{"id":50730,"date":"2023-09-30T11:22:15","date_gmt":"2023-09-30T11:22:15","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=50730"},"modified":"2023-10-07T08:57:53","modified_gmt":"2023-10-07T08:57:53","slug":"health-literacy-in-people-living-with-human-immunodeficiency-virus-infection-a-narrative-review","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol16no3\/health-literacy-in-people-living-with-human-immunodeficiency-virus-infection-a-narrative-review\/","title":{"rendered":"Health Literacy in People Living with Human Immunodeficiency Virus Infection: A Narrative Review"},"content":{"rendered":"\n

Introduction <\/strong><\/p>\n\n\n\n

Overall literacy talents comprise an individual\u2019s\ncapacity to read, write and recognise written information (print literacy),\narticulate and interpret oral language (oral literacy) and interpret and apply\nfor numbers in everyday activities (numeracy). 1-2<\/sup> A subset of\ngeneral academic skills is health literacy, which is generally associated with\nit and has been described as the extent to which people can gain, approach and\nunderstand introductory health care information and its services required to\ntake health decisions. 3<\/sup> In contrast to individuals who are\nrelatively well-educated and health literate, those with restricted or\ndeficient health literacy tend to have more adverse outcomes following medical\ncare, have issues in adhering to clinical directions, experience the ill\neffects of both adverse physical and psychological circumstances, and have\nworse future well-being. Restricted well-being proficiency is connected with\nimperfect well-being results, particularly in the context of chronic diseases\nlike diabetes mellitus, hypertension and human immunodeficiency virus (HIV)\ndisease. 4-10<\/sup><\/p>\n\n\n\n

As a result, low health literacy has been associated with\nnegative health outcomes, including increased hospitalization rates, more\nfrequent hospital visits, and a higher risk of developing illnesses.\nConversely, a higher level of health literacy has been linked to improved\nhealth outcomes. Given these impacts, it is clear that improving health\nliteracy can have a significant impact on both individual and community\nwell-being, particularly for populations such as people living with HIV\n(PLHIV). Interventions aimed at increasing health literacy can play an important\nrole in improving overall health outcomes and reducing disparities in\nhealthcare.11<\/sup><\/p>\n\n\n\n

Concerning HIV, people with low health literacy have less\ninformation on the illness and their medical care needs. Moreover, they showpoor\ndrug compliance,<\/strong> potentially leading to treatment failure\nand lack of achievement of the target viral load reduction.8,12-15<\/sup><\/p>\n\n\n\n

The disparity in literacy levels within a society can\nlead to significant inequalities, as those with lower reading skills are often\ndisadvantaged compared to others, even when controlling for other factors such\nas age, wealth, education, and ethnicity. This has been demonstrated in studies\nwhich have shown that those with lower literacy skills tend to have worse\nphysical and mental health outcomes. These findings highlight the importance of\naddressing literacy levels to reduce health disparities and promote equal\naccess to resources and opportunities. 16-19<\/sup><\/p>\n\n\n\n

Nutbeam (2008) highlights the negative impact of low\nhealth literacy on individual health outcomes. People with limited health\nliteracy skills are more prone to adverse health consequences. This is because\nthey struggle to understand and use health information, services, and\ntechnologies effectively. This may lead to difficulties in navigating the\nhealthcare system, making informed decisions about health, and following\ntreatment plans. Low health literacy also exacerbates existing health\ndisparities and negatively impacts health outcomes for vulnerable populations.\nThus, addressing health literacy is crucial in improving the overall health and\nwell-being of individuals and communities. 20<\/sup><\/p>\n\n\n\n

Health literacy is influenced by a variety of factors,\nincluding education level, socioeconomic status, age, language proficiency, and\ncultural and social norms. People with lower levels of education may struggle\nto understand and interpret health information. Those with lower socioeconomic\nstatus may have limited access to healthcare, knowledge about health and\nwellness, and health information. Older populations may have lower health\nliteracy due to a lack of understanding of modern technology and medical\nadvancements. Furthermore, individuals who are not proficient in the language\nused in health education materials may have difficulty comprehending them,\nleading to lower health literacy. Cultural and social norms can also impact an\nindividual’s understanding of health information. 21-22<\/sup><\/p>\n\n\n\n

