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Ceylan E, Koç A. The association between health literacy, COVID-19 knowledge and adherence to preventive measures in Turkey. Glob Health Promot 2024; 31:6-14. [PMID: 37529918 DOI: 10.1177/17579759231187615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Despite vaccination and various prevention policies, the coronavirus (COVID-19) pandemic maintains its negative effects globally. Therefore, people must be adequately informed and put this knowledge into practice in order to take the necessary precautions. This can be achieved with adequate health literacy. In this context, this study was conducted to determine the relationship between health literacy, COVID-19 knowledge and adherence to preventive measures. The sample of this descriptive cross-sectional online survey consisted of 1086 people. Data were collected using a demographics questionnaire, the European Health Literacy Scale, the COVID-19 Knowledge Assessment Questionnaire and the COVID-19 Adherence Assessment Questionnaire. Participants' health literacy index had a median score of 30.9, with 67.5% having inadequate or problematic health literacy. Gender, age, education, marital status, region of residence, employment status and economic status were associated with health literacy (p < 0.05). Participants' median knowledge and adherence scores were 40 and 54, respectively. There were significant positive correlations between health literacy index, knowledge and adherence scores (p < 0.001). This study demonstrated that health literacy, COVID-19 knowledge and adherence were associated with each other. As a result, strategies aimed at improving health literacy may be beneficial in terms of having better knowledge and demonstrating high adherence to measures, thus, eradicating the COVID-19 pandemic, reducing COVID-19-related conditions and promoting public health.
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Affiliation(s)
- Erdal Ceylan
- Faculty of Health Sciences, Nursing Department, Ankara Yıldırım Beyazıt University, Çubuk/Ankara, Turkey
| | - Ayşegül Koç
- Faculty of Health Sciences, Nursing Department, Ankara Yıldırım Beyazıt University, Çubuk/Ankara, Turkey
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Rodkjaer LØ, Storgaard M, Sørensen NT, Schougaard LMV. Levels of health literacy among people living with HIV in outpatient care: a cross-sectional study from Denmark. AIDS Res Ther 2023; 20:59. [PMID: 37633910 PMCID: PMC10463697 DOI: 10.1186/s12981-023-00562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 08/20/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Low health literacy (HL) among people living with HIV (PLWHIV) encounter more disease related complications, more difficulty understanding health-related information and low adherence. Considering that, the HL levels among PLWHIV needs to be further investigated. The objective of this study was to investigate the levels of HL and patient involvement among PLWHIV in an outpatient clinic in Denmark. A second objective was to examine differences in HL levels across socio-demographic characteristics. METHODS In 2019, a population of 682 PLWHIV from a Danish outpatient hospital clinic were enrolled in cross-sectional study. Patients who had a digital postbox received an electronic questionnaire including following domains; health literacy, patient involvement, and socio-demographic status. Health literacy was measured using the Health Literacy Questionnaire (HLQ) through scores on three subscales: social support for health (HLQ4), engaging with healthcare providers (HLQ6), and understanding health information (HLQ9). An unpaired t-test was used to investigate mean differences in the HLQ scores across socio-demographic variables. RESULTS A total of 338 (55%) patients responded to the questionnaire. The included participants demonstrated high levels of HLQ4 (mean = 4.2) and HLQ6 (mean = 4.2), but lower for HLQ9 (mean = 2.9). In total 70-80% reported being involved in decisions about their health. We found a positive association between high level of HL (HLQ9) and living with a partner and higher levels of HL (HLQ4, HLQ6, and HLQ9) and employment. CONCLUSION PLWHIV in a Danish out-patient care population were found to have high levels of HL despite differences in demographic characteristics. Further research is needed to examine the levels of HL among non-responders to develop HL approaches and strategies to meet the needs of individuals with different HL skills.
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Affiliation(s)
- Lotte Ørneborg Rodkjaer
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
- Research Centre for Patient Involvement, Central Denmark Region, Aarhus University, Aarhus, Denmark.
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | - Liv Marit Valen Schougaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Centre for Patient Involvement, Central Denmark Region, Aarhus University, Aarhus, Denmark
- Center for Patient-reported Outcomes, AmbuFlex, Gødstrup Hospital, Herning, Denmark
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Content and Clinical Validation of the Nursing Outcome "Health Literacy Behaviour": A Validation Protocol. Healthcare (Basel) 2023; 11:healthcare11040481. [PMID: 36833015 PMCID: PMC9957519 DOI: 10.3390/healthcare11040481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/22/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Health literacy (HL) is a result of health promotion and education that has been included as a nursing intervention since 2013. It was proposed, as a nursing activity, to "determine health literacy status at initiation of contact with the patient through informal and/or formal assessments". Because of that, the outcome 'Health Literacy Behaviour' has been incorporated in the sixth edition of the Nursing Outcomes Classification (NOC). It collects the patient's different HL levels and allows them to be identified and evaluated in a social and health context. Nursing outcomes are helpful and provide relevant information for the evaluation of nursing interventions. OBJECTIVES To validate the contents of the nursing outcome 'Health Literacy Behaviour (2015)' in order to use them in nursing care plans, and to evaluate their psychometric properties, application level, and effectiveness in nursing care to detect low health literacy patients. METHODS a methodological two-phased study: (1) an exploratory study and content validation by expert consensus, who will evaluate revised content of nursing outcomes; (2) methodological design by clinical validation. CONCLUSION The validation of this nursing outcome in NOC will enable the generation of a helpful tool that would facilitate nurses to set individualised and efficient care interventions and identify low health literacy populations.
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Iqbal K, Dong X, Zhu W, Wiener J, Dominguez KL, Tanner MR, Kourtis AP, Singh S, Hoover KW. Decreased Human Immunodeficiency Virus Diagnosis Rates Among Black and Hispanic or Latino Men Who Have Sex With Men in US Jurisdictions Supported by the THRIVE Demonstration Project, 2014-2019. Clin Infect Dis 2023; 76:307-314. [PMID: 36124683 PMCID: PMC10999974 DOI: 10.1093/cid/ciac774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Black and Hispanic/Latino men who have sex with men (MSM) are disproportionately affected by human immunodeficiency virus (HIV). In the Targeted Highly Effective Interventions to Reverse the HIV Epidemic (THRIVE) demonstration project, 7 community collaboratives were developed to provide comprehensive HIV prevention services for these populations. METHODS We analyzed National HIV Surveillance System data to determine the number of HIV diagnoses for each year from 2014 to 2019 among Black, Hispanic/Latino, and White MSM in 7 THRIVE-eligible Metropolitan Statistical Areas (MSAs) that were awarded funding and 12 THRIVE-eligible MSAs that were not awarded funding. We used generalized linear Poisson regression models to estimate adjusted estimated annual percentage changes (EAPCs) with 95% confidence intervals for HIV diagnosis rates controlling for HIV prevalence, viral suppression, HIV testing rates, preexposure prophylaxis (PrEP) prescription rates, poverty, education, and insurance status. RESULTS We found larger estimated decreases in HIV diagnosis rates in THRIVE jurisdictions compared with non-THRIVE jurisdictions. The adjusted EAPC among Black MSM was -8.2 (-11.7 to -4.6) in THRIVE MSAs compared with -4.2 (-7.8 to -0.4) in non-THRIVE MSAs. The adjusted EAPC among Hispanic/Latino MSM was -8.6 (-12.2 to -4.8) in THRIVE MSAs compared with -2.6 (-5.1 to -0.1)in non-THRIVE MSAs. The adjusted EAPC among White MSM was -7.6 (-12.0 to -3.1) in THRIVE MSAs compared with 5.9 (1.8-10.1) in non-THRIVE MSAs. CONCLUSIONS The THRIVE community collaborative model was associated with a decrease in HIV diagnoses among Black and Hispanic/Latino MSM. To achieve the goals of the US Ending the HIV Epidemic initiative, effective interventions aimed to increase PrEP use need to be focused on Black and Hispanic/Latino MSM.
