Abstract
BackgroundAlthough this has not been fully studied, videos and pictorial brochures might be equivalent methods of delivering HIV/AIDS and HIV testing information to emergency departments (ED) patients. It also is not known how well or for how long such knowledge is retained, if this information should be tailored according to patient health literacy, and if retention of this knowledge impacts future HIV testing behavior.MethodsWe 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. We will stratify our sample within language (English vs. Spanish) by health literacy level (lower vs. higher) and randomly assign patients to receive HIV/AIDS and HIV testing information by video or pictorial brochure. All patients will be tested for HIV in the ED. At 12-months post-enrollment, we will invite participants 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. 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 measure constructs from the IMB model relevant to our study, and assess their impact on HIV re-testing behavior; we will also examine the moderating influences of information delivery mode, language, and health literacy level. In addition, we will explore simplified screening strategies to identify ED patients with lower health literacy as ways to implement a tailored approach to HIV/AIDS and HIV testing information delivery in EDs.DiscussionStudy 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. The results also will inform EDs when, how, and for whom information needs to be provided for those undergoing testing again for HIV within a one-year period.Trial registrationClinicalTrials.gov Identifier: NCT02284451. Posted November 6, 2014.
Highlights
This has not been fully studied, videos and pictorial brochures might be equivalent methods of delivering HIV/AIDS and HIV testing information to emergency departments (ED) patients
No published research exists that indicates how, in what form, and how often this information should be delivered to improve and retain HIV/AIDS and HIV testing knowledge; if it is best delivered by the two Centers for Disease Control and Prevention (CDC)-recommended delivery modes; if this information must be provided to all patients at every testing encounter; if and how it could be delivered according to patient needs and abilities; or how this information and its delivery mode affects patients HIV testing motivation and skills, HIV risk-taking, and future HIV re-testing
A United Kingdom sexually transmitted disease (STD) clinic study found that an informational pamphlet increased HIV testing knowledge similar to an in-person discussion for lower HIV risk clients [4]
Summary
This has not been fully studied, videos and pictorial brochures might be equivalent methods of delivering HIV/AIDS and HIV testing information to emergency departments (ED) patients. No published research exists that indicates how, in what form, and how often this information should be delivered to improve and retain HIV/AIDS and HIV testing knowledge; if it is best delivered by the two CDC-recommended delivery modes (orally or in writing); if this information must be provided to all patients at every testing encounter; if and how it could be delivered according to patient needs and abilities (e.g., health literacy skills); or how this information and its delivery mode affects patients HIV testing motivation and skills, HIV risk-taking, and future HIV re-testing. A study of 136 HIV/ AIDS written materials found that more than half were at a 10th–12th-grade reading comprehension level and 13% were at a university level [5] As such, these materials are not useful for lower literacy patients. A 1997 review of 72 state, federal, or privately-produced HIV/AIDS brochures concluded that approximately 95% contained inaccuracies so severe that their use was not recommended [9]
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