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J Gen Intern Med. 2005 May;20(5):422-5.

Low health literacy is associated with HIV test acceptance.

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  • 1Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.

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.

PMID:
15963165
PMCID:
PMC1490105
DOI:
10.1111/j.1525-1497.2005.40128.x
[PubMed - indexed for MEDLINE]
Free PMC Article
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