title: Low health literacy is associated with HIV test acceptance.
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.
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
authors.forename: Maribel
authors.initials: M
authors.lastname: Barragán
authors.forename: Giselle
authors.initials: G
authors.lastname: Hicks
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
authors.forename: Carlos
authors.initials: C
authors.lastname: Franco-Paredes
authors.forename: Wayne
authors.initials: W
authors.lastname: Duffus
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
mesh_terms: D000328:Adult; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology; D015438:Health Behavior; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D014481:United States