AIDS and Behavior

, Volume 11, Issue 3, pp 385–392 | Cite as

Medication Beliefs as Mediators of the Health Literacy–Antiretroviral Adherence Relationship in HIV-infected Individuals

  • Joseph Graham
  • Ian M. Bennett
  • William C. Holmes
  • Robert Gross
Original Paper

Abstract

Identifying modifiable barriers to antiretroviral adherence remains an important aim. We hypothesized that mistaken beliefs regarding taking HIV medications mediated the relation between low literacy and poor adherence. We studied 87 HIV-infected individuals on standard antiretroviral regimens for ≥ 3 months. Adherence was assessed using pharmacy refill records. Medication beliefs, including an individual’s norm for acceptable adherence, were measured using questions developed by expert panel. Literacy was associated with ≥95% adherence (64% for ≥9th grade level vs. 40% for <9th grade level). Participants with <95% adherence had a lower threshold of acceptable adherence than those with ≥95% adherence [80% adherence (interquartile range 70–90%) vs. 90% adherence (interquartile range 80–90%)]. However, the effect was independent of literacy. No other beliefs assessed were associated with adherence. Although the beliefs assessed do not mediate the relation between literacy and adherence, we identified low adherence norms as a potentially modifiable belief associated with adherence.

Keywords

HIV-1 Antiretroviral therapy Adherence Health literacy 

Notes

Acknowledgments

This project was supported (or supported in part) by an Agency for Healthcare Research and Quality Centers for Education and Research on Therapeutics cooperative agreement (grant # HS10399), the PENN AIDS Clinical Trials Unit (U01-AI32783), the PENN Center for AIDS Research (P30-AI45008), and National Institutes of Mental Health grant MH-01854. Dr Holmes is supported by a Research Career Development award from the Health Services Research and Development Service of the Department of Veterans Affairs.

