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Low health literacy is associated with HIV test acceptance

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Abstract

BACKGROUND: The Centers for Disease Control and Prevention has proposed increasing the proportion of people who learn their HIV serostatus. The health care setting represents a logical site to accomplish this goal. However, little is known about factors that determine acceptability of HIV testing in health care settings, particularly patients’ health literacy.

OBJECTIVE: To evaluate the association between patients’ health literacy and acceptance of HIV testing among individuals at an urgent care center (UCC).

METHODS: As part of a prospective study that sought to increase HIV testing at a UCC located in an inner-city hospital serving an indigent population, we surveyed patients who had been offered an HIV test by their providers and had accepted or refused testing. Pretest counseling was provided using a low-literacy brochure given to patients upon registration into the clinic. We measured health literacy level using the Rapid Estimate of Adult Literacy in Medicine (REALM) scale.

RESULTS: Three hundred seventy-two patients were enrolled in the study. In univariate analysis, no statistically significant difference between HIV test acceptors or refusers was found for gender, race/ethnicity, marital status, income, type of health insurance, educational level, or type of test offered. Acceptors were more likely to have a low literacy level (odds ratio [OR], 1.763; 95% confidence interval [CI], 1.084 to 2.866) and be less than 40 years old (OR, 1.639; 95% CI, 1.085 to 2.475). In multivariate analysis, low health literacy was shown to be a predictor of HIV test acceptance controlling for age and education (OR, 2.017; 95% CI, 1.190 to 3.418).

CONCLUSIONS: Low health literacy was shown to be a predictor of HIV test acceptance. Patients presenting to a UCC with poorer health literacy appear more willing to comply with health care providers’ recommendations to undergo HIV testing than those with adequate health literacy when an “opt-out” strategy combined with a low-literacy brochure is used.

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Authors and Affiliations

  1. Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Maribel Barragán MPH, Giselle Hicks MPH, Mark V. Williams MD, Carlos Franco-Paredes MD, MPH, Wayne Duffus MD, PhD &  Carlos del Rio MD

  2. Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

    Maribel Barragán MPH, Giselle Hicks MPH, Carlos Franco-Paredes MD, MPH, Wayne Duffus MD, PhD &  Carlos del Rio MD

  3. Emory University Center for AIDS Research, Emory University School of Medicine, Atlanta, GA, USA

    Carlos del Rio MD

Authors
  1. Maribel Barragán MPH
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  2. Giselle Hicks MPH
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  3. Mark V. Williams MD
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  4. Carlos Franco-Paredes MD, MPH
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  5. Wayne Duffus MD, PhD
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  6. Carlos del Rio MD
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Corresponding author

Correspondence to Carlos del Rio MD.

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The authors have no conflicts of interest to report.

See editoral by Chin, p. 448.

This study was supported by cooperative agreement UR3/CCU416463 from the Centers for Disease Control and Prevention, Atlanta, GA.

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Barragán, M., Hicks, G., Williams, M.V. et al. Low health literacy is associated with HIV test acceptance. J GEN INTERN MED 20, 422–425 (2005). https://doi.org/10.1111/j.1525-1497.2005.40128.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.40128.x

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