Medication Literacy and Home Medication Behaviors Among Older Chinese Patients with Chronic Diseases: A National Cross-Sectional Study

Purpose: To describe the status of home medication behaviors and medication literacy among older patients with chronic diseases in China and to identify factors influencing medication literacy levels to inform improvement strategies. Patients and Methods: A national cross-sectional study was conducted from October 2022 to the end of June 2023 across 31 provinces using a multi-center, quota-based convenience sampling approach. Trained pharmacists collected data via face-to-face interviews using a validated Knowledge, Attitude, and Practice (KAP) questionnaire. Medication literacy was dichotomized into adequate (score ≥ 186) and inadequate (< 186). Multivariable logistic regression was employed to identify associated determinants. Results: Among the 10,363 eligible participants, 48.31% demonstrated adequate medication literacy. Prevalent suboptimal home medication behaviors were observed: 57.05% failed to completely retain original medication packaging, and 74.25% could not fully understand package inserts. Through multivariable logistic regression, several key factors were identified as significant predictors of medication literacy. Higher educational attainment (college degree and above: OR = 2.185, 95% CI: 1.744 to 2.738) was identified as a strong predictor of adequate literacy. Conversely, discarding medication package inserts (OR = 0.697, 95% CI: 0.588 to 0.828) and the inability to comprehend package inserts (OR = 0.265, 95% CI: 0.226 to 0.311) were found to be negatively associated with literacy levels. Furthermore, 93.60% of the cohort reported the presence of somatic symptoms, which were frequently misattributed to normal aging rather than potentially modifiable medication-related causes. Conclusion: Medication literacy among older Chinese adults with chronic diseases remains suboptimal, with nearly half failing to achieve adequate levels. Independent self-management is significantly associated with socioeconomic factors and specific behavioral gaps. A home-based pharmaceutical care system should be implemented to prioritize vulnerable groups, advocate for the retention of original packaging, and promote the development of simplified medication instructions. Keywords: older patients, chronic diseases, medication literacy, home medication behavior, influencing factors