In the African country of Mozambique, wherein the adult\npopulation living with acquired immunodeficiency syndrome in 2007 was 11.5%, a\nsurvey showed that only half of the population was educated.16<\/sup> Low\nhealth literacy might adversely affect the capacity of individuals to\nself-manage their disease.17<\/sup> Evidence from research in the United\nStates demonstratesthat HIV subjects with limited health\nliteracy had minimal HIV-related information, lower capacity <\/p>\n\n\n\n

to deal with his\/hermedicine and\nfewer chances of accomplishing imperceptible viral burdens than people with\ngood health literacy.8,11,18-23<\/sup> A few investigations have shown an\nassociation between a lack of well-being education and non-adherence to\nantiretroviral therapy (ART), although some other studies have failed to\ndemonstrate a relationship between health literacy and medication adherence.13,24-25<\/sup><\/p>\n\n\n\n

Despite the emphasis placed on ending epidemics such as\nAIDS, Tuberculosis (TB), and Malaria, and through Sustainable Development Goal\n3.3 (SDG), it remains a challenge without adequate understanding of the burden\nof health literacy and the factors associated with it. These factors play a\ncrucial role in clinical care, epidemiology, and cost-effectiveness. It is\nalarming to note that approximately 25% of the global population is illiterate,\nhighlighting the need for increased literacy efforts.11<\/sup> While these\nestimates provide a rough estimate of the burden, a comprehensive synthesis of\nevidence is still lacking. To effectively address the challenge of ending these\nepidemics, a deeper understanding of health literacy and its associated factors\nis imperative.<\/p>\n\n\n\n

In response to the need for a deeper understanding of\nhealth literacy and its associated factors, we conducted a literature review in\nthe present study. Through a thorough analysis of available studies and\nresearch articles, we aimed to provide a comprehensive narrative on the current\nunderstanding of health literacy and its implications in clinical care,\nepidemiology, and cost-effectiveness. Our review aimed to address the gap in\nknowledge and to provide a basis for future studies in this area. The\nconclusion of our study underscores the importance of continued research and\nexploration in the field of health literacy to effectively address the\nchallenge of ending epidemics such as AIDS, Tuberculosis, Malaria, and\nNeglected Tropical Diseases.<\/p>\n\n\n\n

An essential goal of this review is to describe the\ncharacteristics associated with health literacy in people living with HIV that\nhave a significant impact on clinical practices and that need to be considered\nin determining well-being proficiency and foreseeing health outcomes.<\/p>\n\n\n\n

Race<\/strong><\/p>\n\n\n\n

Waldrop et al<\/em> (2010)\ninvestigated the association of race to well-being proficiency and medicine\ncompliance among African-American HIV patients (n = 207) participating in an\nAIDS drug-help program. Health literacy was measured by perusing the\nunderstanding subscale of the Test of Functional Health Literacy in Adults\n(TOFHLA).26The review showed that well-being proficiency among\nAfrican-Americans was lower than their Caucasian partners, particularly since\nAfrican-Americans adhered to treatment directions less accurately and was below\nthan their Caucasianpartners. Hence, racial variations\nmight be a significant indicator of well-being proficiency abilities among\nblack Americansin their self-administration and\nprescription compliance.20<\/p>\n\n\n\n

Chandra Y et al <\/em>(2007)\ninvestigated the relationship between well-being proficiency, prescription\ncompliance and race. The investigator utilized the Rapid Estimate of Adult\nLiteracy in Medicine (REALM) to quantify well-being proficiency.27 The tool\nrequires the subjects to pronounce words commonly used in the clinical scenario\n(for example,” prescription “, \u201cmedication “, and\n“pill”) and the ability to identify the correctness of the\narticulation. The investigators found that of the 204 participants, 45.1 % were\nblack Americans, the rest being Caucasians; race was not an important element\nvariable determining well-being proficiency, even though Black-American\nsubjects were less compliant with the prescribed regimen compared to theirnon-African\nAmerican counterparts.14<\/sup><\/p>\n\n\n\n

Even though most HIV research on racial disparities in\nwell-being proficiencymainly involved Black Americans,<\/strong> earlier\nstudies have been conducted among Latin Americans.28<\/sup> Mari-Lynn et al<\/em> (2008) studied 231 patients with\nHIV and found that Latinate was fourfoldas likely to\nhave poor health proficiency as compared with Caucasians.29<\/sup> Also,\nindividuals who spoke Spanish in comparison to English-speaking individuals had\npoorer health proficiency.28<\/sup> <\/p>\n\n\n\n

