Health literacy, cognitive & social determinants of HIV appointment attendance

描述(由申请人提供)：研究表明，错过HIV诊所预约的患者更有可能患有晚期疾病，发展为机会性感染并死亡。艾滋病毒/艾滋病对美国较低社会经济阶层的人的影响不成比例，这些人健康素养差的风险很高。健康素养有限的患者可能没有必要的技能来有效地理解和采取行动，需要保持定期的艾滋病毒护理。尽管健康素养低与健康状况较差、住院率增加以及包括艾滋病毒在内的许多疾病不坚持服药有关，但人们对其对坚持常规临床预约的影响知之甚少。此外，与艾滋病毒感染相关的认知障碍本身可能是错过约会的一个风险因素。尽管接受了HAART治疗，但相当多的患者在记忆力、信息处理速度和其他需要组织、计划和排序的高级认知功能方面存在缺陷，而这些正是预约和保持所需的认知技能。到目前为止，还没有关于识字对医疗保健利用的影响的研究解释了认知障碍。此外，艾滋病毒感染者普遍存在的识字和认知挑战也可能影响与护理提供者和社会网络中其他人的互动。对艾滋病毒护理提供者的满意度和社会支持都与艾滋病毒中更好的预约行为有关，并可能提供保护，使其免受因识字和认知能力差而错过预约的潜在影响。因此，这项研究建议前瞻性地确定与后来不遵守门诊艾滋病毒门诊预约有关的因素，对175名艾滋病毒阳性男性和女性进行7个月的前瞻性跟踪调查。预约遵守情况将通过自我报告进行评估，并通过医疗记录进行核实。我们的目标是：1)。评估基线识字对健康相关信息的能力和神经认知能力预测常规HIV门诊就诊的能力；2)评估健康相关信息、神经认知能力、社会支持和患者-提供者沟通的基线素养对坚持常规HIV门诊预约的相对贡献；3)评估健康素养和社会支持之间对错过HIV就诊预约的潜在调节作用。与公共卫生相关：研究表明，错过艾滋病毒诊所预约的人更有可能患上晚期疾病，发生机会性感染并死亡。错过约会也可能间接与艾滋病毒传播有关，因为病毒血症水平较高的人更有可能将病毒传播给其他人。因此，确定不遵守艾滋病毒门诊预约的风险人群的特征对于制定干预措施/计划至关重要，这些干预/计划有助于患者遵守预约，最大限度地发挥现有治疗的好处，并将未来病毒传播的可能性降至最低。

DESCRIPTION (provided by applicant): Studies have shown that patients who miss HIV clinic appointments are more likely to have advanced disease, to develop opportunistic infections and to die. HIV/AIDS disproportionately affects those in the lower socioeconomic strata of the US and these persons are at high risk for poor health literacy. Patients with limited health literacy may not have the requisite skill to effectively understand and act upon the need to maintain regular HIV care. Although low health literacy has been linked to poorer health status, increased hospitalization rates and non-adherence to medications across a number of diseases including HIV, little is known of its effects on adherence to routine clinical appointments. Furthermore, cognitive impairment associated with HIV infection itself may be a risk factor for missed appointments. Despite treatment with HAART, substantial numbers have deficits in memory, information processing speed and other higher order cognitive functions requiring organization, planning and sequencing, the very cognitive skills needed for appointment making and keeping. No studies on the effects of literacy on healthcare utilization to date have accounted for cognitive impairment. Moreover, the literacy and cognitive challenges common in persons infected with HIV may also affect interactions with care providers and others in the social network. Both satisfaction with HIV care providers and social support are linked to better appointment-keeping behavior in HIV and may confer protection against the potential effects of poor literacy and cognition on missed appointments. This study therefore proposes to prospectively identity factors associated with later non-adherence to outpatient HIV clinic appointments in a sample of 175 HIV positive men and women followed prospectively for 7 months. Appointment adherence will be assessed through self-report and verified via medical records. The following are our aims: 1). To assess the ability of baseline literacy for health related information and neurocognitive ability to predict attendance at routine HIV clinic appointments; 2). To assess the relative contribution of baseline literacy for health related information, neurocognitive ability, social support, and patient-provider communication to adherence to routine HIV clinic appointments; 3).To assess potential moderating effects between health literacy and social support on missed HIV medical appointments. PUBLIC HEALTH RELEVANCE: Studies have shown that those who miss HIV clinic appointments are more likely to have advanced disease, to develop opportunistic infections and to die. Missed appointments may also be indirectly tied to HIV transmission since persons with higher levels of viremia are more likely to transmit the virus to others. Therefore, identifying characteristics of individuals at risk for poor adherence to HIV outpatient appointments is essential for developing interventions/programs that assist patients to adhere to their appointments, maximize the benefits of available treatment, and minimize the potential for future spread of the virus.