On March 27 of each year, World Adherence Day, led by the World Heart Federation, reminds us of a persistent and costly problem in health care: many patients do not take medications as prescribed, do not follow recommended lifestyle changes and do not complete treatment programs. The consequences are serious – avoidable hospitalizations, preventable complications, and worsening chronic disease.
But the language of “non-adherence” often places the burden squarely on patients.
What if the real starting point is not adherence, but understanding?
Health literacy – the ability to access, comprehend, evaluate, and apply health information – is a prerequisite for effective self-management. A person cannot follow a treatment plan they do not fully understand. They cannot weigh risks and benefits if explanations are rushed, filled with jargon or disconnected from their daily realities. They cannot be active partners in care if communication is one-directional.
Understanding empowers people to take an active role in their health. Without it, adherence becomes compliance – fragile and unsustainable.
In cardiovascular care, this gap is particularly visible. Patients are often discharged with multiple new medications, instructions about diet and physical activity, warnings about symptoms to monitor and follow-up appointments to schedule. For individuals already coping with fear, uncertainty or complex social circumstances, this can be overwhelming. Even highly educated patients can struggle to absorb and retain information delivered during short clinical encounters.
When treatment plans fail, we often ask why the patient did not follow instructions. We ask less frequently whether we communicated clearly, confirmed understanding or adapted recommendations to individual circumstances.
Health literacy is not simply an individual trait; it is shaped by how health systems are designed. Clear communication requires time. It requires training for health professionals in plain language, teach-back techniques and culturally responsive care. It requires materials that reflect diverse populations and are accessible across literacy levels. It requires care environments that invite questions rather than discourage them.
Importantly, health literacy also requires partnership. Effective communication is not about simplifying information to the point of oversimplification; it is about dialogue. Patients bring lived experience, priorities, constraints, and values. Health professionals bring clinical expertise. Adherence emerges when those perspectives are aligned, not when instructions are simply delivered.
In Canada, where chronic diseases such as cardiovascular disease account for a significant proportion of morbidity and health-care spending, improving adherence is often framed as a cost-saving strategy. But focusing solely on downstream cost ignores a more fundamental issue: respect. Clear communication and patient involvement are not optional enhancements to care; they are ethical obligations.
There is strong evidence that when patients understand their condition and treatment, outcomes improve. Education delivered as part of structured programs – such as cardiac rehabilitation – has been associated with better medication use, healthier behaviours and improved quality of life. Yet access to such programs remains uneven, and educational components are sometimes compressed or inconsistently delivered.
If World Adherence Day is to mean more than a reminder statistic, it should prompt us to reconsider how we define responsibility. Rather than asking, “Why don’t patients adhere?” we might ask, “Have we made understanding possible?”
This shift requires system-level action:
- Embedding health literacy principles into professional training
- Standardizing clear communication practices across care settings
- Investing in culturally responsive educational materials
- Measuring patient understanding as a quality indicator, not just clinical outcomes.
Adherence is not a character trait. It is the result of systems that either enable or hinder understanding.
Understanding empowers. And when people are empowered, they are more likely to engage, persist and take ownership of their health.
On World Adherence Day, the message should be simple but transformative: before we ask patients to follow treatment, we must ensure they truly understand it.
Far more important, in my opinion, is making the Doctor understand why a patient wouldn’t take the medications.
Too often with these meds there are severe, life altering or painful side effects that are dismissed. Like interactions with pre-existing diseases or meds for those and say, eg cardiologists dismiss those.
I need MDs to work together and understand that each specialty matters and that if a patient isn’t taking a medication, there might be an excellent reason. MDs need to work with patients and other MDs and pharmacists to find the right meds. And not assume their first choice is the only right med.
Excellent article and underscores the value of health literacy at so many levels. That being said, it is sad when I have faced physicians in the past and have been told that I “read too much” when discussing some of my symptoms with a specialist especially during the first visit and this reading of mine is from peer reviewed medical articles. This becomes quite frustrating to be quite honest and disconnects the open communication I expect from patient-physician interactions.