Providing information according to patients’ preferred method, video or pictorial brochure, does not increase the knowledge gained from an HIV/AIDS and HIV testing information intervention

Theoretical Background and research questions/hypothesis:

Tailoring health education to patients’ preferred modes of receiving information has been suggested as a method to increase the effectiveness of health education interventions. Patients often are asked about their preferred method of receiving information. However, it is not well understood if delivering information according to patients’ preference actually improves knowledge, or if knowledge gains are affected by their health literacy. In this investigation, we tested whether providing HIV information delivery according to patient preference resulted in greater knowledge gains, and if these preferences were associated with health literacy.

Methods:

We recruited a random sample of 18-64-year-old, HIV uninfected, English- or Spanish-speaking patients at four US emergency departments (EDs) in Alabama, California, Ohio and Rhode Island. Participants were asked their preferred method (i.e., video, pictorial brochure, or no preference) of learning about HIV/AIDS and HIV testing. Regardless of this preference, participants were randomly assigned to watch a video or review a pictorial brochure. Before and after watching the video or reviewing the pictorial brochure, participants completed an assessment of their HIV/AIDS and HIV testing knowledge with a 25-question scale. Health literacy was measured using the Short Assessment of Health Literacy (SAHL). SAHL scores of 14 or less were classified as lower health literacy. We examined differences in preference by health literacy level and language spoken using Fisher’s exact tests. We also assessed whether participants who received their preferred delivery mode had greater gains in scores, controlling for health literacy level, language spoken and mode of information delivery (video vs. pictorial brochure). In this model, we also tested for interactions among preference, language, and health literacy level.

Results:

The study included 647 Spanish speaking participants (51% lower health literacy) and 681 English speaking participants (48% lower health literacy). Among those with lower health literacy, 44% of English speakers and 45% of Spanish speakers had no preference for information delivery mode. Among those who did have a preference, lower health literacy English speakers (63%) were more likely to prefer a video than Spanish-speaking lower health literacy participants (47%) (p<0.005). Among all participants, those who received their preferred information delivery mode did not have greater HIV/AIDS and HIV testing knowledge score gains than other participants (received information using preferred method: ∆ 3.3, 95% CI: 2.7, 3.9; received the information using the non-preferred method: ∆ 3.2, 95% CI: 2.5, 3.8; had no preference ∆ 3.0, 95% CI: 2.6, 3.4; main effect p=0.83). Interaction effects (two-way and three-way) among health literacy, language spoken, and information delivery mode preference were also not significant.

Conclusions:

Offering patients a choice of how they receive health information is a patient-centered approach, but this choice did not affect knowledge gains on HIV/AIDS and HIV testing among adult ED patients.

Implications for research and/or practice:

Considerations other than patient preference, such as ease of delivery and cost, may be considered in providing patient information.