Gender-specific <\/strong><\/p>\n\n\n\n

 The relationship between gender and health\nproficiency is indecisive. C Ann Gakumo et\nal <\/em>(2013) studied the levels of health literacy among both genders; results\nshowed that females were more likely to peruse and understand health\ninformation than males, while males had better grades in arithmetic abilities.30<\/sup>\nDrenna Valverde et al<\/em> investigated\nthe health proficiency of 204 subjects and observed that females were bound to\nhave greater well-being proficiency grades than male subjects. Males scored\nhigher than females on arithmeticabilities despite\nhealth proficiency grades being not significantly different between the groups.\nMales also performedbetter compared to females in\ncomprehension of HIV prescription details.<\/strong> Consequently,\nmales were more likely to appreciateand follow up on\nclinical directions in contrast to females.31<\/sup><\/p>\n\n\n\n

Education<\/strong><\/p>\n\n\n\n

Low education levels were appreciably connected with low\nhealth literacy.32-33<\/sup> Seth C. Kalichman et al<\/em> (1999) studied wellbeing proficiency in 339 subjects with HIV\ninfectionand observed that those with low wellbeing\nproficiency had minimal structured education, contrasted with individuals with\nbetter-structured education.13<\/sup> An investigation of individuals on\nantiretroviral therapyshowed that those with\ncollege-level education or higher had betterproficiency\nabilities, increased CD4 cell count and lesser viral burden than the\nindividuals withsecondary school education. A good\nindicator of antiretroviral treatment compliance was health proficiency and\nlevel of education.10,33<\/sup><\/p>\n\n\n\n

The association between schooling, health-related\narithmetic skill and well-being proficiency in people with HIVhas\nbeen establishedin previous studies.7,35 <\/sup>One\nstudy analysed health proficiency, health-related numeric skillsand\nitsinterrelation witheducational\nattainment in184 subjects, more than 50% of whom wereBlack\nAmericans.30<\/sup>Health education was measured by\nthe Test of Functional Health Literacy in Adults (TOFHLA) and well-being <\/p>\n\n\n\n

arithmetic skill by the numeracy scale of TOFHLA.36-37<\/sup>\nIt showed a significant association between levels of educational status,\nlevels of well-being proficiency, well-being arithmetic skill and prescription\ncompliance. <\/strong>The trial inferred that schoolingwas\nan important component for good outcomes in the Black-American population\naffected by HIV infection.38<\/sup><\/p>\n\n\n\n

Shenoy A K et al<\/em>\n( 2023) studied health literacy and medication regimen complexityin\npatients with human immunodeficiency virus infection in the Indian population.The\nparticipants in the study had varying levels of education, with 5.6% having no\nformal education and 20% have completed college. The median age of participants\nwas 49 years, with an equal distribution of male and female participants. When\nit came to health literacy (HL) scores, no significant difference was seen\nbased on age. However, a statistically significant increase in HL scores was\nobserved based on the participants’ educational status, with those having\nhigher levels of education scoring higher.39<\/sup><\/p>\n\n\n\n

Ageing<\/strong><\/p>\n\n\n\n

In contrast to the general population, older individuals\nappear to have low levels of well-being literacy.1<\/sup> Over 66% of the\nAmerican population with advanced age has minimal well-being proficiency.30<\/sup>\nThe Short Test of Functional Health Literacy was utilized by Juli A. et al<\/em> (1999) to assess the well-being\neducation of health insurance members from the United States (n = 3260).4 The\nresult showed that 53.9% of the Espa\u00f1ola-speaking population and 33.9% of the\nEnglish-speaking population aged 65 years or higher had marginal well-being\nproficiency.4 Cognitive handicaps and educational status were connected with\nwell-being proficiency too. Even though the two elements were controlled,\nwell-being proficiency decreased extensively with age.40<\/sup> The study\nby Debra A. et al<\/em> (2010) on\nwell-being proficiency in adolescents (mean age 20.5 years) with HIV showed no\nsignificant association between well-being proficiency and HIV prescription\ncompliance (n = 186).37 The study by Mari-Lynn et al.(2008) revealed an\nassociation between advancing years and lower well-being proficiency;29<\/sup>\nmeanwhile a few other studies didn’t find such an association.11,39,32,29<\/sup><\/p>\n\n\n\n

