Lower Neurocognitive Functioning Disrupts the Effective Use of Internet-Based Health Resources in HIV Disease: The Mediating Effects of General Health Literacy Capacity

Abstract

HIV-associated neurocognitive impairment is an independent predictor of low general health literacy, which can be associated with poor disease outcomes (e.g., viremia). Given the increasing frequency with which health behaviors occur in an online environment (e.g., health information seeking, provider interactions), there is a specific need to understand the predictors of electronic health (eHealth) literacy of persons living with HIV disease. In this study, 90 HIV+ persons completed the eHealth Literacy Scale (eHEALS), which measures one's awareness, skills and evaluation of online health resources. Participants also completed a comprehensive battery of clinical neurocognitive tests and well-validated performance-based measures of general health literacy capacity (e.g., knowledge, numeracy). Results showed that, independent of education, lower neurocognitive function was moderately related to lower eHEALS scores, particularly in the domains of learning and motor skills. Of particular note, general health literacy capacity emerged as a significant mediator of the relationship between neurocognition and eHealth literacy. Thus, the adverse effects of neurocognition on health literacy capacity carries a downstream adverse influence on HIV+ persons' awareness, skills, and evaluation of health-related resources in the online environment.

Online pharmacy navigation skills are associated with prospective memory in HIV disease

“…These findings align with studies showing that the medio-temporal and prefrontal brain networks that support memory and executive functions are active during INS task performance (Dong et al, 2015;Small et al, 2009). A handful of studies now show that HIV-associated neurocognitive impairment is independently related to lower INS for both household (Woods et al, 2017) and health-related (Woods et al, 2016;Woods & Sullivan, 2019) tasks. Only one pilot study has specifically examined the neurocognitive aspects of online pharmacy skills.…”

“…For the average adult, these issues can make Internet navigation more cumbersome and challenging, but they can be especially difficult for individuals with neurocognitive disorders. Indeed, neurocognitive impairment is associated with higher rates of self-reported problems independently navigating technology (Nygård et al, 2012), including the Internet (Woods & Sullivan, 2019). In a recent systematic review, reported reliably and broadly medium-to-large effect sizes for the relationship between INS performance and a wide range of neurocognitive functions, most notably episodic learning and memory.…”

How did individual differences in neurocognition and health literacy influence the initial uptake and use of health-related information about COVID-19?

“…It is unlikely that the lack of significant findings were due to Type II error, as the current study sample of 217 participants was well-powered to detect small-to-medium effect sizes. These results were surprising, as other studies have demonstrated an association between neurocognition and electronic health literacy (e.g., Woods & Sullivan, 2019), as well as performance on naturalistic online search tasks . Other neurocognitive domains not assessed (e.g., spatial cognition, visual problem-solving) could still play an important role in information-seeking skills.…”

Group differences in health literacy are ameliorated in ehealth literacy

“…Poor health literacy is associated with adverse health outcomes: navigation difficulties within the health system, inaccurate or incomplete reports related to medical history, missed doctor appointments, inaccurate use of medications in terms of timing or dosage decreased rates of adherence to chronic illness regimens and increased risk of hospitalization (Baker et al, 1996 , 1998 , 2002 ; Williams, Baker, Honig, Lee, & Nowlan, 1998 ). Health literacy was also found to be associated with functioning in the digital domain, so that low health literacy (and related skills) are negatively related to the ability to understand (Woods & Sullivan, 2019 ; Zikmund-Fisher, Exe, & Witteman, 2014 ), evaluate online health information and trust in online health information (Diviani, van den Putte, Giani, & van Weert, 2015 ). Reviews (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011 ; Neter & Brainin, 2019 ) indicate consistent evidence on the association between health literacy and mortality, persisting after controlling for socioeconomic status, age, and race.…”