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Affiliation(s)
- Kashif Iqbal
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Xueyuan Dong
- Social and Scientific Systems, Inc., a DLH Holdings company, Atlanta, Georgia, USA
| | - Weiming Zhu
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jeffrey Wiener
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kenneth L Dominguez
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary R Tanner
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Athena P Kourtis
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sonia Singh
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen W Hoover
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Regencia ZJG, Castelo AV, Eustaquio PC, Araña YS, Corciega JOL, Rosadiño JDT, Pagtakhan RG, Baja ES. Non-uptake of HIV testing among trans men and trans women: cross-sectional study of client records from 2017 to 2019 in a community-based transgender health center in Metro Manila, Philippines. BMC Public Health 2022; 22:1755. [PMID: 36114481 PMCID: PMC9479240 DOI: 10.1186/s12889-022-14158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transgender individuals are considered at high risk of contracting HIV infection. Integrating HIV testing and counseling (HTC) services into current transgender health programs is necessary to increase its uptake. Our study aimed to describe the characteristics of trans men (TM) and trans women (TW) who accessed HTC services in a community-based transgender health center in Metro Manila, Philippines, and to examine the relationship between gender identity and their non-uptake of HIV testing. METHODS: We conducted a cross-sectional study of TM and TW seeking care from 2017 to 2019. Medical records of clients were reviewed to ascertain their age, gender identity, year and frequency of clinic visits, lifestyle factors, and non-uptake of HIV testing. The effect of gender identity on the non-uptake of HIV testing was estimated using a generalized linear model with Poisson distribution, log link function, and a robust variance, adjusted for confounding variables. RESULTS: Five hundred twenty-five clients were included in the study, of which about 82.3% (432/525) of the clients declined the HTC services being offered. In addition, the prevalence of non-uptake of HIV testing was 48% higher (Adjusted Prevalence Ratio: 1.48; 95% Confidence Interval: 1.31-1.67) among TM compared to TW. Approximately 3.7% (1/27) and 10.6% (7/66) of the TM and TW, respectively, who accessed the HTC services were reactive. Moreover, most reactive clients were on treatment 87.5% (7/8); three were already virally suppressed, four were on ART but not yet virally suppressed, and one TW client was lost to follow up. CONCLUSION The non-uptake of HTC service of TM and TW is high. HIV program implementers should strategize solutions to reach this vulnerable population for increased and better HTC service uptake and linkage to care.
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Affiliation(s)
- Zypher Jude G Regencia
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, City of Manila, 1000, Philippines
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, City of Manila, 1000, Philippines
| | - Aisia V Castelo
- LoveYourself Inc, Mandaluyong City, 1552, Metro Manila, Philippines
| | | | - Yanyan S Araña
- LoveYourself Inc, Mandaluyong City, 1552, Metro Manila, Philippines
| | | | - John Danvic T Rosadiño
- LoveYourself Inc, Mandaluyong City, 1552, Metro Manila, Philippines
- Faculty of Management and Development Studies, University of the Philippines - Open University, Los Baños, 4031, Laguna, Philippines
| | | | - Emmanuel S Baja
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, City of Manila, 1000, Philippines.
- Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines Manila, City of Manila, 1000, Philippines.
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Etowa J, Tharao W, Mbuagbaw L, Baidoobonso S, Hyman I, Obiorah S, Aden M, Etowa EB, Gebremeskel A, Kihembo M, Nelson L, Husbands W. Community perspectives on addressing and responding to HIV-testing, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) among African, Caribbean and Black (ACB) people in Ontario, Canada. BMC Public Health 2022; 22:913. [PMID: 35525946 PMCID: PMC9078631 DOI: 10.1186/s12889-022-13093-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/14/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The African, Caribbean, and Black (ACB) population of Ontario, Canada is comprised of individuals with diverse ethnic, cultural and linguistic backgrounds and experiences; some of whom have resided in Canada for many generations, and others who have migrated in recent decades. Even though the ACB population represents less than 3.5% of the Canadian population, this group accounts for 21.7% of all new HIV infections. It is well-documented that ACB populations, compared to the general population, experience multi-level barriers to accessing appropriate and responsive HIV services. In this paper, we present qualitative findings on the ACB population's experiences with HIV-testing, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) and obtain their perspectives on how to improve access. METHODS We conducted twelve Focus Group Discussions (FGDs), within a two-day World Café event and used socio-ecological framework and community-based participatory research (CBPR) approaches to guide this work. We meaningfully engaged ACB community members in discussions to identify barriers and facilitators to HIV testing, PEP and PrEP and how these may be addressed. The FGDs were transcribed verbatim and thematic analysis guided data interpretation. Credibility of data was established through data validation strategies such as external audit and peer-debriefing. RESULTS Our analyses revealed multi-level barriers that explain why ACB community members do not access HIV testing, PEP and PrEP. Fear, health beliefs, stigma and lack of information, were among the most frequently cited individual- and community-level barriers to care. Health system barriers included lack of provider awareness, issues related to cultural sensitivity and confidentiality, cost, and racism in the health care system. Participants identified multi-level strategies to address the HIV needs including community-based educational, health system and innovative inter-sectoral strategies. CONCLUSION CBPR, co-led by community members, is an important strategy for identifying the multi-level individual, interpersonal, community, institutional and structural factors that increase HIV vulnerability in ACB communities, notably anti-Black systemic racism. Study findings suggest the need for targeted community-based strategies and strategies aimed at reducing health system barriers to testing and care.
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Affiliation(s)
- Josephine Etowa
- grid.28046.380000 0001 2182 2255School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Wangari Tharao
- grid.439329.6Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario Canada
| | - Lawrence Mbuagbaw
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario Canada
| | - Shamara Baidoobonso
- grid.55602.340000 0004 1936 8200Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia Canada
| | - Ilene Hyman
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Suzanne Obiorah
- Suzanne Obiorah, Community and Social Services, Ottawa, Ontario Canada
| | - Muna Aden
- grid.439329.6Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario Canada
| | - Egbe B. Etowa
- Canadians of African Descent Health Organization, Ottawa, Ontario Canada
| | - Akalewold Gebremeskel
- grid.28046.380000 0001 2182 2255School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Medys Kihembo
- grid.439329.6Women’s Health in Women’s Hands Community Health Centre, Toronto, Ontario Canada
| | - LaRon Nelson
- grid.47100.320000000419368710School of Nursing, Yale University, New Haven, CT USA
| | - Winston Husbands
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
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Stonbraker S, Sanabria G, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Rowell-Cunsolo T, Halpern M, Bakken S, Schnall R, George M. "If They Give Their Mind to HIV, They Don't Last as Long": An Explanatory Model of HIV Infection in a Limited-Resource Setting Informs Person-Centered Care. Glob Qual Nurs Res 2022; 9:23333936221097112. [PMID: 35719278 PMCID: PMC9203948 DOI: 10.1177/23333936221097112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 03/04/2022] [Accepted: 03/19/2022] [Indexed: 11/18/2022] Open
Abstract
Explanatory models describe individuals’ perceptions of their illness experiences, which can guide culturally relevant care. We constructed an explanatory model of the experience of living with human immunodeficiency virus (HIV) in the Dominican Republic. Following qualitative descriptive methodology, we conducted interviews in Spanish using a semi-structured interview guide developed using Kleinman’s explanatory model framework. Two bilingual researchers coded interview transcripts following conventional content analysis. We used deductive codes from Kleinman’s framework and inductive codes external to the framework to construct the codebook. We arranged codes by shared meaning into categories and constructed themes that reflected shared findings from inductive categories and deductive codes. Twenty-six persons living with HIV participated. They provided rich descriptions of their experiences represented by four cross-cutting themes, which informed the explanatory model. By incorporating this in-depth understanding of patients’ illness experiences into care delivery, nurses can cultivate culturally meaningful and trusting patient-centered partnerships that improve health.
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Affiliation(s)
- Samantha Stonbraker
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, USA
| | | | | | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
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Kiran S, Karnam Y, Niharika B. Epidemiological evaluation of maternal periodontal status in human immunodeficiency virus seropositive pregnant women in India. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2022. [DOI: 10.4103/jiaphd.jiaphd_97_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Casais B, Proença JF. The use of positive and negative appeals in social advertising: a content analysis of television ads for preventing HIV/AIDS. INTERNATIONAL REVIEW ON PUBLIC AND NONPROFIT MARKETING 2022; 19:623-647. [PMCID: PMC8541814 DOI: 10.1007/s12208-021-00318-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/10/2021] [Indexed: 05/29/2023]
Abstract
Effectiveness of positive and negative appeals in social advertising depends on the target audience and the context in which the messages are applied. However, there is a dearth of research on the real use of such message appeals by social marketers. Considering the importance of practice theory in social marketing, this paper presents a longitudinal research on the use of positive and negative appeals in social advertising, since communication has been particularly relevant in social marketing practices over time. A content analysis of 375 HIV/AIDS-prevention TV ads from four European countries indicates that positive appeals had expressive and higher proportional use over the entire period under analysis. The researchers identified positive appeals, especially in rhetoric, music and voice tonality, while negative appeals are more prevalent in narratives and signs from the scenes. The results show that participation of public figures promoting coping response was low, but increasing over time. Negative appeals are mostly expressed in countries with higher uncertainty avoidance indexes and higher epidemic incidence rates. The prevalence of positive and negative appeals in social advertisements informs about practitioners’ choices when designing campaigns and allows analyzing congruity between the use of appeals and theoretical recommendations for social marketing effectiveness. The study opens the discussion about the application of social marketing theories into practice and how the analysis of social marketing practices may contribute to design innovative theoretical approaches, particularly regarding a topic plagued by inconsistent findings in the literature on message-frame effectiveness in social marketing. The practitioners’ preference for the gain-frame perspective over the protection motivation approach allows inquiring about the motivations and constraints leading to that choice.