From 2012 through 2017 stable fractions of newer\ndiagnosed HIV-positive patients older than 50 years is around 17% with\nthis  50% of HIV cases in an advanced country like the USA, where HIV\nprescription is accessible were 50 years or more advanced age group. Since\nadvancing age prompts an increase in comorbid conditions along with HIV,\nelderly persons are required to remember and follow a large number of clinical\ninstructions.4<\/sup> Remembering such information can be challenging,\nconsidering the potential presence of cognitive impairment in this population,\nwhich might create problems with thinking and planning.13,41<\/sup>\nTherefore, more studies are required to elucidate the effects of well-being\neducation and well-being numeracy, as well as scholarly inability, on the\ntreatment outcomes in this increasing population.<\/p>\n\n\n\n

Adherence<\/strong><\/p>\n\n\n\n

Poor medication adherence is a serious barrier to\nsuccessful chronic disease management. Miranda C. et al<\/em> (2015) identified higher levels of health literacy,\nspecifically reading comprehension, as significantly related to\nneuropsychological variables, sociocultural variables, and behavioural and\nclinical health outcomes in adults with HIV infection.42<\/sup> Multiple\nstudies concluded that health literacy is related to prescription compliance.44-46,22,31,50-55\n<\/sup>Marta Rivero et al<\/em> (2015) found\nsignificant interactions between adherence and functional health literacy.56<\/sup>\nThe study by Kalichman et al<\/em> (2011) proposed\nthat health literacy prognosticates prescription compliance.57<\/sup><\/p>\n\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

The aim of this review, following the methodology\noutlined by Arksey and O’Malley 58<\/sup>, is to evaluate the breadth,\ndepth, and nature of research on the impact of health literacy interventions on\nhealth outcomes. The objective is to determine the effectiveness of health\nliteracy interventions in improving health outcomes and reducing health\ndisparities. By increasing individuals’ understanding and utilization of health\ninformation, health literacy interventions have the potential to improve health\noutcomes and promote informed health decision-making, leading to better\nself-management of chronic conditions. They can also enhance access to health\nservices and reduce health disparities among vulnerable populations. Moreover,\nthe efficient delivery of care resulting from health literacy interventions can\nreduce healthcare costs. The outcome of this study will shed light on the\nsignificance of health literacy interventions and their role in promoting\nbetter health outcomes.<\/p>\n\n\n\n

Insufficient information in the research literature and\nscope for future studies <\/strong><\/p>\n\n\n\n

The review was investigated with consideration regarding\nCharacteristics related to health literacy among individuals living with human\nimmunodeficiency virus. Characteristics related to HIV well-being proficiency\nhave significant ramifications for HIV research in a clinical setting. For\nexample, we will want to foster instruments to gauge HIV health literacy, alter\nthe variables related to limited well-being proficiency and anticipate health\noutcomes.<\/p>\n\n\n\n

Implication on clinical practice<\/strong><\/p>\n\n\n\n

The shortfall of non-conceptual models of health literacy\nis an issue in the utilization of general proficiency instruments. HIV\ndisease-specific health literacy instruments would be more useful and likely to\nprovide more meaningful results rather than those obtained through the use of\ngeneral instruments. The lack of such specific instruments, chiefly those that\nfocus on disease-related knowledge, needs to be addressed. HIV well-being\neducation exploration should identify factors related to well-being proficiency\nand create interventions that can further improve health outcomes, particularly\nprescription adherence.<\/p>\n\n\n\n

Limitations<\/strong><\/p>\n\n\n\n

This narrative review has limitations. The vast majority\nof the HIV research referenced in this study was conducted among the western\nand African populations with HIV. The studies generally excluded individuals\nover 50 years of age, restricting the applicability of the study findings. The\nhealth literacy assessment instruments which are utilized in the studies were\nnot disease-specific which limits the generalizability of findings. These\ninadequacies comprise a significant research gap that needs to be taken into\nconsideration in future studies.<\/p>\n\n\n\n

Conclusion <\/strong><\/p>\n\n\n\n

In conclusion, this narrative review highlights the\nimportant role that health literacy plays in the management of HIV. However, it\nis crucial to acknowledge the limitations of the studies reviewed in this\narticle, which were primarily conducted among western and African populations\nand excluded individuals over 50 years of age. Additionally, the health\nliteracy assessment instruments used in these studies were not specific to the\ndisease, which limits the generalizability of the findings.<\/p>\n\n\n\n

