Association between health literacy and quality of life in patients with multiple sclerosis

Background: Multiple sclerosis (MS) is a chronic autoimmune disease that significantly affects the quality of life (QOL) of patients. Health literacy, employment, and medication adherence are key factors influencing disease management and overall well-being. However, limited research has explored these relationships in Jordanian MS patients.
Objective: This study aimed to examine the association between health literacy, employment status, medication adherence, and QOL among MS patients in Jordan.
Method: A cross-sectional study was conducted with 307 MS patients (median age 35 years (IQR: 28–44), 68.4% females) from Al-Bashir Hospital in Amman. Participants completed validated questionnaires, including the Health Literacy Survey-12 (HLS-Q12), the Multiple Sclerosis Impact Scale (MSIS-29), and the Medication Adherence Rating Scale (MARS-5). Disease severity was assessed using the Expanded Disability Status Scale (EDSS) and Language function was evaluated using the Communication and Language Assessment in Multiple Sclerosis (CALMS). Associations between predictor variables and QOL outcomes were assessed using quantile regression analysis
Results: Higher health literacy (HL) was linked to better QOL (per-point HLS-Q12: physical β = −0.27, 95% CI −0.50–−0.05, p = 0.019; psychological β = −0.31, 95% CI −0.46–−0.16, p < 0.001). After adding CALMS (Model B), the HL–psychological QOL association remained but weakened (β = −0.20, 95% CI −0.37–−0.02, p = 0.034), while the physical effect lost significance. The influence of non-injectable regimens and age on psychological QOL also diminished. Disability remained the strongest and most consistent predictor (per-point EDSS: physical Model A β = 5.19, 95% CI [4.57, 5.80], Model B β = 4.29, 95% CI [2.937, 5.65]; both < .001; psychological Model A β = 1.61, 95% CI [1.24, 1.98], Model B β = 1.17, 95% CI [0.672, 1.664]; both p < 0.001).
Conclusion: Key drivers of QOL were health literacy, treatment route, and disability. Interventions that raise HL and enable shared selection of non-injectable options, when clinically appropriate, are likely to yield the largest QOL gains.