title: 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).
  
  
  CONCLUSIONS
  While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, self-efficacy mediated this relationship.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Health Literacy and Learning Program (HeLP), Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. mswolf@northwestern.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Chandra Y
authors.initials: CY
authors.lastname: Osborn
authors.forename: Silvia
authors.initials: S
authors.lastname: Skripkauskas
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Gregory
authors.initials: G
authors.lastname: Makoul
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D016009:Chi-Square Distribution; D002641:Chicago; D004334:Drug Administration Schedule; D004521:Educational Measurement; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008145:Louisiana; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000458:organization & administration; D018570:Risk Assessment; D012307:Risk Factors; D020377:Self Efficacy; D011795:Surveys and Questionnaires
chemical_list: D019380:Anti-HIV Agents