In light of these limitations, it is recommended that\nfurther research be conducted on HIV health literacy in diverse geographical\nlocations with varying socioeconomic, societal, and healthcare characteristics.\nSuch studies will provide a more comprehensive understanding of the\nrelationship between health literacy and the management of HIV and inform the\ndevelopment of effective interventions to improve health literacy among\nindividuals living with HIV.<\/p>\n\n\n\n

In conclusion, this review highlights the need for\nongoing efforts to enhance our understanding of the complexities of health\nliteracy and its impact on the management of HIV and to develop innovative\nstrategies to address the disparities that exist.<\/p>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

  1. Nielsen-Bohlman L, Panzer AM, Kindig DA. The extent and associations of limited health literacy. InHealth literacy: a prescription to end confusion 2004. National Academies Press (US).
    CrossRef<\/a><\/li>
  2. Rothman, R. L., Montori, V. M., Cherrington, A., & Pignone, M. P. (2008). Perspective: the role of numeracy in health care. Journal of health communication<\/em>, 13<\/em>(6), 583-595.
    CrossRef <\/a><\/li>
  3. Parker RM, Ratzan SC, Lurie N. Health literacy: a policy challenge for advancing high-quality health care. Health affairs. 2003 Jul;22(4):147-53.
     CrossRef <\/a><\/li>
  4. Gazmararian JA, Baker DW, Williams MV, Parker RM, Scott TL, Green DC, Fehrenbach SN, Ren J, Koplan JP. Health literacy among Medicare enrollees in a managed care organization. Jama. 1999 Feb 10;281(6):545-51.
     CrossRef <\/a><\/li>
  5. Sudore RL, Mehta KM, Simonsick EM, Harris TB, Newman AB, Satterfield S, Rosano C, Rooks RN, Rubin SM, Ayonayon HN, Yaffe K. Limited literacy in older people and disparities in health and healthcare access. Journal of the American Geriatrics Society. 2006 May;54(5):770-6.
     CrossRef <\/a><\/li>
  6. Davis TC, Wolf MS, Bass PF, Middlebrooks M, Kennen E, Baker DW, Bennett CL, Durazo-Arvizu R, Bocchini A, Savory S, Parker RM. Low literacy impairs comprehension of prescription drug warning labels. Journal of general internal medicine. 2006 Aug;21:847-51.
     CrossRef <\/a><\/li>
  7. Wolf MS, Davis TC, Tilson HH, Bass III PF, Parker RM. Misunderstanding of prescription drug warning labels among patients with low literacy. American Journal of Health-System Pharmacy. 2006 Jun 1;63(11):1048-55.
     CrossRef <\/a><\/li>
  8. Wolf MS, Davis TC, Arozullah A, Penn R, Arnold C, Sugar M, Bennett CL. Relation between literacy and HIV treatment knowledge among patients on HAART regimens. AIDS care. 2005 Oct 1;17(7):863-73.
     CrossRef <\/a><\/li>
  9. Baker DW, Wolf MS, Feinglass J, Thompson JA. Health literacy, cognitive abilities, and mortality among elderly persons. Journal of general internal medicine. 2008 Jun;23:723-6.
     CrossRef <\/a><\/li>
  10. Muvuka B, Combs RM, Ayangeakaa SD, Ali NM, Wendel ML, Jackson T. Health literacy in African-American communities: Barriers and strategies. HLRP: Health Literacy Research and Practice. 2020 Jul 16;4(3):e138-43.
     CrossRef <\/a><\/li>
  11. Stormacq C, Wosinski J, Boillat E, Van den Broucke S. Effects of health literacy interventions on health-related outcomes in socioeconomically disadvantaged adults living in the community: a systematic review. JBI evidence synthesis. 2020 Jul 1;18(7):1389-469.
    CrossRef <\/a><\/li>
  12. Malloy-Weir LJ, Charles C, Gafni A, Entwistle VA. Empirical relationships between health literacy and treatment decision making: a scoping review of the literature. Patient education and counseling. 2015 Mar 1;98(3):296-309.
     CrossRef <\/a><\/li>