References

  1. Bangsberg, D. R., Perry, S., Charlebois, E. D., Clark, R. A., Roberston, M., Zolopa, A. R., et al. (2001). Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS, 15(9), 1181–1183.PubMedCrossRefGoogle Scholar
  2. Bennett, I. M., Robbins, S., Al-Shamali, N., & Haecker, T. (2003). Screening for low literacy among adult caregivers of pediatric patients. Family Medicine, 35(8), 585–590.PubMedGoogle Scholar
  3. Bennett, I. M., Switzer, J., Aguirre, A. C., Evans, K., & Barg, F. (2006). Breaking it down: patient–provider communication and prenatal care utilization among African-American women with low and higher literacy. Annals of Family Medicine, 4(4), 334–340.PubMedCrossRefGoogle Scholar
  4. Berkman, N. D., Dewalt, D. A., Pignone, M. P., Sheridan, S. L., Lohr, K. N., Lux, L., et al. (2004). Literacy and health outcomes. Evidence Report/Technology Assessment No. 87 (Prepared by RTI International-University of North Carolina Evidence-based Practice Center under Contract No. 290-02-0016). AHRQ Publication No. 04-E007-2. Rockville, MD: Agency for Healthcare Research and Quality. January 2004.Google Scholar
  5. Davis, T. C., Long, S. W., Jackson, R. H., Mayeaux, E. J., George, R. B., Murphy, P. W., et al. (1993). Rapid estimate of adult literacy in medicine: A shortened screening instrument. Family Medicine, 25(6), 391–395.PubMedGoogle Scholar
  6. Davis, T. C., Mayeaux, E. J., Fredrickson, D., Bocchini, J. A. Jr., Jackson, R. H., & Murphy, P. W. (1994). Reading ability of parents compared with reading level of pediatric patient education materials. Pediatrics, 93(3), 460–468.PubMedGoogle Scholar
  7. Davis, T. C., Michielutte, R., Askov, E. N., Williams, M. V., & Weiss, B. D. (1998). Practical assessment of adult literacy in health care. Health Education and Behavior, 25(5), 613–624.PubMedCrossRefGoogle Scholar
  8. DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160(14), 2101–2107.PubMedCrossRefGoogle Scholar
  9. Estrada, C. A., Martin-Hryniewicz, M., Peek, B. T., Collins, C., & Byrd, J. C. (2004). Literacy and numeracy skills and anticoagulation control. American Journal of Medical Science, 328(2), 88–93.CrossRefGoogle Scholar
  10. Gazmararian, J. A., Baker, D. W., Williams, M. V., Parker, R. M., Scott, T. L., Green, D. C., et al. (1999). Health literacy among Medicare enrollees in a managed care organization. JAMA, 281(6), 545–551.PubMedCrossRefGoogle Scholar
  11. Gross, R., Bilker, W. B., Friedman, H. M., & Strom, B. L. (2001). Effect of adherence to newly initiated antiretroviral therapy on plasma viral load. AIDS, 15(16), 2109–2117.PubMedCrossRefGoogle Scholar
  12. Gross, R., Zhang, Y., & Grossberg, R. (2005). Medication refill logistics and refill adherence in HIV. Pharmacoepidemiology and Drug Safety, 3, 3.Google Scholar
  13. Grossberg, R., Zhang, Y., & Gross, R. (2004). A time-to-prescription-refill measure of antiretroviral adherence predicted changes in viral load in HIV. Journal of Clinical Epidemiology, 57(10), 1107–1110.PubMedCrossRefGoogle Scholar
  14. Hope, C. J., Wu, J., Tu, W., Young, J., & Murray, M. D. (2004). Association of medication adherence, knowledge, and skills with emergency department visits by adults 50 years or older with congestive heart failure. American Journal of Health System Pharmacy, 61(19), 2043–2049.PubMedGoogle Scholar
  15. Jones, B. N., Teng, E. L., Folstein, M. F., & Harrison, K. S. (1993). A new bedside test of cognition for patients with HIV infection. Annals of Internal Medicine, 119(10), 1001–1004.PubMedGoogle Scholar
  16. Kalichman, S. C., Ramachandran, B., & Catz, S. (1999). Adherence to combination antiretroviral therapies in HIV patients of low health literacy. Journal of General Internal Medicine, 14(5), 267–273.PubMedCrossRefGoogle Scholar
  17. Kalichman, S. C., & Rompa, D. (2000). Functional health literacy is associated with health status and health-related knowledge in people living with HIV–AIDS. Journal of Acquired Immune Deficiency Syndromes, 25(4), 337–344.PubMedCrossRefGoogle Scholar
  18. McNabb, J. J., Nicolau, D. P., Stoner, J. A., & Ross, J. (2003). Patterns of adherence to antiretroviral medications: The value of electronic monitoring. AIDS, 17(12), 1763–1767.PubMedCrossRefGoogle Scholar
  19. Nielsen-Bohlman L., Panzer A., & Kindig D. (Eds.). (2004). Health literacy: A prescription to end confusion. Washington: The National Academies Press.Google Scholar
  20. Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., et al. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133(1), 21–30.PubMedGoogle Scholar
  21. Reynolds, N. R. (2004). Adherence to antiretroviral therapies: State of the science. Current HIV Research, 2(3), 207–214.PubMedCrossRefGoogle Scholar
  22. Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., et al. (2002). Association of health literacy with diabetes outcomes. JAMA, 288(4), 475–482.PubMedCrossRefGoogle Scholar
  23. Wainberg, M. A., & Friedland, G. (1998). Public health implications of antiretroviral therapy and HIV drug resistance. JAMA, 279(24), 1977–1983.PubMedCrossRefGoogle Scholar
  24. Williams, M. V., Parker, R. M., Baker, D. W., Parikh, N. S., Pitkin, K., Coates, W. C., et al. (1995). Inadequate functional health literacy among patients at two public hospitals. JAMA, 274(21), 1677–1682.PubMedCrossRefGoogle Scholar
  25. Wilson, H. S., Hutchinson, S. A., & Holzemer, W. L. (2002). Reconciling incompatibilities: A grounded theory of HIV medication adherence and symptom management. Qualitative Health Research, 12(10), 1309–1322.PubMedCrossRefGoogle Scholar
  26. Wilson, I. B., Tchetgen, E., & Spiegelman, D. (2001). Patterns of adherence with antiretroviral medications: An examination of between-medication differences. Journal of Acquired Immune Deficiency Syndromes, 28(3), 259–263.PubMedGoogle Scholar
  27. Wolf, M. S., Davis, T. C., Arozullah, A., Penn, R., Arnold, C., Sugar, M., et al. (2005). Relation between literacy and HIV treatment knowledge among patients on HAART regimens. AIDS Care, 17(7), 863–873.PubMedGoogle Scholar
  28. Wood, E., Hogg, R. S., Yip, B., Harrigan, P. R., O’Shaughnessy, M. V., & Montaner, J. S. (2003). Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 × 10(9) cells/L. Annals of Internal Medicine, 139(10), 810–816.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Joseph Graham
    • 1
  • Ian M. Bennett
    • 1
  • William C. Holmes
    • 2
    • 4
    • 5
  • Robert Gross
    • 3
    • 4
  1. 1.Department of Family Medicine and Community HealthUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  2. 2.Division of General Internal MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  3. 3.Division of Infectious Diseases, Department of MedicineUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  4. 4.Center for Clinical Epidemiology and BiostatisticsUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  5. 5.Center for Health Equity Research and PromotionPhiladelphia VA Medical CenterPhiladelphiaUSA

Personalised recommendations