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Affiliation(s)
- Beatriz Casais
- School of Economics and Management, and CICS.NOVA.UMinho, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - João F. Proença
- Faculty of Economics, University of Porto, Porto, Portugal
- Advance/CSG, ISEG, University of Lisbon, Lisboa, Portugal
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Stonbraker S, Liu J, Sanabria G, George M, Cunto-Amesty S, Alcántara C, Abraído-Lanza AF, Halpern M, Rowell-Cunsolo T, Bakken S, Schnall R. Clinician Use of HIV-Related Infographics During Clinic Visits in the Dominican Republic is Associated with Lower Viral Load and Other Improvements in Health Outcomes. AIDS Behav 2021; 25:4061-4073. [PMID: 34129143 PMCID: PMC8602767 DOI: 10.1007/s10461-021-03331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 02/05/2023]
Abstract
We designed an infographic intervention to help clinicians provide health information to persons living with HIV. In this study, we assessed the extent to which our intervention may improve objectively and subjectively measured health outcomes (CD4 count, viral load, and engagement with clinician among others) when integrated into routine visits in the Dominican Republic. In this pretest-posttest study, we followed participants for 9 months at 3-month intervals. Physicians administered the intervention during participants' first 3 visits. Outcome measures, selected using a conceptual model, were assessed at 4 time points. We assessed changes in outcomes over time with general linear regressions and Wilcoxon Signed-Rank tests. Participants (N = 50) were mostly female (56%) and had been living with HIV for a mean of 6.3 years (SD = 6.1). All outcomes, except CD4 count, demonstrated statistically significant improvements by study end. This provides preliminary evidence our intervention may improve outcomes, but further testing is needed.
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Affiliation(s)
- Samantha Stonbraker
- Anschutz Medical Campus, University of Colorado College of Nursing, 13120 E. 19th Ave, Aurora, CO, 80045, USA.
- Clínica de Familia La Romana, La Romana, Dominican Republic.
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | | | - Maureen George
- Columbia University School of Nursing, New York, NY, USA
| | | | | | | | - Mina Halpern
- Clínica de Familia La Romana, La Romana, Dominican Republic
| | | | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, USA
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GÜR K, DANIŞ R, DERİNSU AC, TURAN A, AKSOY Z, TUNCEL A. Access to Health Services by the Parents of Individuals with Intellectual Disability according to their Health Literacy Levels. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.881581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Maiorana A, Sevelius J, Keatley J, Rebchook G. "She is Like a Sister to Me." Gender-Affirming Services and Relationships are Key to the Implementation of HIV Care Engagement Interventions with Transgender Women of Color. AIDS Behav 2021; 25:72-83. [PMID: 31912274 PMCID: PMC7223907 DOI: 10.1007/s10461-020-02777-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present findings from qualitative interviews (N = 67) with 36 staff and 31 participants of nine distinct individual and/or group level interventions to engage transgender women of color (TWOC) in HIV care in the U.S. We examine the commonalities amongst the intervention services (addressing unmet basic needs, facilitating engagement in HIV care, health system navigation, improving health literacy, emotional support), and the relationships formed during implementation of the interventions (between interventionists and participants, among participants in intervention groups, between participants and peers in the community). Interventionists, often TWOC themselves, who provided these services developed caring relationships, promoted personal empowerment, and became role models for participants and the community. Intervention groups engaged participants to reinforce the importance of health and HIV care and provided mutual support. Gender affirming services and caring relationships may be two key characteristics of interventions that address individual and structural-level barriers to engage TWOC in HIV care.
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Affiliation(s)
- Andres Maiorana
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd floor, Box 0886, San Francisco, CA, 94143, USA.
| | - Jae Sevelius
- Center for AIDS Prevention Studies and Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, CA, USA
| | - JoAnne Keatley
- Center of Excellence for Transgender Health, University of California San Francisco, San Francisco, CA, USA
| | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd floor, Box 0886, San Francisco, CA, 94143, USA
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Sanders M, Tobin JN, Cassells A, Carroll J, Holder T, Thomas M, Luque A, Fiscella K. Can a brief peer-led group training intervention improve health literacy in persons living with HIV? Results from a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2021; 104:1176-1182. [PMID: 33221117 DOI: 10.1016/j.pec.2020.10.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/13/2020] [Accepted: 10/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The goal of this study was to determine if a 6-week, peer-led intervention improves health literacy and numeracy among people living with HIV (PLWH). METHODS We used a randomized controlled trial with repeated measurements, which included six, 90-minute, group-based training sessions. We recruited PLWH participants (n = 359) from safety-net practices in the New York City Metropolitan area and Rochester, NY. Participants were randomly assigned (1:1) to an intervention group (n = 180) or a control group (n = 179). Outcome measures were collected at baseline, eight weeks post-baseline, and at six months using the Brief Estimate of Health Knowledge and Action-HIV (BEHKA-HIV), the Electronic Health Literacy Scale (eHEALS), the Rapid Estimate of Adult Literacy (REALM), and the Newest Vital Sign (NVS). RESULTS The intervention group had statistically significant improvements in eHealth literacy and BEHKA-HIV compared to the control group. There were no statistically significant changes in general health literacy or numeracy in either group. The intervention had the greatest impact on participants with the lowest levels of eHealth literacy at baseline. CONCLUSION The intervention had a positive impact on participants' HIV health literacy and eHealth literacy. PRACTICE IMPLICATIONS Our findings have implications for broadening the function of peer-workers in the health care continuum.
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Affiliation(s)
- Mechelle Sanders
- Department of Family Medicine, University of Rochester Medical Center, Rochester, USA.
| | - Jonathan N Tobin
- Clinical Directors Network, Inc. (CDN), New York, USA; Center for Clinical and Translational Science, The Rockefeller University, New York, USA
| | | | - Jennifer Carroll
- Department of Family Medicine, University of Colorado, Aurora, USA
| | - Tameir Holder
- Clinical Directors Network, Inc. (CDN), New York, USA
| | - Marie Thomas
- Department of Family Medicine, University of Rochester Medical Center, Rochester, USA
| | - Amneris Luque
- Department of Internal Medicine, Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, USA
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14
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Wolfe HL, Baughman A, Davoust M, Sprague Martinez LS, Rajabiun S, Drainoni ML. Client Satisfaction with Community Health Workers in HIV Care Teams. J Community Health 2021; 46:951-959. [PMID: 33770333 DOI: 10.1007/s10900-021-00978-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
Community health workers (CHWs) integrated in human immunodeficiency virus (HIV) care teams undertake a variety of tasks to help patients navigate health care, develop care plans, and address social needs. Given the broad role of CHWs in HIV care, we sought to understand which client attributes are associated with various dimensions of CHW satisfaction using a sample of 204 people with HIV (PWH) from various geographic regions across the United States. Multivariable linear regressions were used to determine which client attributes were associated with complete satisfaction with CHWs using 10 validated measures. The mean age of participants was 40.6 years old (SD = 12.8) and over 70% were Black or African American. Adjusted models reveal clients who were female, have marginal health literacy, or have a substance use disorder diagnosis were more likely to not be completely satisfied across multiple dimensions (p ≤ .05). Conversely, being housed and having a mental health diagnosis were associated with being more likely to be completely satisfied (p ≤ .04). Clients' sociodemographic characteristics and health conditions may be indicative of unique needs, leading to differing expectations of CHWs. CHW training modalities should consider the complex interplay of care needs based upon different client backgrounds and experiences among PWH. Addressing unique needs resulting from social determinants of health and that arise from conditions co-occurring with HIV, such as substance use disorders, should be incorporated into CHW service delivery.
