“Keep it simple”: older African Americans’ preferences for a health literacy intervention in HIV management

Abstract

PurposeHealth literacy is lower in minorities and older adults, and has been associated with nonadherence to medications, treatment, and care in people living with human immunodeficiency virus (HIV). Likewise, African Americans with HIV are more likely to be nonadherent to their HIV medications, less likely to keep their clinic appointments related to HIV treatment and care, and more likely to die during hospitalizations than their ethnic counterparts. The present study explored the preferences of older African Americans with HIV for a health literacy intervention to promote HIV management.Patients and methodsIn this qualitative study, 20 older adult African Americans living with HIV were recruited from an HIV/acquired immunodeficiency syndrome outpatient clinic in the southeastern region of the US. Using patient-centered participatory design methods, semi-structured individual interviews were conducted to determine patient preferences for intervention development and design. Health literacy was also measured using the Rapid Estimate of Adult Literacy in Medicine – Revised (REALM-R).ResultsFour major themes emerged related to intervention development and design: keep health information simple; use a team-based approach for health education; tailor teaching strategies to patients’ individual needs; and account for patients’ low experience, but high interest, in technology. Forty-five percent of the study population had low health literacy based on the revised Rapid Estimate of Adult Literacy in Medicine.ConclusionFuture interventions that target minorities and older adults living with HIV should consider patients’ learning needs, sex-specific and mental health needs, and delivery approaches, in order to increase uptake and improve disease management and health outcomes.

Older African Americans and the HIV Care Continuum: A Systematic Review of the Literature, 2003–2018

“…It would be useful to also assess whether HIV stigma reduction interventions can be expanded to address multiple dimensions and levels of stigma (e.g., enacted stigma, community-level stigma) or the social norms related to prejudice and discrimination (e.g., race and gender discrimination) that seem to hinder older African Americans' engagement in the HIV care continuum [59]. Additionally, structural interventions that address poverty, healthcare access, health and medication literacy, and transportation availability should be evaluated and implemented specifically for older African Americans [60][61][62]. Finally, patient-centered approaches that provide comprehensive HIV care and routinely incorporate chronic management strategies can strengthen efforts to link and retain older PLWH in care and promote adherence to medication [63].…”

Perceptions of a Breast Cancer Survivorship Intervention: Pearls of Wisdom from Young African American Women

“…37 Resultant educational interventions may be more effective in reducing barriers and health disparities in QOL among them. 38 This study also indicates that the health care team should be aware of, assess for, and intervene in age-and culturallyspecific needs that may arise in young AA survivors. Participants reported instances of unmet needs.…”

Priority Topics for Health Education to Support HIV Self‐Management in Limited‐Resource Settings

“…The importance of targeted and tailored clinical communication was highlighted in the integrative review (Stonbraker & Larson, ), in the HHS guidelines (HHS, ), in other studies (Mallinson, Rajabiun, & Coleman, ; Street, ), and is especially important in limited‐resource settings where patients are more likely to have low health literacy. One corresponding clinical recommendation to improve health education is to use an interdisciplinary team‐based approach to education, since this technique may make information provision more comprehensive and can help to address some of the psychosocial concerns facing patients (Gakumo et al., ). Healthcare providers can also explore additional methods to enhance individual clinical communication, such as by leaning techniques to more effectively communicate with individuals who have low health literacy or by providing print materials to augment patient education.…”

“…Barriers to obtain the information needed for effective self‐management in limited‐resource settings, such as the DR, are numerous, since services may be difficult to access, language and cultural differences and stigma are present, and patients’ limited educational backgrounds and low health literacy are likely to complicate healthcare interactions (Gebre, Forbes, & Peters, ; Rojas et al., ). Given these vast information needs and numerous sociocultural challenges to obtaining that information, health education interventions must be appropriately tailored to meet patients’ needs in order to improve their HIV self‐management behaviors (Gakumo, Enah, Vance, Sahinoglu, & Raper, ).…”