Peneva Y. B. 1, Gencheva D. 2, Genchev G. 2, Georgieva L. M. 1
| 1 Medical University – Sofia, Bulgaria 2 Medical University – Plovdiv, Bulgaria |
Abstract
Background and Aim of Study: Cardiovascular diseases remain the leading cause of mortality worldwide. Effective management of cardiovascular risk depends not only on medical treatment but also on patients’ health literacy, psychological status and adherence to prescribed therapy. Increasing evidence suggests that psychosocial determinants play an important role in long-term cardiovascular outcomes.
The aim of the study: to compare health literacy, mental health status and medication adherence among patients from Bulgaria and Germany and to evaluate their associations.
Material and Methods: A cross-sectional survey was conducted among 862 adult patients from Bulgaria (n=186) and Germany (n=676). Data were collected using a structured questionnaire including measures of cardiovascular risk factors, health literacy, mental health (PHQ-based assessment) and medication adherence (Modified Medication Adherence Report Scale). Statistical analyses were performed using IBM SPSS Statistics 27.0 and MedCalc 23.5.5.
Results: German patients demonstrated significantly higher medication adherence scores compared to Bulgarian patients (p<0.01). Bulgarian participants showed a higher prevalence of moderate and severe psychological symptoms. A significant association was found between mental health status and medication adherence (p=0.009), with patients reporting normal psychological status demonstrating higher adherence levels. Health literacy was also significantly associated with medication adherence (p=0.034), particularly among German participants. No significant relationship was observed between health literacy and lifestyle score.
Conclusions: Health literacy and mental health are important determinants of medication adherence among adult primary care patients from Bulgaria and Germany. Integrating psychological assessment and health literacy interventions into primary care may improve cardiovascular prevention and long-term treatment outcomes. The findings also support the development of the Bulgarian-HEART Model as an integrated framework for cardiovascular risk management in primary care.
Keywords
ardiovascular risk, primary care, health literacy, mental health, medication adherence, Bulgaria; Germany
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Information about the authors:
Peneva Yoanna Boyanova (Corresponding Author) – https://orcid.org/0009-0004-8758-1086;
Gencheva Dolina – https://orcid.org/0000-0001-7664-4329; MD, PhD, First Department of Internal Diseases, section of Cardiology, Medical University of Plovdiv, Plovdiv, Bulgaria.
Genchev Gencho – https://orcid.org/0000-0003-0561-029X; Eng., PhD, Professor of Biostatistics and Medical Informatics, Medical University – Sofia, Sofia, Bulgaria.
Georgieva Lidia Mladenova – https://orcid.org/0000-0002-9320-9203; Doctor of Medical Sciences, MD, Full Professor, Professor of Social Medicine, Healthcare Organization and Management, Faculty of Public Health, Medical University – Sofia, Sofia, Bulgaria.
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APA
Peneva, Y. B., Gencheva, D., Genchev, G., & Georgieva, L. M. (2026). Health literacy, mental health and medication adherence among adult primary care patients: A comparative study between Bulgaria and Germany. International Journal of Science Annals, 9(1), 01–08. https://doi.org/10.26697/ijsa.2026.1.7
Harvard
Peneva, Y. B., Gencheva, D., Genchev, G., & Georgieva, L. M. "Health literacy, mental health and medication adherence among adult primary care patients: A comparative study between Bulgaria and Germany". International Journal of Science Annals, [online] 9(1), pp. 01–08. viewed 30 June 2026, https://culturehealth.org/ijsa_archive/ijsa.2026.1.7.pdfVancouver
Peneva, Y. B., Gencheva, D., Genchev, G., & Georgieva, L. M. Health literacy, mental health and medication adherence among adult primary care patients: A comparative study between Bulgaria and Germany. International Journal of Science Annals [Internet]. 2026 [cited 30 June 2026]; 9(1): 01–08. Available from: https://culturehealth.org/ijsa_archive/ijsa.2026.1.7.pdf https://doi.org/10.26697/ijsa.2026.1.7