  13. Cornish K, Fox G, Fyfe T, Koopmans E, Pousette A, Pelletier CA. Understanding physical literacy in the context of health: a rapid scoping review. BMC Public Health. 2020 Dec;20:1-9.
     CrossRef <\/a><\/li>
  14. Jefferies P, Ungar M, Aubertin P, Kriellaars D. Physical literacy and resilience in children and youth. Frontiers in public health. 2019 Nov 19;7:346.
     CrossRef <\/a><\/li>
  15. Cavanaugh KL. Health literacy in diabetes care: explanation, evidence and equipment. Diabetes management (London, England). 2011 Mar;1(2):191.
    CrossRef <\/a><\/li>
  16. Kalichman SC, Cherry J, Cain D. Nurse-delivered antiretroviral treatment adherence intervention for people with low literacy skills and living with HIV\/AIDS. Journal of the Association of Nurses in AIDS Care. 2005 Sep 1;16(5):3-15.
     CrossRef <\/a><\/li>
  17. Ma T, Meng H, Ye Z, Jia C, Sun M, Liu D. Health literacy mediates the association between socioeconomic status and productive aging among elderly Chinese adults in a newly urbanized community. Frontiers in Public Health. 2021 Apr 9;9:647230.
    CrossRef <\/a><\/li>
  18. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health promotion international. 2000 Sep 1;15(3):259-67.
    CrossRef <\/a><\/li>
  19. Bekker MH, Lhajoui M. Health and literacy in first-and second-generation Moroccan Berber women in the Netherlands: Ill literacy?. International Journal for Equity in Health. 2004 Dec;3(1):1-1.
     CrossRef <\/a><\/li>
  20. Rasu RS, Bawa WA, Suminski R, Snella K, Warady B. Health literacy impact on national healthcare utilization and expenditure. International journal of health policy and management. 2015 Nov;4(11):747.
    CrossRef<\/a><\/li>
  21. Kalichman SC, Benotsch E, Suarez T, Catz S, Miller J, Rompa D. Health literacy and health-related knowledge among persons living with HIV\/AIDS. American journal of preventive medicine. 2000 May 1;18(4):325-31.
    CrossRef <\/a><\/li>
  22. Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. Journal of general internal medicine. 1999 May;14:267-73.
    CrossRef <\/a><\/li>
  23. Osborn CY, Paasche-Orlow MK, Davis TC, Wolf MS. Health literacy: an overlooked factor in understanding HIV health disparities. American journal of preventive medicine. 2007 Nov 1;33(5):374-8.
    CrossRef <\/a><\/li>
  24. Wolf MS, Davis TC, Osborn CY, Skripkauskas S, Bennett CL, Makoul G. Literacy, self-efficacy, and HIV medication adherence. Patient education and counseling. 2007 Feb 1;65(2):253-60.
     CrossRef <\/a><\/li>
  25. Tique JA, Howard LM, Gaveta S, Sidat M, Rothman RL, Vermund SH, Ciampa PJ. Measuring health literacy among adults with HIV infection in Mozambique: development and validation of the HIV literacy test. AIDS and Behavior. 2017 Mar;21:822-32.
     CrossRef <\/a><\/li>
  26. Lori JR, Dahlem CH, Ackah JV, Adanu RM. Examining antenatal health literacy in Ghana. Journal of Nursing Scholarship. 2014 Nov;46(6):432-40.
    CrossRef <\/a><\/li>
  27. Keikelame MJ, Swartz L. Lost opportunities to improve health literacy: observations in a chronic illness clinic providing care for patients with epilepsy in Cape Town South Africa. Epilepsy & Behavior. 2013 Jan 1;26(1):36-41.
     CrossRef <\/a><\/li>
  28. Waldrop-Valverde D, Jones DL, Gould F, Kumar M, Ownby RL. Neurocognition, health-related reading literacy, and numeracy in medication management for HIV infection. AIDS patient care and STDs. 2010 Aug 1;24(8):477-84.
     CrossRef <\/a><\/li>
  29. Waldrop-Valverde D, Osborn CY, Rodriguez A, Rothman RL, Kumar M, Jones DL. Numeracy skills explain racial differences in HIV medication management. AIDS and Behavior. 2010 Aug;14:799-806.
     CrossRef <\/a><\/li>
