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Medication adherence in persons treated for human immunodeficiency virus (HIV) continues to be an important focus for intervention. While high levels of adherence are required for good clinical outcomes, research shows many patients do not achieve these levels. Despite multiple interventions to improve adherence, most require multiple sessions delivered by trained clinicians. Cost and lack of trained personnel limit the availability of these interventions. Alternatives to clinician-delivered interventions are interventions provided via electronic devices (eg, personal/tablet computers and smartphones). Modern technology allows devices to provide tailoring of content to patient characteristics and learning needs, and to be excellent platforms to deliver multimedia teaching content. The intervention reported drew on research on health literacy in persons with HIV and the relation of health literacy to medication adherence in persons treated for HIV to develop an electronically delivered application. Using the Information–Motivation–Behavioral Skills model as a conceptual framework for understanding patients’ information needs, a computer-delivered intervention was developed, its usability and acceptability was assessed, and medication adherence in 118 patients for 1 month before and after they completed the intervention was evaluated. Changes in participant adherence were evaluated in sequential models with progressively lower levels of baseline medication adherence. Results show that although changes in adherence in the entire sample only approached statistical significance, individuals with adherence less than 95% showed significant increases in adherence over time. Participants’ self-reported knowledge and behavioral skills increased over the course of the study. Their change in information predicted their post-intervention adherence, suggesting a link between the intervention’s effects and outcomes. A computer-delivered intervention targeting HIV-related health literacy may thus be a useful strategy for improving patient adherence.

Objective Health literacy has been recognized as an important factor in patients' health status and outcomes, but the relative contribution of demographic variables, cognitive abilities, academic skills, and health knowledge to performance on tests of health literacy has not been as extensively explored. The purpose of this paper is to propose a model of health literacy as a composite of cognitive abilities, academic skills, and health knowledge (ASK model) and test its relation to measures of health literacy in a model that first takes demographic variables into account. Methods A battery of cognitive, academic achievement, health knowledge and health literacy measures was administered to 359 Spanish- and English-speaking community-dwelling volunteers. The relations of health literacy tests to the model were evaluated using regression models. Results Each health literacy test was related to elements of the model but variability existed across measures. Conclusion Analyses partially support the ASK model defining health literacy as a composite of abilities, skills, and knowledge, although the relations of commonly used health literacy measures to each element of the model varied widely. Practice implications Results suggest that clinicians and researchers should be aware of the abilities and skills assessed by health literacy measures when choosing a measure.

Psychiatric pharmacists have specialized knowledge, skills, and training or substantial experience working with patients with psychiatric or neurologic disorders. As part of the collaborative team with a physician, psychiatric pharmacists can provide comprehensive medication management (CMM), a direct patient care service, to patients with psychiatric or neurologic disorders. CMM is a standard of care in which all medications for an individual patient are assessed to determine appropriateness, effectiveness, safety, and adherence. Studies have shown that when psychiatric pharmacists are included as part of the collaborative team with a physician, medication-related outcomes for patients with psychiatric or neurologic disorders improve. Despite the evidence supporting the value of psychiatric pharmacists as part of the health care team, the very limited mechanisms for compensation for CMM limit the numbers of patients with psychiatric or neurologic disorders who have access to services provided by a psychiatric pharmacist. We believe that all patients with psychiatric or neurologic disorders should have access to CMM provided by a psychiatric pharmacist.

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