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Medication Beliefs as Mediators of the Health Literacy–Antiretroviral Adherence Relationship in HIV-infected Individuals

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Abstract

Identifying modifiable barriers to antiretroviral adherence remains an important aim. We hypothesized that mistaken beliefs regarding taking HIV medications mediated the relation between low literacy and poor adherence. We studied 87 HIV-infected individuals on standard antiretroviral regimens for ≥ 3 months. Adherence was assessed using pharmacy refill records. Medication beliefs, including an individual’s norm for acceptable adherence, were measured using questions developed by expert panel. Literacy was associated with ≥95% adherence (64% for ≥9th grade level vs. 40% for <9th grade level). Participants with <95% adherence had a lower threshold of acceptable adherence than those with ≥95% adherence [80% adherence (interquartile range 70–90%) vs. 90% adherence (interquartile range 80–90%)]. However, the effect was independent of literacy. No other beliefs assessed were associated with adherence. Although the beliefs assessed do not mediate the relation between literacy and adherence, we identified low adherence norms as a potentially modifiable belief associated with adherence.

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Acknowledgments

This project was supported (or supported in part) by an Agency for Healthcare Research and Quality Centers for Education and Research on Therapeutics cooperative agreement (grant # HS10399), the PENN AIDS Clinical Trials Unit (U01-AI32783), the PENN Center for AIDS Research (P30-AI45008), and National Institutes of Mental Health grant MH-01854. Dr Holmes is supported by a Research Career Development award from the Health Services Research and Development Service of the Department of Veterans Affairs.

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Authors and Affiliations

  1. Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Joseph Graham & Ian M. Bennett

  2. Division of General Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    William C. Holmes

  3. Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Robert Gross

  4. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 804 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA

    William C. Holmes & Robert Gross

  5. Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA, USA

    William C. Holmes

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  1. Joseph Graham
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  2. Ian M. Bennett
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  4. Robert Gross
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Corresponding author

Correspondence to Robert Gross.

Appendices

Appendix 1: Adherence Norm Questionnaire

It is not easy to take all the doses of HIV medications that are prescribed. In fact, no one takes every dose of his or her HIV medication 100% of the time. For you, how often is it okay to miss doses of your HIV medications? In other words, how many doses of your HIV medications can you miss before you really begin to worry about it? To help you answer this question, imagine that you have ten doses of HIV medication to take over the next few days. How many of these ten doses could you miss before you really began to worry? (Use the line below to answer this question.)

I could miss____out of ten doses before I really began to worry about it.

Appendix 2: Misconceptions Questionnaire

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Graham, J., Bennett, I.M., Holmes, W.C. et al. Medication Beliefs as Mediators of the Health Literacy–Antiretroviral Adherence Relationship in HIV-infected Individuals. AIDS Behav 11, 385–392 (2007). https://doi.org/10.1007/s10461-006-9164-9

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