  30. Kalichman SC, Amaral CM, Stearns H, White D, Flanagan J, Pope H, Cherry C, Cain D, Eaton L, Kalichman MO. Adherence to antiretroviral therapy assessed by unannounced pill counts conducted by telephone. Journal of general internal medicine. 2007 Jul;22:1003-6.
     CrossRef <\/a><\/li>
  31. Osborn CY, Davis TC, Bailey SC, Wolf MS. Health literacy in the context of HIV treatment: introducing the Brief Estimate of Health Knowledge and Action (BEHKA)\u2014HIV Version. AIDS and Behavior. 2010 Feb;14:181-8.
    CrossRef <\/a><\/li>
  32. Miller LG, Liu H, Hays RD, Golin CE, Ye Z, Beck CK, Kaplan AH, Wenger NS. Knowledge of antiretroviral regimen dosing and adherence: a longitudinal study. Clinical Infectious Diseases. 2003 Feb 15;36(4):514-8.
    CrossRef <\/a><\/li>
  33. Colbert AM, Sereika SM, Erlen JA. Functional health literacy, medication\u2010taking self\u2010efficacy and adherence to antiretroviral therapy. Journal of advanced nursing. 2013 Feb;69(2):295-304.
     CrossRef <\/a><\/li>
  34. Liu H, Miller LG, Hays RD, Golin CE, Zhao H, Wenger NS, Kaplan AH. A comprehensive evaluation of survey questions for adherence to antiretroviral medications and exploratory analyses for identifying optimal sets of survey questions. AIDS Patient Care & STDs. 2006 Nov 1;20(11):760-72.
    CrossRef <\/a><\/li>
  35. Cressman MN, Liljequist L. The effect of grade norms in college students: Using the Woodcock\u2013Johnson III Tests of Achievement. Journal of Learning Disabilities. 2014 May;47(3):271-8.
    CrossRef<\/a><\/li>
  36. Davis TC, Wolf MS, Arnold CL, Byrd RS, Long SW, Springer T, Kennen E, Bocchini JA. Development and validation of the Rapid Estimate of Adolescent Literacy in Medicine (REALM-Teen): a tool to screen adolescents for below-grade reading in health care settings. Pediatrics. 2006 Dec;118(6):e1707-14.
    CrossRef <\/a><\/li>
  37. Van Servellen G, Brown JS, Lombardi E, Herrera G. Health literacy in low-income Latino men and women receiving antiretroviral therapy in community-based treatment centers. AIDS Patient Care and STDs. 2003 Jun 1;17(6):283-98.
    CrossRef <\/a><\/li>
  38. Drainoni ML, Rajabiun S, Rumptz M, Welles SL, Relf M, Rebholz C, Holmes L, Dyl A, Lovejoy T, Dekker D, Frye A. Health literacy of HIV-positive individuals enrolled in an outreach intervention: Results of a cross-site analysis. Journal of Health Communication. 2008 Apr 15;13(3):287-302.
    CrossRef <\/a><\/li>
  39. Gakumo CA, Vance DE, Moneyham LD, Deupree JP, Estrada CA. Health numeracy and health literacy within the context of management of patients with human immunodeficiency virus. Nursing: Research and Reviews. 2013 Feb 22:23-31.
     CrossRef <\/a><\/li>
  40. Waldrop-Valverde D, Jones DL, Jayaweera D, Gonzalez P, Romero J, Ownby RL. Gender differences in medication management capacity in HIV infection: the role of health literacy and numeracy. AIDS and Behavior. 2009 Feb;13:46-52.
     CrossRef <\/a><\/li>
  41. Kalichman SC, Rompa D. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2000 Dec 1;25(4):337-44.<\/li>
  42. Kalichman SC, Pope H, White D, Cherry C, Amaral CM, Swetzes C, Flanagan J, Kalichman MO. Association between health literacy and HIV treatment adherence: further evidence from objectively measured medication adherence. Journal of the International Association of Physicians in AIDS Care. 2008 Dec;7(6):317-23.
     CrossRef <\/a><\/li>
  43. Waldrop-Valverde D, Jones DL, Jayaweera D, Gonzalez P, Romero J, Ownby RL. Gender differences in medication management capacity in HIV infection: the role of health literacy and numeracy. AIDS and Behavior. 2009 Feb;13:46-52.
    CrossRef <\/a><\/li>
  44. Fagerlin A, Zikmund-Fisher BJ, Ubel PA, Jankovic A, Derry HA, Smith DM. Measuring numeracy without a math test: development of the Subjective Numeracy Scale. Medical Decision Making. 2007 Sep;27(5):672-80.
