Latent structure of health literacy and its association with health-related management and decision-making in HIV
Anastasia Matchanova, Michelle A. Babicz, Luis D. Medina, Pariya L. Fazeli, David E. Vance, Steven Paul Woods
Abstract
Objective Determine the latent structure of health literacy in persons living with HIV (PLWH) and its association with health management and decision-making. Method: Participants included 220 PLWH and 123 seronegative participants from Southern California and Alabama who completed a battery of well-validated health literacy measures, along with assessments of health management self-efficacy, health-related decision-making, depression, and basic clinical laboratory measures. Results: Exploratory factor analysis in HIV − participants showed that the shared variance between a battery of health literacy measures, including health word reading, verbal comprehension, numeracy, and self-reported problems was best explained by a single factor. Similarly, a confirmatory factor analysis in PLWH also supported a single factor structure, but for a re-specified four-test solution based on the core performance-based measures of health literacy. In analyses adjusting for demographics, PLWH demonstrated significantly lower health literacy composite scores as compared to their HIV − counterparts. Among PLWH, lower health literacy was independently associated with lower self-efficacy for health management and poorer health-related decision-making. Conclusions: Findings suggest that numeracy, word recognition, and verbal comprehension and reasoning comprise a unitary construct of health literacy that is lower in PLWH as compared to seronegatives and is independently associated with important downstream aspects of health management and decision-making.