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Affiliation(s)
- Hill L Wolfe
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
| | - Allyson Baughman
- Center for Innovation in Social Work and Health, Boston University School of Social Work, Boston, MA, USA
| | - Melissa Davoust
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Linda S Sprague Martinez
- Center for Innovation in Social Work and Health, Boston University School of Social Work, Boston, MA, USA.,Macro Department, Boston University School of Social Work, Boston, MA, USA
| | - Serena Rajabiun
- Center for Innovation in Social Work and Health, Boston University School of Social Work, Boston, MA, USA.,Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Evans Center for Implementation and Improvement Sciences, Boston University, Boston, MA, USA
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15
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Gray C, Crawford G, Lobo R, Maycock B. Getting the right message: a content analysis and application of the health literacy INDEX tool to online HIV resources in Australia. HEALTH EDUCATION RESEARCH 2021; 36:61-74. [PMID: 33319239 DOI: 10.1093/her/cyaa042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/29/2020] [Indexed: 06/12/2023]
Abstract
Health literacy is considered by some as a determinant of health. Research suggests that different levels of health literacy may be associated with human immunodeficiency virus (HIV) knowledge and behaviour, including willingness to test. This study assessed the health literacy demands of existing Australia HIV prevention resources available online using a health literacy assessment and content analysis. Two reviewers assessed 66 resources using the Health Literacy INDEX. Sixty-one (92%) scored below 50%, with an average score of 35.5%. A coding frame was developed to conduct a content analysis of the resources excluding videos, multiple webpages and booklets (n = 52). We coded for six categories of knowledge: HIV knowledge (100% of resources), transmission (96%), acquired immune deficiency syndrome (AIDS) knowledge (88%), testing (87%), consequence of infection (85%) and prevention (77%). We found that resources required a reading grade above grade 8, and very few resources considered audience appropriateness. There were missed opportunities to encourage HIV prevention or testing. Some resources used incorrect language to refer towards people living with HIV, and transmission and prevention messages were often inconsistent. Guidelines for developing HIV prevention resources are warranted to improve health literacy, accessibility and appropriateness of resources and ensure consistent messages and framing of HIV risk.
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Affiliation(s)
- Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Western Australia 6102, Australia
| | - Gemma Crawford
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Western Australia 6102, Australia
| | - Roanna Lobo
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Bentley, Western Australia 6102, Australia
| | - Bruce Maycock
- College of Medicine & Health, University of Exeter, Devon, Exeter EX4 4SB, UK
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16
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Perez TA, Chagas EFB, Pinheiro OL. Health functional literacy and adherence to antiretroviral therapy in people living with HIV. Rev Gaucha Enferm 2021; 42:e20200012. [PMID: 33566947 DOI: 10.1590/1983-1447.2021.20200012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To verify the relationship between adherence to antiretroviral therapy and Functional Health Literacy. METHODS Cross-sectional study, carried out in the Specialized Care Service in 2019, using questionnaires about adherence to treatment and Functional Health literacy people living with human immunodeficiency virus. The LFS questionnaire has questions about numerical and text interpretation skills and the adherence questionnaire addresses how to use antiretrovirals. Viral load was verified by analysis of medical records. Associations between variables were analyzed using the Chi-square test. RESULTS 78 patients were interviewed and a significant association between the variables to treatment adherence and Functional Literacy in Health was observed. The association between adherence to therapy and viral load levels was also significant. CONCLUSIONS The data found show a significant association between the variables, ie, the lower the functional health literacy, the greater the difficulty to adhere to treatment.
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Affiliation(s)
| | - Eduardo Federighi Baisi Chagas
- Faculdade de Medicina de Marília (FAMEMA). Marília, São Paulo, Brasil.,Universidade de Marília (UNIMAR). Marília, São Paulo, Brasil
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17
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Sianturi EI, Perwitasari DA, Soltief SN, Atiqul Islam M, Geboers B, Taxis K. Health literacy of people living with HIV in a rural area in Indonesia: A cross-sectional study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:127-134. [PMID: 32649018 PMCID: PMC7818436 DOI: 10.1111/hsc.13075] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 05/25/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
Indonesia, the fourth most populated country in the world, has experienced a fivefold increase in Human Immunodeficiency Virus (HIV)-infected individuals since 2001. Little is known about health literacy in people living with HIV (PLHIV) in Indonesia. This study aimed to determine the level of health literacy among PLHIV in Indonesia and assess associations between sociodemographic variables, beliefs about medicines, stigma and health literacy. We conducted a cross-sectional study using questionnaires in PLHIV in Papua, Indonesia. The short version of the Test of Functional Health Literacy in Adults (S-TOFHLA), Beliefs about Medicines Questionnaire (BMQ) and HIV stigma scale as well as questions on demographic information were completed by the participants from two hospitals in Papua, Indonesia. In a multivariate logistic regression analysis, we assessed the association between sociodemographic variables, stigma, beliefs about medicine and low health literacy. Overall, 331 participants were included, 62.0% female, 67.0% Papuans. A total of 38.5% of participants had low health literacy. PLHIV with multi-dose regimen were less likely to have low health literacy than those taking a fixed-dose combination (OR = 0.51; 95%CI = 0.32-0.82). PLHIV who had social support in medicine-taking were more likely to have low health literacy (OR = 1.78; 95%CI = 1.07-2.97). More awareness about medication overuse (OR = 1.17; 95%CI = 1.06-1.29) and medication harm (OR = 1.10; 95%CI = 1.01-1.20) were also associated with having low health literacy. Overall, interventions targeting health literacy may be a promising strategy to improve self-management.
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Affiliation(s)
- Elfride I. Sianturi
- PharmacoTherapy, ‐Epidemiology & ‐Economics (PTEE)Department of PharmacyUniversity of GroningenGroningenThe Netherlands
- Faculty of Mathematics and Natural SciencesUniversity of Cenderawasih PapuaJayapuraPapuaIndonesia
| | | | | | - Md. Atiqul Islam
- PharmacoTherapy, ‐Epidemiology & ‐Economics (PTEE)Department of PharmacyUniversity of GroningenGroningenThe Netherlands
- Department of StatisticsShahjalal University of Science and TechnologySylhetBangladesh
| | - Bas Geboers
- Department of Health SciencesUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Katja Taxis
- PharmacoTherapy, ‐Epidemiology & ‐Economics (PTEE)Department of PharmacyUniversity of GroningenGroningenThe Netherlands
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18
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Gönderen Çakmak HS, Uncu D. Relationship between Health Literacy and Medication Adherence of Turkish Cancer Patients Receiving Oral Chemotherapy. Asia Pac J Oncol Nurs 2020; 7:365-369. [PMID: 33062832 PMCID: PMC7529023 DOI: 10.4103/apjon.apjon_30_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/06/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: The aim of this study was to explore the relationship between health literacy and self-report medication adherence of Turkish cancer patients receiving oral chemotherapy. Methods: The present research was a descriptive and cross-sectional study and conducted with 100 voluntary cancer patients who were admitted to the medical oncology outpatient clinic and received oral chemotherapy. The data were collected through a questionnaire form consisting of the Oral Chemotherapy Adherence Scale and the Turkish Health Literacy Scale (TSOY-32). The collected data were analyzed using descriptive statistics, one-way ANOVA, and Pearson's correlation coefficient. Results: The results revealed that 57% of the patients were female, 35% were primary school graduates, 51% were breast cancer, and 36% took capecitabine. The mean index scores of the participants on both scales were calculated as 12.39 ± 1.51 and 73.25 ± 6.18, respectively. Overall, a positive and strong correlation was found between oral chemotherapy adherence and health literacy of the participants (r = 0.707, P = 0.000). Conclusions: Medication adherence and health literacy levels among the cancer patients in Turkey are alarming so that patient-centered interventions and training are required to overcome the barriers to medication adherence.
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Affiliation(s)
| | - Doğan Uncu
- Department of Medical Oncology, T. C. Ministry of Health Ankara City Hospital, Ankara, Turkey
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19
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Siddiqui E, Shah AM, Sambol J, Waller AH. Readability Assessment of Online Patient Education Materials on Atrial Fibrillation. Cureus 2020; 12:e10397. [PMID: 33062517 PMCID: PMC7552109 DOI: 10.7759/cureus.10397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Health literacy is emerging as an important factor for medical outcomes as more patients turn to the internet for information about their disease. However educational materials on complex conditions such as atrial fibrillation tend to still be esoteric and result in compromised patient autonomy. We add to the current literature by examining the reading level of websites of major healthcare intuitions and general medicine websites. An online Google search using the term "atrial fibrillation" was used to collect patient educational material from the first 20 academic health institutions (AHI) and 20 non-affiliated general medicine websites (GMW). The materials were assessed for readability using nine (9) tests from the analysis software Readability Studio (Oleander Software Solutions Ltd., Maharashtra, India). The patient education materials from the AHI and GMW websites were written at a college freshman reading grade level (13.050 ± 0.845) and high school junior year reading level (11.64 ± 0.789) respectively. The GMW tend to have a wider range of readability levels, and many were scored at the 6th-grade level. In conclusion, the readability levels of patient education materials on atrial fibrillation from both the AHI and GMW are well above the 6th-grade level recommended by the NIH and AMA, posing a risk to the patients' understanding of the materials. The high readability scores found across all websites and the differences between the groups have been attributed to the various goals and target audiences of the material.
