Abstract
Background: Informal family caregivers frequently undertake complex medication-management responsibilities for people with chronic diseases, making their ability to understand and apply health information potentially important for medication safety. Objective: To determine the association between family caregiver health literacy and nurse-documented medication administration errors during home-based chronic disease management. Methods: This cross-sectional analytical study included 85 caregiver–patient dyads recruited consecutively through home health agency networks in industrial and urban areas of Punjab between September 2025 and January 2026. Caregiver functional health literacy was assessed using the S-TOFHLA, while medication administration errors documented in nursing records and medication-reconciliation records during the preceding 30 days were evaluated as binary and count outcomes. Independent-samples t testing, Pearson correlation, and multivariable logistic regression were performed. Results: Mean caregiver S-TOFHLA score was 58.4±12.6, and 38/85 dyads (44.7%) had at least one documented medication error. Caregivers in error-positive dyads had lower S-TOFHLA scores than those without errors (51.2±10.8 vs 64.2±10.5; mean difference −13.0, 95% CI −17.61 to −8.39; p<0.001; Cohen's d=−1.22). Health-literacy score correlated inversely with total error count (r=−0.58, 95% CI −0.71 to −0.42; p<0.001). After adjustment for caregiver age, care-recipient age, and daily medication count, higher S-TOFHLA score remained associated with lower odds of a documented medication error (aOR=0.89 per point, 95% CI 0.84–0.94; p<0.001). Conclusion: Lower caregiver functional health literacy was independently associated with nurse-documented medication administration errors in this cross-sectional home-care sample. These findings support further evaluation of literacy-sensitive caregiver medication-support strategies