Health Literacy among Foreign-Born Women Living with HIV

Overview: This proposal studied the relationships between health literacy and HIV management factors among foreign-born women living with HIV. We found that better resilience, less HIV stigma, and higher levels of education were associated with better health literacy among foreign-born women living with HIV.Proposal text: Background. Health literacy refers to individuals’ ability to comprehend medical texts to function as patients and make appropriate health decisions, which is closely related to socioeconomic status and education. Foreign-born women living with HIV are more likely to be in disadvantaged socioeconomic status as low-income individuals and ethnic minorities. Therefore, they are more likely to have lower health literacy especially for those with language barriers and lower education levels. Lack of health literacy has been associated with lower self-efficacy for health management and poorer health-related decision-making (Matchanova et al., 2021), indicated by poor HIV knowledge (Kalichman et al., 2017), more negative health care perceptions and experiences, lower CD4 cell counts, higher viral loads (Kalichman et al., 2017), poor adherence to ART (Fazeli et al., 2020; Jones et al., 2013; Kalichman et al., 2017; Wolf et al., 2007), and increased HIV stigma (Levison, Bogart, et al., 2017). While there is a wide body of research examining health literacy and its association with ART adherence, less is known about the association of health literacy with other risk and protective factors associated with HIV management such as resilience and HIV stigma among foreign-born women.
Objective. This study aims to examine the relationships between resilience, HIV stigma, education, and first language and health literacy.
Methods. The analyses will use data from the women’s interagency HIV study (WIHS). All participants in this study will be foreign-born cisgender women (Nf189). All the key variables were collected in 2018, except country of origin and other sociodemographic data which were measured in baseline visit. Health literacy was measured using three questions drawn from the Health Literacy Screening Questions (Chew et al., 2004). Resilience was measured by the Connor-Davidson Resilience Scale–10 item. HIV stigma in health care settings was measured by the negative self-image subscale of the revised HIV Stigma Scale. This is a cross-sectional study. Descriptive and hierarchical linear regression models were conducted. We employed a critical alpha of .05 to define statistically significant associations.
Results. Model 1 was statistically significant (F(5, 183) = 9.56, p < 0.001) as was Model 2 with all variables (F(19, 169) = 3.56, p < 0.001). Results showed that less HIV stigma (B=-0.227, p=0.036), higher resilience (B=0.073, p=0.007), and higher levels of education (B=1.620, p=0.002; B=2.057, p < 0.001), and English as the primary language (B=1.336, p=0.001) were associated with better health literacy. When all the covariates were included in the model, HIV stigma (B=-0.223, p=0.047), resilience (B=0.074, p=0.007) and education (B=1.181, p=0.031; B=1.570, p=0.005) were still significantly associated with health literacy, while English as primary language were no longer a significant predictor.

Conclusion and implications. This study found that better resilience, less HIV stigma, and higher levels of education were associated with better health literacy among foreign-born women living with HIV. Race/ethnicity, country of origin, and English as a primary language were not significant predictors in the final model. Therefore, interventions aimed at improving the resilience and reducing stigma among these women will be helpful with their health literacy, other than focusing on language learning per se.