Facilitating HIV/AIDS and HIV Testing Literacy for Emergency Department Patients

描述(由申请人提供)：疾病控制和预防中心(CDC)建议所有患者在每次艾滋病毒检测时都应收到关于艾滋病毒/艾滋病和艾滋病毒检测的口头或书面信息。然而，对于繁忙的急诊科(ED)来说，口头提供信息是艾滋病毒检测的障碍，书面小册子可能对健康水平较低或一般识字率较低的人没有用。在提高艾滋病毒/艾滋病和艾滋病毒检测知识方面，视频可能与口头传播的信息一样有效或更有效，特别是对于健康素养较低的人。然而，播放视频所需的资源可能会限制它们在ED中的使用。图画宣传册是一种很有希望的替代方案，但效果尚不清楚。无论患者是如何被告知的，我们都不知道这些知识被保留得多好或保留了多久，这些信息是否应该根据患者的需求和能力来传递，以及这些知识的保留是否会影响未来的艾滋病毒检测行为。这项R01研究将解决我们理解中的这些差距。我们将在600名英语和西班牙语的18岁ED患者中进行一项多点、随机、对照的纵向试验，以调查这些问题。使用健康素养的有效衡量标准，我们将分层 我们的样本在语言中按健康素养水平(低与高)进行比较。我们将通过视频或画册随机分配患者接受艾滋病毒/艾滋病和艾滋病毒检测信息。在注册一年后，我们将为参与者提供再次进行艾滋病毒检测的机会。作为主要目标，我们将比较图片小册子和视频在提高短期(ED)艾滋病毒/艾滋病和艾滋病毒检测知识以及在12个月内保留这些知识方面的效果。更具体地说，我们将确定短期改善和长期知识保留是否以及如何与信息提供方式(画册或视频)、患者健康素养水平(较低或更高)和语言(英语或西班牙语)相互作用。作为次要目标，我们将使用信息-动机-行为技能(IMB)模型作为启发式框架，考察与我们的研究相关的IMB模型的组成部分及其相互关系，它们对HIV复检行为的影响，以及通过该模型调节信息传递方式、语言和健康素养水平的影响。关于艾滋病毒重新测试行为，我们将评估：(1)作为研究的一部分，在登记后一年进行的吸收测试；(2)在研究期间但不作为研究的一部分进行测试；以及(3)研究前一年与研究后登记的测试利用的变化。研究结果将指导以教育为基础的艾滋病毒/艾滋病和艾滋病毒检测信息的传递；也就是说，是否应该根据语言和/或健康素养水平为患者选择传递方式(录像带或画册)，或者是否可以使用任何一种方式。结果还将告知急诊科医生，何时、如何以及为谁提供信息，以便在一年内再次检测艾滋病毒。

DESCRIPTION (provided by applicant): The Centers for Disease Control and Prevention (CDC) recommends that all patients should receive information about HIV/AIDS and HIV testing orally or in writing at every HIV testing encounter. However, for busy emergency departments (EDs), delivering information orally is a barrier to HIV testing, and written brochures likely are not useful for those with lower health or general literacy. Videos might be as or more efficacious than orally-delivered information in improving HIV/AIDS and HIV testing knowledge, particularly for those with lower health literacy skills. However, the resources required to show videos might limit their use in EDs. Pictorial brochures are a promising alternative, but are of unknown efficacy. Regardless of how patients are informed, we do not know how well or for how long this knowledge is retained, if this information should be delivered according to patient needs and abilities, and if retention of this knowledge impacts future HIV testing behavior. This R01 study will address these gaps in our understanding. We will conduct a multi-site, randomized, controlled, longitudinal trial among 600 English- and 600 Spanish-speaking 18-64-year-old ED patients to investigate these questions. Using a valid measure of health literacy, we will stratify our sample within language by health literacy level (lower vs. higher). We will randomly assign patients to receive HIV/AIDS and HIV testing information by video or pictorial brochure. At one year post-enrollment, we will offer participants an opportunity to be tested again for HIV. As primary aims, we will compare the efficacy of pictorial brochures and videos in improving short-term (in ED) HIV/AIDS and HIV testing knowledge and retaining this knowledge over 12 months. More specifically, we will determine if and how short-term improvement and longer-term retention of knowledge interacts with information delivery mode (pictorial brochure or video), patient health literacy level (lower or higher) and language (English or Spanish). As secondary aims, using the Information-Motivation-Behavioral Skills (IMB) model as a heuristic framework, we will examine components of the IMB model relevant to our study and their interrelationships, their impact on HIV re-testing behavior, and the moderating influence of information delivery mode, language and health literacy level through the model. In regards to HIV re-testing behaviors, we will assess: (1) testing uptake at one year post-enrollment when offered as part of the study, (2) testing utilization during the study period but not as part of the study, and (3) change in testing utilization one year pre vs. post study enrollment. Study findings will guide ED-based delivery of HIV/AIDS and HIV testing information; that is, whether delivery modes (video or pictorial brochure) should be selected for patients by language and/or health literacy level, or whether either mode could be used. The results also will inform EDs when, how, and for whom information needs to be provided for those testing again for HIV within one year.