Neurocognitive Impairment is Associated with Lower Health Literacy Among Persons Living with HIV Infection

Abstract

This study sought to determine the effects of HIV-associated neurocognitive disorders (HAND) on health literacy, which encompasses the ability to access, understand, appraise, and apply healthrelated information. Participants included 56 HIV seropositive individuals, 24 of whom met Frascati criteria for HAND, and 24 seronegative subjects who were comparable on age, education, ethnicity, and oral word reading. Each participant was administered a brief battery of wellvalidated measures of health literacy, including the Expanded Numeracy Scale (ENS), Newest Vital Sign (NVS), Rapid Estimate of Adult Literacy in Medicine (REALM), and Brief Health Literacy Screen (BHLS). Results revealed significant omnibus differences on the ENS and NVS, which were driven by poorer performance in the HAND group. There were no significant differences on the REALM or the BHLS by HAND status. Among individuals with HAND, lower scores on the NVS were associated with greater severity of neurocognitive dysfunction (e.g., NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript working memory and verbal fluency) and self-reported dependence in activities of daily living. These preliminary findings suggest that HAND hinders both fundamental (i.e., basic knowledge, such as numeracy) and critical (i.e., comprehension and application of healthcare information) health literacy capacities, and therefore may be an important factor in the prevalence of health illiteracy. Health literacy-focused intervention may play an important role in the treatment and health trajectories among persons living with HIV infection. KeywordsHIV-associated neurocognitive disorders; Neuropsychology; Disability; Health literacy Health literacy has been broadly defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions [1]." A recent systematic review by Berkman et al. [2] found considerable evidence that lower health literacy increases risk of suboptimal health outcomes, including more hospitalizations, reduced utilization of preventative medicine, and non-adherence to prescribed medications. Health literacy may play a particularly important role in health outcomes for underserved populations with chronic medical conditions, such as HIV disease [3]. It is estimated that between 20 and 40 % of persons infected with HIV have low health literacy [4], usually defined as self-reported difficulties with understanding healthcare materials or poor performance on validated measures of medical word knowledge or comprehension (e.g., Rapid Estimates of Adult Literacy in Medicine (REALM)). Specifically, HIV-related low health literacy is associated with limited knowledge of HIV disease [5] and refusal of HIV testing [6]. In the setting of HIV disease, low health literacy is particularly prevalent among ethnic and racial minorities and persons with lower levels of educational attainment [7]. HIV-infected persons with lower health literacy a...

Health-Related Decision-Making in HIV Disease

“…Within the HIV+ sample, both health-related decision-making tasks were associated with competency in numeracy, which is affected in HAND (Morgan et al, 2015). These findings are in accordance with studies that have shown that poor numeracy predicts poorer health outcomes, less accurate perception of health risks, and a compromised ability to make medical decisions (e.g., Reyna & Brainerd, 2007).…”

Association of Individual and Systemic Barriers to Optimal Medical Care in People Living With HIV/AIDS in Miami-Dade County

“…Socioeconomic factors that also reflect individuals’ life circumstances 15 including food insecurity and poor dietary factors 16–19 , low health literacy 20,21 , low education 22–24 , homelessness 15,25,26 , and social stigma 27,28 have been identified as important barriers to receipt of adequate HIV care. Additionally, at the individual level, the negative impact of psychosocial barriers on HIV-related health outcomes have been evident in previous research, including factors as substance use 25,29–32 , mental illness 31 , anxiety 17,33 , perceived stress 22,33 , depression 17,22,25,33 , hopelessness 22 , avoidant coping 22,27 , personality traits 34 , low self-efficacy 35,36 , low self-worth 37 , lack of social support 27,35,38–40 , lack of acceptance of seropositivity 37 , and low patient satisfaction.…”

Is the Newest Vital Sign a Useful Measure of Health Literacy in HIV Disease?

“…In contrast, the NVS assesses more complex cognitive functions associated with reading comprehension, numeracy, and problem solving, and may be more sensitive to health illiteracy by virtue of tapping into more aspects of neurocognitive functioning. 11,25 Thus, it stands to reason that the assessment of health literacy using the NVS may provide an added degree of clinical utility to providers in health-related environments at little cost, both in terms of time (i.e., the NVS takes only 3 minutes to administer) or expense. Further research is needed to assess whether such information impacts patient care, such as aiding clinicians in identifying good candidates for health literacy interventions or persons at risk for disengaging from healthcare.…”

“…9 Individuals with HIV that evidence limited health literacy have less knowledge about their disease, 10 are more likely to be non-adherent to their medication regimen, have lower self-efficacy for health behaviors, 9 and higher rates of HIV-associated neurocognitive impairment. 11 Evidence for the association between health literacy and clinical markers of HIV severity (e.g., CD4 cell count, viral load, and AIDS diagnoses) is weak and conflicting. 4,12 Indeed, some studies report significant relationships between lower health literacy and HIV disease severity, 13 whereas other studies show null results.…”

“…One study by Morgan et al 11 found that, among 24 individuals with HIV-associated neurocognitive disorders, lower scores on the NVS were correlated with greater severity of neurocognitive dysfunction, most notably working memory ( r s = .65) and verbal fluency ( r s = .70). In a study of 46 HIV+ individuals, lower NVS scores were related to worse performance on web-based measures of online healthcare skills, including pharmacy refills ( r s = .42) and health records navigation ( r s = .46).…”