Health Literacy in Low-Income Latino Men and Women Receiving Antiretroviral Therapy in Community-Based Treatment Centers

The current study describes deficits in health literacy in a sample of 90 low-income HIV-positive Latino men and women having problems with treatment adherence. Some HIV/AIDS populations, including certain underserved ethnic minority groups seeking community-based treatment services, are reported to have low levels of health literacy. Studies of HIV/AIDS patients receiving supervised antiretroviral therapy show that the level of health literacy relates to patients' adherence to treatment and self-reported health status. The study focused on the extent to which system level factors impact health literacy in the context of predisposing individual characteristics.

Subjects were recruited from two administratively linked community clinics in Los Angeles with an HIV division serving primarily low-income Latino men and women of Mexican and Central American origins. The sample was 90 percent male, 94.4 percent born outside the United States, and most comfortable with the Spanish language.

Data were gathered on individual predisposing factors such as age, gender, birthplace, income, primary language, total years of education and proportion of education in the United States. Acculturation -- the process by which a person incorporates a new culture -- was measured with Marin's five-item acculturation subscale measuring facility with language. The researchers also assessed: level of psychological distress, time since diagnosis and time on antiretrovirals, participation in HIV instruction/support services (case management and treatment advocacy), quality of provider communications, HIV illness and treatment knowledge and misconceptions, recognition and understanding of instructions on prescription medication bottles.

The study regarded education, language and level of acculturation as individual predisposing factors that could potentially influence health literacy. More than three-quarters of the sample (82 percent) had equal to or less than a high-school level of education, and a low level of acculturation, the average score being 1.8 with a potential range of 1-5. Forty-two percent had monthly incomes equal to or less than $500. The mean age of the group was 40 years, but ages ranged from 21-78. Ninety-six percent of the sample had been on combination antiretroviral therapy for at least three consecutive months; the mean was 52 months, with a range of less than one month to 144 months. Most patients perceived moderately good provider communications, although there was variability in the range of scores on each subscale of the quality of provider communications measure. Self-reports indicated that 84.4 percent of the sample received HIV instructional support services.

Researchers conducted hierarchal multiple linear regression analyses to examine the relationship between individual predisposing, enabling, and system enabling factors. They entered factors sequentially to look at the contribution each made to the model. Level of education was the only individual predisposing factor and the only single variable significantly associated with correct responses to the HIV knowledge/misconception measure. Higher education was associated with greater knowledge of HIV-related treatment issues, while education, income, and quality of provider communications were associated with understanding HIV terms. Age, education, time since diagnosis and time on antiretrovirals were significantly associated with the ability to read and understand prescription bottle instructions. These findings supported the study's hypothesis that individual predisposing factors influence health literacy. They did not determine the exact relationship between individual predisposing and system enabling factors.

"Further research," the authors concluded, "is needed to examine the role of treatment programs in mediating relationships between individual predisposing factors and health literacy and the linkages between health literacy, health promotion behaviors, and subsequent health status in at-risk populations."

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