Health literacy mediates the effects of educational attainment on online pharmacy navigation skills in older adults with HIV disease

Abstract

ObjectiveThe Internet serves an increasingly critical role in health behaviors for older adults with chronic medical conditions. Guided by theories of health behaviors and literacy, this study examined whether the relationship between educational attainment and online pharmacy skills in older persons with HIV disease (PWH) is mediated by health literacy. Design: Participants included 98 PWH age 50 and older who completed the Test of Online Pharmacy Skills (TOPS), which required them to navigate an experimenter-controlled online pharmacy to perform several naturalistic tasks (e.g., refill an existing prescription). Participants also completed the Medication-Management Test-Revised (MMT-R). Results: Mediation analyses revealed a significant indirect effect of education on both online pharmacy accuracy and MMT-R, which was fully mediated by health literacy. In contrast, there was no direct or indirect effect of education on online pharmacy speed when health literacy was included as a mediator. Conclusion: Health literacy plays an important role in the relationship between years of education attained and the ability of older PWH to successfully navigate online pharmacy tasks and manage their medications. Future studies might examine whether interventions to improve electronic health literacy among older PWH who have lower educational attainment have beneficial effects on online health behaviors.

Keywords:

• Academic achievement
• numeracy
• acquired immune deficiency syndrome
• health management
• internet navigation skills

Acknowledgements

The authors are grateful to Jessica Beltran and Javier Villalobos for study coordination, Donald R. Franklin and Stephanie Corkran for data processing, Dr. J. Hampton Atkinson and Jennifer Marquie Beck for participant recruitment, Drs. Scott Letendre, Sara Gianella Weibel, Mark Bondi and Elizabeth Twamley for serving as co-investigators on the parent grant. This material is the result of work supported by resources from the Department of Veterans Affairs Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, and the VA Puget Sound Health Care System, Seattle, Washington.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Steven Paul Woods, upon reasonable request.

Additional information

Funding

This research was supported by National Institutes of Health grants R01-MH073419 and P30-MH062512. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government.