Abstract:

Low health literacy is associated with poor medication adherence in HIV-positive persons. Antiretroviral (ARV) medications, when taken appropriately, have been shown to markedly suppress HIV and have offered the possibility of dramatic clinical improvement and prolonged the lives of persons with HIV. However, critical factors important in promoting adherence in some groups in the United States may not be the same as those essential among Spanish-language dominant Hispanics (SDH) with limited English-language skills. As linguistic minorities, SDH face challenges to reaching optimal ARV adherence, such as difficulties in obtaining and understanding accurate information about HIV and its treatment. Addressing the problem of low health literacy in SDH with HIV may be a crucial step in improving their health status.

The development of e-health applications to promote health literacy that can be readily available online may be an effective way to address health disparities. Once created, costs for their continued deployment can be low, making them a cost-effective strategy for persons living with HIV. Therefore, the purpose of this research was to adapt a computer-based automated application that will provide linguistically and culturally appropriate, individually tailored health literacy education to HIV-positive SDH in the United States. Data were collected by conducting 30 in-depth interviews with patients and their health care providers to identify cultural factors impacting medication adherence among HIV-positive SDH and adapted a tailored, automated computer-based health literacy intervention to be delivered in Spanish. IBM® SPSS® 20 was used to analyze quantitative data. Qualitative data were coded and analyzed using a concurrent triangulation approach to converge the findings.

The sample consisted of low-income, unemployed or part-time employed, low acculturated Hispanics, many of whom (44%) had less than a high school degree; only 4 participants had a college degree.

Major themes identified within cultural contexts relevant to understanding motivational factors related to ARV adherence and incorporated them into the intervention:
1) HIV-stigma;
2) the role of familia (family);
3) social support,
4) depression.

We culturally and linguistically adapted an intervention, initially developed for English-speaking HIV-positive persons, that provides information about HIV infection, treatment, and medication related problem solving skills which are essential to improving adherence and health outcomes. The intervention, based on the Information-Motivation-Behavioral (IMB) Skills model, was adapted so that it might be effective with HIV-positive Hispanics whose dominant language is Spanish. We identified variables relevant to SDH that may promote or hinder adherence to antiretroviral medications, such as culturally-specific beliefs about or attitudes toward HIV infection and its treatment, and culture-specific motivational factors related to medication adherence.

For HIV-positive SDH, intervening to improve adherence will likely be most effective by targeting potential culturally relevant motivational barriers. Findings were used to guide adaptation of a theoretically-grounded, Internet based e-health education intervention that targets core cultural determinants of adherence, builds on knowledge, and addresses motivational factors for continuation of care.

Keywords:

Health literacy, HIV/AIDS, Hispanics, Latinos, antiretroviral adherence, e-health, tailored intervention, Internet.