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Affiliation(s)
| | - Aakash M Shah
- Department of Cardiothoracic Surgery, Rutgers New Jersey Medical School, Newark, USA
| | - Justin Sambol
- Department of Cardiothoracic Surgery, Rutgers New Jersey Medical School, Newark, USA
| | - Alfonso H Waller
- Department of Cardiovascular Disease, Rutgers New Jersey Medical School, Newark, USA
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20
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Mahathir M, Wiarsih W, Permatasari H. How Do People Living With HIV Acquire HIV Related Information: A Qualitative Evaluation of Jakarta Setting. JURNAL NERS 2020. [DOI: 10.20473/jn.v15i2.19432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: People living with HIV are fully aware of their risk behavior and future threats that might arise. The rapid progress of HIV serves the population with many options of healthcare services and treatments. Insufficient knowledge and information will only lower the outcomes of HIV eradication efforts. The ultimate goals to eradicate HIV are to upscale status notification and treat all with appropriate antiretroviral and viral suppression, but it needs sufficient information to administer. Programs and interventions have already been proposed, but an inquiry is needed to ensure all the information is actually there. The study aimed to explore the experience of people living with HIV acquiring HIV-related information.Methods: This study used phenomenological qualitative study and in-depth interviews were conducted to 12 people living with HIV. Semi-structured questions were delivered to all participants which explored their tangible experience in terms of nurturing sufficient HIV-related information.Results: The study found four consequential themes: non-government organizations play a major role in HIV education, peers are a comfortable platform to discuss, it is all over the media and healthcare personnel are a source of knowledge. Conclusion: The distribution of HIV information and knowledge is now widespread. This situation marks part of the success in fighting HIV. Remarkable attempts can be maintained by optimizing the viable option of information delivery. Keyword: HIV knowledge; people living with HIV; qualitative study
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21
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Nosyk B, Zang X, Krebs E, Enns B, Min JE, Behrends CN, Del Rio C, Dombrowski JC, Feaster DJ, Golden M, Marshall BDL, Mehta SH, Metsch LR, Pandya A, Schackman BR, Shoptaw S, Strathdee SA. Ending the HIV epidemic in the USA: an economic modelling study in six cities. Lancet HIV 2020; 7:e491-e503. [PMID: 32145760 PMCID: PMC7338235 DOI: 10.1016/s2352-3018(20)30033-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The HIV epidemic in the USA is a collection of diverse local microepidemics. We aimed to identify optimal combination implementation strategies of evidence-based interventions to reach 90% reduction of incidence in 10 years, in six US cities that comprise 24·1% of people living with HIV in the USA. METHODS In this economic modelling study, we used a dynamic HIV transmission model calibrated with the best available evidence on epidemiological and structural conditions for six US cities: Atlanta (GA), Baltimore (MD), Los Angeles (CA), Miami (FL), New York City (NY), and Seattle (WA). We assessed 23 040 combinations of 16 evidence-based interventions (ie, HIV prevention, testing, treatment, engagement, and re-engagement) to identify combination strategies providing the greatest health benefit while remaining cost-effective. Main outcomes included averted HIV infections, quality-adjusted life-years (QALYs), total cost (in 2018 US$), and incremental cost-effectiveness ratio (ICER; from the health-care sector perspective, 3% annual discount rate). Interventions were implemented at previously documented and ideal (90% coverage or adoption) scale-up, and sustained from 2020 to 2030, with outcomes evaluated until 2040. FINDINGS Optimal combination strategies providing health benefit and cost-effectiveness contained between nine (Seattle) and 13 (Miami) individual interventions. If implemented at previously documented scale-up, these strategies could reduce incidence by between 30·7% (95% credible interval 19·1-43·7; Seattle) and 50·1% (41·5-58·0; New York City) by 2030, at ICERs ranging from cost-saving in Atlanta, Baltimore, and Miami, to $95 416 per QALY in Seattle. Incidence reductions reached between 39·5% (26·3-53·8) in Seattle and 83·6% (70·8-87·0) in Baltimore at ideal implementation. Total costs of implementing strategies across the cities at previously documented scale-up reached $559 million per year in 2024; however, costs were offset by long-term reductions in new infections and delayed disease progression, with Atlanta, Baltimore, and Miami projecting cost savings over the 20 year study period. INTERPRETATION Evidence-based interventions can deliver substantial public health and economic value; however, complementary strategies to overcome social and structural barriers to HIV care will be required to reach national targets of the ending the HIV epidemic initiative by 2030. FUNDING National Institutes of Health.
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Affiliation(s)
- Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
| | - Xiao Zang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Emanuel Krebs
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Benjamin Enns
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Jeong E Min
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Czarina N Behrends
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Carlos Del Rio
- Rollins School of Public Health and Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Julia C Dombrowski
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, Leonard M Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Matthew Golden
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | | | - Shruti H Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Bruce R Schackman
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Steven Shoptaw
- School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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22
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Tavousi M, Haeri-Mehrizi A, Rakhshani F, Rafiefar S, Soleymanian A, Sarbandi F, Ardestani M, Ghanbari S, Montazeri A. Development and validation of a short and easy-to-use instrument for measuring health literacy: the Health Literacy Instrument for Adults (HELIA). BMC Public Health 2020; 20:656. [PMID: 32397970 PMCID: PMC7216550 DOI: 10.1186/s12889-020-08787-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 04/27/2020] [Indexed: 11/18/2022] Open
Abstract
Background Health literacy is the ability to access to, understand, evaluate and use of essential health information to make basic health decisions. This study aimed to develop and psychometrically evaluate an instrument for measuring health literacy among adults (the Health Literacy Instrument for Adults - HELIA). Methods In addition to a literature review, a panel of specialists from different disciplines was formed to generate an item pool. Then, a framework was defined to develop the initial questionnaire based on a definition of health literacy and the most important global public health issues. The initial questionnaire contained 66 items. Next, 15 experts in public health were approached to assess content validity. Consequently, 19 items were removed and a provisional version of the questionnaire with 47 items was provided. Finally, a random sample of adults completed the questionnaire and psychometric properties of the instrument were assessed. Results Overall, 323 adults aged 18 to 65 years old completed the questionnaire. When the exploratory factor analysis was performed, 33 items were loaded, which indicated a 5-factor solution for the questionnaire that jointly explained 52.9% of the variance observed. The factors were as follows: access to information (6 items), reading (4 items), understanding (7 items), appraisal (4 items), and decision making/behavioral intention (12 items). Confirmatory factory analysis also indicated a good fit to the data for the five-latent structure (χ2/df = 1.60, SRMR = 0.049; RMSEA = 0.043; CFI = 0.98; NFI = 0.95; NNFI = 0.98 and GFI = 0.87). Additional analysis for internal consistency showed satisfactory results with Cronbach’s alpha coefficients ranging from 0.72 to 0.89. Intraclass correlation coefficient (test-retest analysis) also showed acceptable stability for the questionnaire (ICC = 0.84). The mean score for health literacy as measured by the HELIA was 76.3 (SD = 15.1) out of 100 for the study sample. Conclusion The findings suggest that the Health Literacy Instrument for Adults (HELIA) is a valid and reliable instrument for measuring health literacy. It is a short and easy-to-use instrument that could be applied in different settings.
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Affiliation(s)
- Mahmoud Tavousi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Aliasghar Haeri-Mehrizi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Fatemeh Rakhshani
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Rafiefar
- Health Education and Promotion Office, Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Atoosa Soleymanian
- Health Education and Promotion Office, Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Fatemeh Sarbandi
- Health Education and Promotion Office, Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Mona Ardestani
- Health Education and Promotion Office, Deputy of Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Shahla Ghanbari
- Department of Public Health, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
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23
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Maduka DO, Swanson MR, Markey K, Anderson BJ, Tracy M, Manganello JA. Health Literacy Among In-Care Older HIV Diagnosed Persons with Multimorbidity: MMP NYS (Excluding NYC). AIDS Behav 2020; 24:1092-1105. [PMID: 31435885 DOI: 10.1007/s10461-019-02627-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Older persons living with diagnosed HIV (PLWDH) are also at risk for age-related chronic conditions. With conflicting results on studies assessing health literacy and durable viral suppression, this study is the first in assessing this relationship using representative data on older in-care HIV-diagnosed persons with multimorbidity. Weighted data collected 2009-2014 from the Medical Monitoring Project (MMP) was used. Health literacy was assessed using the three-item Brief Health Literacy Screen (BHLS). The mean health literacy score was 11.22 (95% CI 10.86-11.59), and the mean multimorbidity was 4.75 (SE = 0.32). After adjusting, health literacy (OR 0.87, 95% CI 0.77-0.99) was found to be significantly associated with durable viral suppression. Adequate health literacy can help with achieving durable viral suppression. For these persons, addressing health literacy might increase their ability to access and navigate the healthcare system, thereby helping them stay engaged and maintain adherence to HIV care.
