Literacy, self-efficacy, and HIV medication adherence

Abstract Objective We examined the relationship between patient literacy level and self-reported HIV medication adherence, while estimating the mediating roles of treatment knowledge and self-efficacy on this relationship. Methods Structured patient interviews with a literacy assessment, supplemente...

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Veröffentlicht in:Patient education and counseling 2007-02, Vol.65 (2), p.253-260
Hauptverfasser: Wolf, Michael S, Davis, Terry C, Osborn, Chandra Y, Skripkauskas, Silvia, Bennett, Charles L, Makoul, Gregory
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container_end_page 260
container_issue 2
container_start_page 253
container_title Patient education and counseling
container_volume 65
creator Wolf, Michael S
Davis, Terry C
Osborn, Chandra Y
Skripkauskas, Silvia
Bennett, Charles L
Makoul, Gregory
description Abstract Objective We examined the relationship between patient literacy level and self-reported HIV medication adherence, while estimating the mediating roles of treatment knowledge and self-efficacy on this relationship. Methods Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among 204 consecutive patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while the Patient Medication Adherence Questionnaire (PMAQ) was used to assess medication self-efficacy and adherence to antiretroviral regimens in the past 4 days. Results Approximately one-third of patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal to low literacy skills. In multivariate analyses, low literate patients were 3.3 times more likely to be non-adherent to their antiretroviral regimen ( p < 0.001). Patients’ self-efficacy, but not knowledge, mediated the impact of low literacy on medication adherence (AOR 7.4, 95% CI 2.7–12.5). Conclusion While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, self-efficacy mediated this relationship. Practice implications Comprehensive intervention strategies that go beyond knowledge transfer may be needed to address self-efficacy among patients across all literacy levels to be successful in the management of difficult medication schedules.
doi_str_mv 10.1016/j.pec.2006.08.006
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Methods Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among 204 consecutive patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while the Patient Medication Adherence Questionnaire (PMAQ) was used to assess medication self-efficacy and adherence to antiretroviral regimens in the past 4 days. Results Approximately one-third of patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal to low literacy skills. In multivariate analyses, low literate patients were 3.3 times more likely to be non-adherent to their antiretroviral regimen ( p &lt; 0.001). Patients’ self-efficacy, but not knowledge, mediated the impact of low literacy on medication adherence (AOR 7.4, 95% CI 2.7–12.5). Conclusion While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, self-efficacy mediated this relationship. Practice implications Comprehensive intervention strategies that go beyond knowledge transfer may be needed to address self-efficacy among patients across all literacy levels to be successful in the management of difficult medication schedules.</description><identifier>ISSN: 0738-3991</identifier><identifier>EISSN: 1873-5134</identifier><identifier>DOI: 10.1016/j.pec.2006.08.006</identifier><identifier>PMID: 17118617</identifier><language>eng</language><publisher>Ireland: Elsevier Ireland Ltd</publisher><subject>Adult ; Anti-HIV Agents - therapeutic use ; Antiretroviral Therapy, Highly Active - psychology ; Chi-Square Distribution ; Chicago ; Drug Administration Schedule ; Educational Measurement ; Educational Status ; Female ; Health Knowledge, Attitudes, Practice ; Health literacy ; Health Services Needs and Demand ; HIV ; HIV Infections - drug therapy ; HIV Infections - psychology ; Humans ; Internal Medicine ; Knowledge ; Literacy ; Logistic Models ; Louisiana ; Male ; Medication adherence ; Middle Aged ; Multivariate Analysis ; Nursing ; Patient Compliance - psychology ; Patient Compliance - statistics &amp; numerical data ; Patient Education as Topic - organization &amp; administration ; Risk Assessment ; Risk Factors ; Self Efficacy ; Surveys and Questionnaires</subject><ispartof>Patient education and counseling, 2007-02, Vol.65 (2), p.253-260</ispartof><rights>2006</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c472t-d2a554b802fc8db0bdafb85f5d7d0917a3ddf050662bcffb2ebdb9ea84ddcf8b3</citedby><cites>FETCH-LOGICAL-c472t-d2a554b802fc8db0bdafb85f5d7d0917a3ddf050662bcffb2ebdb9ea84ddcf8b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.pec.2006.08.006$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17118617$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wolf, Michael S</creatorcontrib><creatorcontrib>Davis, Terry C</creatorcontrib><creatorcontrib>Osborn, Chandra Y</creatorcontrib><creatorcontrib>Skripkauskas, Silvia</creatorcontrib><creatorcontrib>Bennett, Charles L</creatorcontrib><creatorcontrib>Makoul, Gregory</creatorcontrib><title>Literacy, self-efficacy, and HIV medication adherence</title><title>Patient education and counseling</title><addtitle>Patient Educ Couns</addtitle><description>Abstract Objective We examined the relationship between patient literacy level and self-reported HIV medication adherence, while estimating the mediating roles of treatment knowledge and self-efficacy on this relationship. Methods Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among 204 consecutive patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while the Patient Medication Adherence Questionnaire (PMAQ) was used to assess medication self-efficacy and adherence to antiretroviral regimens in the past 4 days. Results Approximately one-third of patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal to low literacy skills. In multivariate analyses, low literate patients were 3.3 times more likely to be non-adherent to their antiretroviral regimen ( p &lt; 0.001). Patients’ self-efficacy, but not knowledge, mediated the impact of low literacy on medication adherence (AOR 7.4, 95% CI 2.7–12.5). Conclusion While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, self-efficacy mediated this relationship. 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subjects Adult
Anti-HIV Agents - therapeutic use
Antiretroviral Therapy, Highly Active - psychology
Chi-Square Distribution
Chicago
Drug Administration Schedule
Educational Measurement
Educational Status
Female
Health Knowledge, Attitudes, Practice
Health literacy
Health Services Needs and Demand
HIV
HIV Infections - drug therapy
HIV Infections - psychology
Humans
Internal Medicine
Knowledge
Literacy
Logistic Models
Louisiana
Male
Medication adherence
Middle Aged
Multivariate Analysis
Nursing
Patient Compliance - psychology
Patient Compliance - statistics & numerical data
Patient Education as Topic - organization & administration
Risk Assessment
Risk Factors
Self Efficacy
Surveys and Questionnaires
title Literacy, self-efficacy, and HIV medication adherence
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