    CrossRef <\/a><\/li>
  45. Lipkus IM, Samsa G, Rimer BK. General performance on a numeracy scale among highly educated samples. Medical decision making. 2001 Feb;21(1):37-44.
     CrossRef <\/a><\/li>
  46. Poojar B, Shenoy A, Kamath A, Ramapuram J, Rao SB. Evaluation of health literacy and medication regimen complexity index among patients with human immunodeficiency virus infection: A single-Centre, prospective, cross-sectional study. Clinical Epidemiology and Global Health. 2023 Jan 1;19:101206.
    CrossRef <\/a><\/li>
  47. Drainoni ML, Rajabiun S, Rumptz M, Welles SL, Relf M, Rebholz C, Holmes L, Dyl A, Lovejoy T, Dekker D, Frye A. Health literacy of HIV-positive individuals enrolled in an outreach intervention: Results of a cross-site analysis. Journal of Health Communication. 2008 Apr 15;13(3):287-302.
     CrossRef <\/a><\/li>
  48. Howard LM, Tique JA, Gaveta S, Sidat M, Rothman RL, Vermund SH, Ciampa PJ. Health literacy predicts pediatric dosing accuracy for liquid zidovudine in Mozambique. AIDS (London, England). 2014 Apr 4;28(7):1041.
     CrossRef <\/a><\/li>
  49. McTavish S, Moore S, Harper S, Lynch J. National female literacy, individual socio-economic status, and maternal health care use in sub-Saharan Africa. Social science & medicine. 2010 Dec 1;71(11):1958-63.
     CrossRef <\/a><\/li>
  50. Ciampa PJ, Vaz LM, Blevins M, Sidat M, Rothman RL, Vermund SH, Vergara AE. The association among literacy, numeracy, HIV knowledge and health-seeking behavior: a population-based survey of women in rural Mozambique. PloS one. 2012 Jun 22;7(6):e39391.
     CrossRef <\/a><\/li>
  51. Miranda C. The impact of health literacy, neuropsychological impairment, and sociocultural factors on medication adherence in HIV+ adults<\/em> (Doctoral dissertation, Fordham University).<\/li>
  52. Graham J, Bennett IM, Holmes WC, Gross R. Medication beliefs as mediators of the health literacy\u2013antiretroviral adherence relationship in HIV-infected individuals. AIDS and Behavior. 2007 May;11:385-92.
     CrossRef <\/a><\/li>
  53. Paasche\u2010Orlow MK, Cheng DM, Palepu A, Meli S, Faber V, Samet JH. Health literacy, antiretroviral adherence, and HIV\u2010RNA suppression: a longitudinal perspective. Journal of General Internal Medicine. 2006 Aug;21(8):835-40.
    CrossRef <\/a><\/li>
  54. Kalichman SC, Pope H, White D, Cherry C, Amaral CM, Swetzes C, Flanagan J, Kalichman MO. Association between health literacy and HIV treatment adherence: further evidence from objectively measured medication adherence. Journal of the International Association of Physicians in AIDS Care. 2008 Dec;7(6):317-23.
     CrossRef <\/a><\/li>
  55. Kalichman SC, Catz S, Ramachandran B. Barriers to HIV\/AIDS treatment and treatment adherence among African-American adults with disadvantaged education. Journal of the National Medical Association. 1999 Aug;91(8):439.<\/li>
  56. Rivero-M\u00e9ndez M, Su\u00e1rez-P\u00e9rez EL, Sol\u00eds-B\u00e1ez SS. Measuring health literacy among people living with HIV who attend a community-based ambulatory clinic in Puerto Rico. Puerto Rico health sciences journal. 2015 Mar;34(1):31.<\/li>
  57. Kalichman SC, Pellowski J, Kalichman MO, Cherry C, Detorio M, Caliendo AM, Schinazi RF. Food insufficiency and medication adherence among people living with HIV\/AIDS in urban and peri-urban settings. Prevention Science. 2011 Sep;12(3):324-32.
     CrossRef <\/a><\/li>
  58. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. International journal of social research methodology. 2005 Feb 1;8(1):19-32.
     CrossRef <\/a><\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"

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