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24
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Ekong E, Ndembi N, Okonkwo P, Dakum P, Idoko J, Banigbe B, Okuma J, Agaba P, Blattner W, Adebamowo C, Charurat M. Epidemiologic and viral predictors of antiretroviral drug resistance among persons living with HIV in a large treatment program in Nigeria. AIDS Res Ther 2020; 17:7. [PMID: 32066473 PMCID: PMC7027291 DOI: 10.1186/s12981-020-0261-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 01/23/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Expanded access to combination antiretroviral therapy (cART) throughout sub-Saharan Africa over the last decade has remarkably improved the prognosis of persons living with HIV (PLWH). However, some PLWH experience virologic rebound after a period of viral suppression, usually followed by selection of drug resistant virus. Determining factors associated with drug resistance can inform patient management and healthcare policies, particularly in resource-limited settings where drug resistance testing is not routine. METHODS A case-control study was conducted using data captured from an electronic medical record in a large treatment program in Nigeria. Cases PLWH receiving cART who developed acquired drug resistance (ADR) and controls were those without ADR between 2004 and 2011. Each case was matched to up to 2 controls by sex, age, and education. Logistic regression was used estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with ADR. RESULTS We evaluated 159 cases with ADR and 299 controls without ADR. In a multivariate model, factors associated with ADR included older age (OR = 2.35 [age 30-40 years 95% CI 1.29, 4.27], age 41 + years OR = 2.31 [95% CI 1.11, 4.84], compared to age 17-30), higher education level (secondary OR 2.14 [95% CI 1.1.11-4.13]), compared to primary and tertiary), non-adherence to care (OR = 2.48 [95% CI 1.50-4.00]), longer treatment duration (OR = 1.80 [95% CI 1.37-2.35]), lower CD4 count((OR = 0.95 [95% CI 0.95-0.97]) and higher viral load (OR = 1.97 [95% CI 1.44-2.54]). CONCLUSIONS Understanding these predictors may guide programs in developing interventions to identify patients at risk of developing ADR and implementing prevention strategies.
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Affiliation(s)
- Ernest Ekong
- Department of Prevention, Care and Treatment, Institute of Human Virology-Nigeria (IHVN), Federal Capital Territory, Plot 252, Herbert Macaulay Way, Central Business District, Abuja, Nigeria.
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Nicaise Ndembi
- Department of Prevention, Care and Treatment, Institute of Human Virology-Nigeria (IHVN), Federal Capital Territory, Plot 252, Herbert Macaulay Way, Central Business District, Abuja, Nigeria.
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | - Patrick Dakum
- Department of Prevention, Care and Treatment, Institute of Human Virology-Nigeria (IHVN), Federal Capital Territory, Plot 252, Herbert Macaulay Way, Central Business District, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John Idoko
- Jos University Teaching Hospital, Jos, Nigeria
| | | | - James Okuma
- Department of Prevention, Care and Treatment, Institute of Human Virology-Nigeria (IHVN), Federal Capital Territory, Plot 252, Herbert Macaulay Way, Central Business District, Abuja, Nigeria
| | | | - William Blattner
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Clement Adebamowo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Manhattan Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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25
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Reynolds R, Smoller S, Allen A, Nicholas PK. Health Literacy and Health Outcomes in Persons Living with HIV Disease: A Systematic Review. AIDS Behav 2019; 23:3024-3043. [PMID: 30783871 DOI: 10.1007/s10461-019-02432-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Low health literacy is associated with challenges for those living with HIV including medication non-adherence and poorer health outcomes. The aim of this study was to systematically review the literature on health literacy and health outcomes in persons living with HIV. The extended guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, as well as A Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist were utilized to guide the approach to the review. A variety of electronic databases including PubMed, CINAHL, PsychInfo, and Cochrane Library were searched. Additional literature available on U.S. government websites was also included in the search. Search terms were used in a variety of combinations and included HIV, health literacy, adherence, and health outcomes. Forty-eight studies were identified that addressed health literacy and health outcomes in HIV. Although several studies in this review did not provide robust results of statistical significance linking health literacy with health outcomes, all of the studies addressed the key significance of health literacy within the scope of living with HIV disease. The relationship between health literacy and the identified health outcomes requires further research and explication.
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Rao S, Av S, Unnikrishnan B, Madi D, Shetty AK. Correlates of Late Presentation to HIV care in a South Indian Cohort. Am J Trop Med Hyg 2019; 99:1331-1335. [PMID: 30226140 DOI: 10.4269/ajtmh.18-0386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Late presentation to healthcare by HIV infected patients' is common in India despite access to free combination antiretroviral therapy (cART). We assessed risk factors for late presentation among patients with a recent HIV diagnosis in an academic university-based antiretroviral treatment center. This retrospective study included 474 recently diagnosed HIV-infected patients registered for cART between 2012 and 2013. Subjects with CD4+ T-lymphocyte (CD4) count ≤ 350 cells/μL or with an AIDS defining event were defined as late presenters (LP) and patients with CD4 count ≤ 200 cells/μL or with an AIDS defining event were defined as LP with advanced HIV disease (LPAD). Multivariable logistic regression analysis was used to investigate factors associated with late presentation. Of the 474 patients, 356 (75.1%) were LP. Of these, 299 (83.99%) were LPAD and 57 (16.01%) LP were AIDS-free. Median CD4 count among LP was 134 cells/μL (interquartile range 72.25-219). Mean age of LP was 42.50 ± 8.88 years; 256 (71.9%) were males. Increasing age (> 51 years; Adjusted odds ratio [aOR] 4.19; P = 0.014) and rural residence (aOR 3.19; P = < 0.001) were independently associated with late presentation. HIV-positive housewives (aOR 0.34; P = 0.027), HIV-positive individuals with negative partners (aOR 0.48; P = 0.006), and partners with unknown HIV status (aOR 0.43; P = 0.007) were less likely to present late compared with positive partners of people living with HIV/AIDS (PLWHA). Most patients were LP despite free access to cART. Rural population and older PLWHA should be targeted while implementing HIV care. There is a need to strengthen the HIV care cascade by linking PLWHA to cART immediately after diagnosis.
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Affiliation(s)
- Satish Rao
- Department of Medicine, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
| | - Satheesh Av
- Department of Medicine, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
| | - Deepak Madi
- Department of Medicine, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
| | - Avinash K Shetty
- Office of Global Health, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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The determinants of access to information on the Internet and knowledge of health related topics in European countries. Health Policy 2018; 122:1348-1355. [PMID: 30337158 DOI: 10.1016/j.healthpol.2018.09.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 07/11/2018] [Accepted: 09/25/2018] [Indexed: 11/21/2022]
Abstract
The aim of this study is to analyze the determinants of access to health-related information on the Internet and their influence on perceived knowledge of health-related topics in European countries. Referring to the European citizens' digital health literacy survey and applying structural equation modelling hypotheses, the obtained results showed that assumption of acceptance of information and capacity level are the main determinants which have the biggest influence on the perception of access to health-related information on the Internet. The access to health-related information negatively determined the perceived level of knowledge about health-related topics, which reveals that people making more use of the information are more critical in assessing the level of their knowledge. People who evaluated their health status as poor stated that they knew about health-related topics less. Therefore, the high level of access to health-related information does not mean that people would assume having more knowledge about health-related topics. The establishment of a platform on the Internet, which would supply all understandable information on health-related topics, would be the main tool for enhancing the level of knowledge of health-related topics.
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Corado K, Jain S, Morris S, Dube MP, Daar ES, He F, Aldous JL, Sitapati A, Haubrich R, Milam J, Karris MY. Randomized Trial of a Health Coaching Intervention to Enhance Retention in Care: California Collaborative Treatment Group 594. AIDS Behav 2018; 22:2698-2710. [PMID: 29725790 DOI: 10.1007/s10461-018-2132-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Poor linkage, engagement and retention remain significant barriers in achieving HIV treatment goals in the US. HIV-infected persons entering or re-entering care across three Southern California academic HIV clinics, were randomized (1:1) to an Active, Linkage, Engagement, Retention and Treatment (ALERT) specialist for outreach and health coaching, or standard of care (SOC). The primary outcome of time to loss to follow up (LTFU) was compared using Cox proportional hazards regression modeling. No differences in the median time to LTFU (81.7 for ALERT versus 93.6 weeks for SOC; HR 1.27; p = 0.40), or time to ART initiation was observed (N = 116). Although, ALERT participants demonstrated worsening depressive symptomatology from baseline to week 48 compared to SOC (p = 0.02). The ALERT intervention did not improve engagement and retention in HIV care over SOC. Further studies are needed to determine how best to apply resources to improve retention and engagement.
