Simple, illustrated medicines information improves ARV knowledge and patient self-efficacy in limited literacy South African HIV patients

Abstract

Few studies have investigated antiretroviral (ARV) knowledge and self-efficacy in limited literacy patients. Using a randomized controlled study design, we investigated the influence of a simple pre-tested patient information leaflet (PIL) containing both text and illustrations on HIV- and ARV-related knowledge and on self-efficacy over six months in a limited literacy African population. The recruited patients were randomly allocated to either control (standard care) or intervention group (standard care plus illustrated PIL). HIV and medicines-related knowledge was evaluated with a 22-question test at baseline, one, three, and six months. Self-efficacy was assessed using a modified version of the HIV Treatment Adherence Self-Efficacy Scale. Two-thirds of the patients were female, mean age was 39.0 ± 9.6 years and mean education was 7.3 ± 2.8 years. Patients who received the PIL showed a significant knowledge increase over the six-month period (62.0–94.4%), with improvement at each subsequent interview whereas the control group showed no improvement. At baseline, side effect knowledge was the lowest (50–56%) but increased in the intervention group to 92%. Similarly, other medicine-related knowledge at baseline (57–67%) improved significantly (93%) and was sustained over six months. Cohen's d values post-baseline ranged between 1.36 and 2.18, indicating a large intervention effect. Self-efficacy improved significantly over six months in intervention but not control patients. At baseline, patients with ≤3 years of education had lower knowledge and self-efficacy but this was not observed post-intervention, which we attribute to the PIL mitigating the effect of limited education. Knowledge and self-efficacy were significantly correlated in the intervention group. In conclusion, a low-cost intervention of a well-designed, pre-tested, simple, illustrated PIL significantly increased both ARV knowledge and self-efficacy in HIV patients with limited education.

Keywords:

• knowledge
• self-efficacy
• low literacy
• written patient information
• pictograms

Acknowledgments

Thanks go to Professor Sarah Radloff for her help with statistical analysis and Mrs Susan Abraham, our graphic artist, for producing the pictograms. Thanks also go to our participants and our interpreters for their participation in the project.

Funding

Financial support for the study was received from the Center for AIDS Research, University of California, San Diego, USA [grant number P30AI036214] and from Rhodes University, Grahamstown, South Africa.

Additional information

Funding

Funding: Financial support for the study was received from the Center for AIDS Research, University of California, San Diego, USA [grant number P30AI036214] and from Rhodes University, Grahamstown, South Africa.