Baseline medication adherence and response to an electronically delivered health literacy intervention targeting adherence

Abstract

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.

Discussing the Effects of Poor Health Literacy on Patients Facing HIV: A Narrative Literature Review

“…Indeed, several scholars claimed that specific interventions tailored to the individual levels of health literacy should be devised to improve medication adherence of people with limited health literacy skills. 46 On the contrary, Colbert and colleagues 47 suggested that perceived self-efficacy deeply affects medication adherence, while functional health literacy is not related to either medication adherence or self-efficacy beliefs. Moreover, a recent study about adolescents living with HIV infection showed that health literacy affected neither medication adherence nor self-efficacy perception, even after controlling for age and education levels.…”

eHealth Literacy in People Living with HIV: Systematic Review (Preprint)

“…Although one RCT scored 8 of 13 [23] and one of three quasi-experimental studies scored 6 of 9, [24] they had strengthened validity of causal inferences by comparing control and intervention groups. In addition, two quasi-experimental studies scored 6 of 9 [25,26] and lacked a comparison group to determine pre-post intervention effects.…”

“…Four studies were conducted in the U.S., [24][25][26][27] two in Uganda, [23,28] and one in Peru. [29] Various study designs were used: cross-sectional, [27][28][29] quasi-experimental, [24][25][26] and a RCT. [23] Two studies identified a theoretical or conceptual framework used in their research.…”

“…[23] Two studies identified a theoretical or conceptual framework used in their research. [23,25] Study participants were recruited from a variety of settings: community-based HIV/AIDS organizations, [25,[27][28][29] HIV hospital settings, [23,26] and both community-based and hospital settings. [24] Overall, HIV-infected adults older than 18 years were included; one study included only people who had advanced immunosuppression (CD4+ T cell count < 350 cells/mm 3 and taking ARTs for at least four years), [28] one included women only, [27] and one involved men who have sex with men (MSM) and/or transgender women (TGW).…”

“…Among studies that included women, most had a majority of female participants (56-100%), but two [24][25][26] included only 9% and 29% of females, respectively. Studies in the U.S.…”