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Affiliation(s)
- Katya Corado
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and the David Geffen School of Medicine at UCLA, 1124 West Carson Street, Building CDCRC, Box 496, Torrance, CA, 90502, USA.
| | - Sonia Jain
- Deparment of Family and Preventive Medicine, University California San Diego, San Diego, CA, USA
| | - Sheldon Morris
- Deparment of Family and Preventive Medicine, University California San Diego, San Diego, CA, USA
| | - Michael P Dube
- Department of Medicine, Keck School of Medicine of the University Southern California, Los Angeles, CA, USA
| | - Eric S Daar
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center and the David Geffen School of Medicine at UCLA, 1124 West Carson Street, Building CDCRC, Box 496, Torrance, CA, 90502, USA
| | - Feng He
- Deparment of Family and Preventive Medicine, University California San Diego, San Diego, CA, USA
| | | | - Amy Sitapati
- Deparment of Medicine, University California San Diego, San Diego, CA, USA
| | | | - Joel Milam
- Department of Preventive Medicine, Keck School of Medicine of the University Southern California, Los Angeles, CA, USA
| | - Maile Young Karris
- Deparment of Medicine, University California San Diego, San Diego, CA, USA
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Stitzer ML, Hammond AS, Matheson T, Sorensen JL, Feaster DJ, Duan R, Gooden L, del Rio C, Metsch LR. Enhancing Patient Navigation with Contingent Incentives to Improve Healthcare Behaviors and Viral Load Suppression of Persons with HIV and Substance Use. AIDS Patient Care STDS 2018; 32:288-296. [PMID: 29883190 DOI: 10.1089/apc.2018.0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This secondary analysis compares health behavior outcomes for two groups of HIV+ substance users randomized in a 3-arm trial [1] to receive Patient Navigation with (PN+CM) or without (PN) contingent financial incentives (CM). Mean age of participants was 45 years; the majority was male (67%), African American (78%), unemployed (35%), or disabled (50%). Behaviors incentivized for PN+CM were (1) attendance at HIV care visits and (2) verification of an active HIV medication prescription. Incentives were associated with shorter time to treatment initiation and higher rates of behaviors during the 6-month intervention with exception of month 6 HIV care visits. Median HIV care visits were 3 (IQR 2-4) for PN+CM versus 1.5 (IQR 0-3) for PN (Wilcoxon p < 0.001); median validated medication checks were 4 (IQR 2-6) for PN+CM versus 1 (IQR 0-3) for PN (Wilcoxon p < 0.001). Viral suppression rates at end of treatment were not significantly different for the two groups but were directly related to the number of behaviors completed for both care visits (χ2(1) = 7.69, p = 0.006) and validated medication (χ2(1) = 8.49, p = 0.004). Results support use of incentives to increase performance of key healthcare behaviors. Adjustments to the incentive program may be needed to achieve greater rates of sustained health behavior change that result in improved viral load outcomes.
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Affiliation(s)
- Maxine L. Stitzer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Alexis S. Hammond
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Tim Matheson
- San Francisco Department of Public Health, San Francisco, California
| | - James L. Sorensen
- UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
| | - Daniel J. Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Lauren Gooden
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University, New York, New York
| | - Carlos del Rio
- Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Lisa R. Metsch
- Department of Sociomedical Sciences Mailman School of Public Health, Columbia University, New York, New York
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Miller DB, Cage JL, Nowacki AS, Jackson B, Modlin CS. Health Literacy (HL) & Health-Related Quality of Life (HRQL) Among Minority Men. J Natl Med Assoc 2018; 110:124-129. [DOI: 10.1016/j.jnma.2017.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/07/2017] [Accepted: 10/02/2017] [Indexed: 11/25/2022]
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Arafat SMY, Majumder MAA, Kabir R, Papadopoulos K, Uddin MS. Health Literacy in School. OPTIMIZING HEALTH LITERACY FOR IMPROVED CLINICAL PRACTICES 2018. [DOI: 10.4018/978-1-5225-4074-8.ch010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Health literacy is a core element of patient-centered healthcare. Poor health literacy is a silent epidemic across the globe as it affects every aspect of health. Schools bear an important role in increasing health literacy. Improving health literacy in adolescence is supposed to improve the later life as adolescents are used to carry their modified behavior lifelong. Various school-based interventions covering physical and mental health have been studied and found to be effective. International bodies recommend incorporation of health-related tasks into school lessons and considered that teaching the young people will be a good investment for future. Multisectoral collaborations and locally proved effective strategies are the practical challenges. This chapter aims to focus on health literacy, global scenario of health literacy, measurement tools, role of school, interventions, limitations, and challenges of health literacy.
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Abstract
OBJECTIVE We performed an impact and cost-effectiveness analysis of a novel HIV service delivery model in a high prevalence, remote district of Malawi with a population of 143 800 people. DESIGN A population-based retrospective analysis of 1-year survival rates among newly enrolled HIV-positive patients at 682 health facilities throughout Malawi, comparing facilities implementing the service delivery model (n = 13) and those implementing care-as-usual (n = 669). METHODS Through district-level health surveillance data, we evaluated 1-year survival rates among HIV patients newly enrolled between July 2013 and June 2014 - representing 129 938 patients in care across 682 health facilities - using a multilevel modeling framework. The model, focused on social determinants of health, was implemented throughout Neno District at 13 facilities and compared with facilities in all other districts. Activity-based costing was used to annualize financial and economic costs from a societal perspective. Incremental cost-effectiveness ratios were expressed as quality-adjusted life-years gained. RESULTS The national average 1-year survival rate for newly enrolled antiretroviral therapy clients was 78.9%: this rate was 87.9% in Neno District, compared with 78.8% across all other districts in Malawi (P < 0.001; 95% confidence interval: 0.079-0.104). The economic cost of receiving care in Neno district (n = 6541 patients) was $317/patient/year, compared with an estimated $219/patient in other districts. This translated to $906 per quality-adjusted life-year gained. CONCLUSION Neno District's comprehensive model of care, featuring a strong focus on the community, is $98 more expensive per capita per annum but demonstrates superior 1-year survival rates, despite its remote location. Moreover, it should be considered cost-effective by traditional international standards.
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Palumbo R, Annarumma C, Adinolfi P, Musella M. The missing link to patient engagement in Italy. J Health Organ Manag 2017; 30:1183-1203. [PMID: 27834606 DOI: 10.1108/jhom-01-2016-0011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to discuss the changing patterns of users' behavior in the health care service system. Although patient engagement and health services' co-production are understood as essential ingredients in the recipe for sustainable health systems, some determinants to patient involvement are still widely neglected by both policy makers and health care professionals. Among others, inadequate health literacy performs as a significant barrier to patient empowerment. Design/methodology/approach A survey aimed at objectively measuring health literacy-related skills was administered to a random sample of 600 Italian patients. The Italian version of the Newest Vital Sign (NVS) was used to assess the ability of the respondents to deal with written health information. Moreover, the respondents were asked to self-report their ability to navigate the health system. It was presumed that inadequate health literacy as measured by the NVS is related with impaired self-reported functional, interactive, and critical health-related competencies, paving the way for the inability and the unwillingness of patients to be involved in the health care provision. Findings About half of the sample showed inadequate health literacy. However, poor NVS scores were only slightly associated with limited self-reported functional, interactive, and critical health-related competencies. In general, patients with inadequate health-related skills were not likely to be engaged in the provision of health services. Elderly, people suffering from financial deprivation and less educated individuals were found to be at special risk of living with limited health literacy. Practical implications Limited health literacy is a common and relevant issue among people dealing with the health care service system. The impaired ability to collect, process, and use health information produces barriers to patient engagement and prevents the evolution of patients' behavior toward health care co-production. Originality/value Health literacy is a widely overlooked issue in the Italian national health system. This paper contributes in shedding light on the determinants and effects of health literacy of Italian hospital patients. Besides, some insights on the validity of the methodological tools typically used to assess health-related skills are provided.
