be experiencing early to mid-stages of chronic disease progression in chronic diseases, such as hypertension, diabetes, and cardiovascular diseases, are increasingly prevalent among the middle-aged adults, a trend seen across many Middle Eastern populations due to lifestyle, dietary, and genetic factors.^[19] It was observed that the participant’s marital status may also play a role in health management, as research indicates that married individuals often experience better health outcomes due to social support. The presence of a spouse can encourage adherence to treatment regimens and provide emotional support, which is beneficial for chronic disease management.^[20] In Saudi culture, where family structures are strong, marriage may further reinforce these benefits, offering both practical and emotional support in managing health conditions. Another study about the lack of resources concluded that the most important barrier to physical activity was a lack of willpower and social support for adherence to physical activity and healthy diet.^[21,22]

Our research reveals a significant association between high levels of health literacy and improved disease management outcomes. The individuals with a high level of education (57.6%) showed a greater level of adherence. These findings align with similar studies that suggest individuals with adequate health literacy are more likely to follow prescribed treatments, better manage symptoms, and prevent complications.^[23,24] The study also highlights the interconnection between health literacy and compliance. Patients with higher health literacy tend to be more compliant with their treatment plans, likely due to a better understanding of the benefits and potential consequences of their actions.^[25,26] Specifically, in the context of Arar, where cultural, linguistic, and socioeconomic factors influence health practices, health literacy has emerged as a cornerstone in empowering patients to make informed decisions about their health.

Compliance with prescribed treatment regimens was another critical factor in disease management. The data showed that patients who adhered closely to their treatment plans reported fewer complications and hospital visits, emphasizing the need for interventions focused on compliance. This outcome corroborates findings from studies conducted globally, which highlight the direct impact of compliance on disease control and quality of life in chronic illness patients.^[27] This finding aligns with research by Osterberg and Blaschke,^[28] who found that consistent medication adherence was associated with better clinical outcomes and reduced complications in chronic disease patients. In Arar, however, more than half (53.6%) of participants reported missing medication due to misunderstandings of the instructions, and this may have hindered compliance, suggesting that targeted policies and healthcare support systems are necessary to improve compliance rates, a conclusion also found in a similar study by Almalki et al.^[29]

Moreover, 25.4% of the participants claimed to experience difficulties with understanding medical information. The difficulty in understanding this, reported by over a quarter of the participants highlights a pressing need for improved health communication strategies within healthcare settings. In this context, healthcare providers in Arar could benefit from implementing tailored education programs and patient-centered communication strategies to address the specific needs of those with limited health literacy. Research suggests that enhancing communication through simplified language, visual aids, and culturally appropriate messaging can significantly improve patients’ understanding of medical information.^[30,31] These approaches can foster a more inclusive healthcare environment where patients feel supported in navigating their treatment plans and are better equipped to manage their conditions.^[32,33]

In conclusion, the study emphasizes the vital role of health literacy and adherence in managing chronic diseases, especially in Arar, Saudi Arabia. By promoting these factors through focused educational programs and making healthcare resources more accessible, health providers can markedly enhance patient outcomes and alleviate the strain of chronic illnesses on the healthcare system.

CONCLUSION

This study underscores the critical interplay between health literacy and treatment compliance in the effective management of chronic diseases in Arar, Saudi Arabia. Participants with higher education were significantly have adherence to medical advice, which reflected in a fewer complications and better treatment outcomes. Yet, the findings reveal persistent challenges that over a quarter of participants struggled to understand medical information, and more than half reported nonadherence due to misinterpreted instructions. These insights highlighted the urgent need for managerial and educational interventions. In a region where chronic conditions are on the rise and family support plays a pivotal role, enhancing both health education and system-level support can empower patients, improve compliance, and ultimately ease the burden of chronic diseases. Simply put, better understanding leads to better outcomes.

Disclosures

We disclose that no author involved in this research has any conflict of interest that could potentially bias the results or interpretation of the study.