Literacy, self-efficacy, and HIV medication adherence
Abstract
Objective We examined the relationship between patient literacy level and self-reported HIV medication adherence, while estimating the mediating roles of treatment knowledge and self-efficacy on this relationship.Methods Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among 204 consecutive patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while the Patient Medication Adherence Questionnaire (PMAQ) was used to assess medication self-efficacy and adherence to antiretroviral regimens in the past 4 days.Results Approximately one-third of patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal to low literacy skills. In multivariate analyses, low literate patients were 3.3 times more likely to be non-adherent to their antiretroviral regimen (p < 0.001). Patients' self-efficacy, but not knowledge, mediated the impact of low literacy on medication adherence (AOR 7.4, 95% CI 2.7-12.5).Conclusion While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, self-efficacy mediated this relationship.Practice implications Comprehensive intervention strategies that go beyond knowledge transfer may be needed to address self-efficacy among patients across all literacy levels to be successful in the management of difficult medication schedules.
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Confidence in one's ability to pursue goals affects how well people adhere to medication across many long-term illnesses.
“Self-efficacy or confidence in one’s ability to successfully engage in goal-directed behavior has been shown to influence medication adherence across many chronic illnesses.”
From Reliability and validity of a self‐efficacy instrument for hepatitis C antiviral treatment regimens (2012) · cites this paper as [20]
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- Authors
- Wolf, M. S., Davis, T. C., Osborn, C. Y., Skripkauskas, S., Bennett, C. L., & Makoul, G.
- Affiliations
- Northwestern University (US)
- Louisiana State University (US)
- Venue
- Patient Education and Counseling
- Publisher
- Elsevier BV
- Published
- 2007-02
- Volume
- 65
- Issue
- 2
- Pages
- 253-260
- ISSN
- 0738-3991 (ISSN-L)
- OpenAlex
- W1988268812
- Cited by
- 292
- References
- 58
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 7 · 2023: 10 · 2022: 10 · 2021: 17 · 2020: 13 · 2019: 13 · 2018: 14 · 2017: 12 · 2016: 29 · 2015: 23 · 2014: 18 · 2013: 27 · 2012: 23
- FWCI
- 5.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Patient Education and Counseling (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention (K01 EH000067-01)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- health literacy, medication adherence, HIV, antiretroviral therapy, self-efficacy, treatment knowledge, mediation, patient education
- MeSH terms
- Adult, Chicago, Drug Administration Schedule, Educational Measurement, Educational Status, Female, Health Services Needs and Demand, Humans, Health Knowledge, Attitudes, Practice, Louisiana, Male, Middle Aged, Patient Compliance, Patient Education as Topic, Surveys and Questionnaires, Risk Factors, HIV Infections, Multivariate Analysis, Chi-Square Distribution, Logistic Models, Risk Assessment, Anti-HIV Agents, Self Efficacy, Antiretroviral Therapy, Highly Active
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