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Affiliation(s)
- Rocco Palumbo
- Department of Management and Information Technology, University of Salerno , Salerno, Italy
| | - Carmela Annarumma
- Department of Management and Information Technology, University of Salerno , Salerno, Italy
| | - Paola Adinolfi
- Department of Management and Information Technology, University of Salerno , Salerno, Italy
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Cooke IJ, Jeremiah RD, Moore NJ, Watson K, Dixon MA, Jordan GL, Murray M, Keeter MK, Hollowell CMP, Murphy AB. Barriers and Facilitators toward HIV Testing and Health Perceptions among African-American Men Who Have Sex with Women at a South Side Chicago Community Health Center: A Pilot Study. Front Public Health 2017; 4:286. [PMID: 28097120 PMCID: PMC5206579 DOI: 10.3389/fpubh.2016.00286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/15/2016] [Indexed: 11/13/2022] Open
Abstract
In the United States, African-Americans' (AAs) HIV infection rates are higher than any other racial group, and AA men who have sex with women (MSW) are a significant proportion of new cases. There is little research into AA MSW HIV/AIDS knowledge, barriers, and facilitators of HIV testing in Chicago. We enrolled a convenience sample of AA MSW from a community health clinic who completed self-administered surveys assessing HIV knowledge and testing-related barriers and facilitators. The survey was a combination of questions from several validated instruments, and additional questions were written based on key informant interviews with social scientists to tailor the questionnaire for AA men living on the South Side of Chicago. We recruited 20 AA MSW (mean age 47.4 years). Sixty-five percent had incomes <$10,000/year, 30% were insured, and 50% had post-secondary education. Despite low socioeconomic status, their HIV literacy was relatively high. The identified major barriers to testing were low perceived HIV risk, concerns over privacy, and external stigma at testing sites. Future efforts should focus on educating AA MSW on actual risk for HIV and address issues of privacy and stigma at testing sites.
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Affiliation(s)
- Ian J. Cooke
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rohan D. Jeremiah
- School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Michael A. Dixon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Mary K. Keeter
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Adam B. Murphy
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Fuller SM, Koester KA, Guinness RR, Steward WT. Patients' Perceptions and Experiences of Shared Decision-Making in Primary HIV Care Clinics. J Assoc Nurses AIDS Care 2016; 28:75-84. [PMID: 27712863 DOI: 10.1016/j.jana.2016.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/26/2016] [Indexed: 11/15/2022]
Abstract
Shared decision-making (SDM) is considered best practice in health care. Prior studies have explored attitudes and barriers/facilitators to SDM, with few specific to HIV care. We interviewed 53 patients in HIV primary care clinics in California to understand the factors and situations that may promote or hinder engagement in SDM. Studies in other populations have found that patients' knowledge about their diseases and their trust in providers facilitated SDM. We found these features to be more nuanced for HIV. Perceptions of personal agency, knowledge about one's disease, and trust in provider were factors that could work for or against SDM. Overall, we found that participants described few experiences of SDM, especially among those with no comorbidities. Opportunities for SDM in routine HIV care (e.g., determining antiretroviral therapy) may arise infrequently because of treatment advances. These findings yield considerations for adapting SDM to fit the context of HIV care.
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Palumbo R, Annarumma C, Adinolfi P, Musella M, Piscopo G. The Italian Health Literacy Project: Insights from the assessment of health literacy skills in Italy. Health Policy 2016; 120:1087-94. [PMID: 27593949 DOI: 10.1016/j.healthpol.2016.08.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 07/27/2016] [Accepted: 08/14/2016] [Indexed: 11/26/2022]
Abstract
Inadequate health literacy, namely the problematic individual's ability to navigate the health care system, has been depicted as a silent epidemic affecting a large part of the world population. Inadequate health literacy has been variously found to be a predictor of patient disengagement, inappropriateness of care, increased health care costs, and higher mortality rates. However, to date the evidence on the prevalence of limited health literacy is heterogeneous; moreover, studies dealing with this topic show a pronounced geographical concentration. To contribute in filling these gaps, this paper investigates health literacy skills in Italy. Drawing on the European Health Literacy Survey (HLS-EU), a tool to measure self-perceived levels of health literacy was administered to a representative sample of Italian citizens. A stepwise regression analysis allowed to shed light on the determinants and consequences of limited health literacy. Findings suggested that inadequate health literacy is a prevailing problem in Italy, even though it has been overlooked by both policy makers and health care practitioners. Financial deprivation was found to be a significant predictor of inadequate health literacy. Low health literate patients reported higher hospitalization rates and greater use of health services. As compared with the European Countries, Italy showed some peculiarities in terms of health literacy levels and socio-demographic determinants of health literacy, which provide with intriguing insights for policy making.
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Affiliation(s)
- Rocco Palumbo
- Department of Management & Innovation Systems, University of Salerno, Via Giovanni Paolo II, nr. 132, Fisciano, Salerno 84084, Italy.
| | - Carmela Annarumma
- Department of Management & Innovation Systems, University of Salerno, Via Giovanni Paolo II, nr. 132, Fisciano, Salerno 84084, Italy
| | - Paola Adinolfi
- Department of Management & Innovation Systems, University of Salerno, Via Giovanni Paolo II, nr. 132, Fisciano, Salerno 84084, Italy
| | | | - Gabriella Piscopo
- Department of Management & Innovation Systems, University of Salerno, Via Giovanni Paolo II, nr. 132, Fisciano, Salerno 84084, Italy
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D'Almeida KW, Lert F, Spire B, Dray-Spira R. Determinants of virological response to antiretroviral therapy: socio-economic status still plays a role in the era of cART. Results from the ANRS-VESPA 2 study, France. Antivir Ther 2016; 21:661-670. [PMID: 27355137 DOI: 10.3851/imp3064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Disparities in combined antiretroviral therapy (cART) outcomes have been consistently reported among people living with HIV (PLWHIV). The present study aims at investigating the mechanisms underlying those disparities among PLWHIV in France. METHODS We used data from the Vespa2 survey, a large national cross-sectional survey, representative of HIV-infected people followed at hospitals in 2011. Among participants diagnosed ≥1996, HIV treatment-naive at the time of cART initiation and on cART for at least 12 months, the frequency of sustained virological suppression (SVS; undetectable viral load [<50 copies/ml] for at least 6 months) at the time of the survey, was assessed and its social determinants were measured through logistic regression, accounting for clinical and biological determinants of response to cART. RESULTS Among 1,246 participants, 77.7% had achieved SVS. SVS was less frequent among those unemployed (0.6 [range 0.3-1.0]) and those with the lowest level of education (0.4 [range 0.2-0.9]). The late presenters, diagnosed at a CD4+ T-cell count <200/mm3 (0.5 [range 0.3-0.9]) and the late starters, diagnosed at a CD4+ T-cell count >200 but initiating cART at CD4+ T-cell count <200 (0.3 [range 0.1-0.8]) were less likely than the ideal starters (≥350 CD4+ T-cells/mm3 at cART initiation) to achieve SVS, as were those who reported suboptimal adherence versus those reporting optimal adherence (0.4 [range 0.2-0.7]). In bivariate analyses, material deprivation, discrimination and a weak social network were also associated with a poorer treatment response. CONCLUSIONS Structural social factors remain strong determinants of treatment response and should be addressed in a broad approach of care, but wider political issues should also be investigated.
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Affiliation(s)
- Kayigan W D'Almeida
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136) - Équipe de recherche en épidémiologie sociale, Paris, France.,Centre de recherche en Epidemiologie et Sante des Populations Ringgold standard institution, Villejuif, Île-de-France, France
| | - France Lert
- Centre de recherche en Epidemiologie et Sante des Populations Ringgold standard institution, Villejuif, Île-de-France, France
| | - Bruno Spire
- INSERM, UMR912, Economics and Social Sciences Applied to Health and Analysis of Medical Information (SESSTIM), Marseille, France.,Aix Marseille University, UMRS912, IRD, Marseille, France.,ORS PACA, Southeastern Health Regional Observatory, Marseille, France
| | - Rosemary Dray-Spira
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136) - Équipe de recherche en épidémiologie sociale, Paris, France.,Centre de recherche en Epidemiologie et Sante des Populations Ringgold standard institution, Villejuif, Île-de-France, France
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Health literacy and infectious diseases: why does it matter? Int J Infect Dis 2016; 43:103-110. [PMID: 26751238 DOI: 10.1016/j.ijid.2015.12.019] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/14/2015] [Accepted: 12/24/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Multifactorial interventions are crucial to arrest the threat posed by infectious diseases. Public involvement requires adequate information, but determinants such as health literacy can impact on the effective use of such knowledge. The influence of health literacy on infectious diseases is examined in this paper. METHODS Databases were searched from January 1999 through July 2015 seeking studies reporting on health literacy and infections such tuberculosis, malaria, and influenza, and infection-related behaviours such as vaccination and hand hygiene. HIV was excluded, as comprehensive reviews have already been published. RESULTS Studies were found on antibiotic knowledge and use, the adoption of influenza and MMR immunizations, and screening for sexually transmitted and viral hepatitis infections. There was a lack of investigations on areas such as tuberculosis, malaria, hand hygiene, and diarrhoeal diseases. CONCLUSIONS Limited or insufficient health literacy was associated with reduced adoption of protective behaviours such as immunization, and an inadequate understanding of antibiotics, although the relationship was not consistent. Large gaps remain in relation to infectious diseases with a high clinical and societal impact, such as tuberculosis and malaria.
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