Can a Video Substitute for An In-Person Discussion In Delivering HIV Pre-Test Information to Spanish-Speaking Latinos and Better Serve Those with Lower Health Literacy?

Theoretical Background and research questions/hypothesis: Effective ways of delivering HIV pre-test information to Spanish-speaking Latinos, particularly for those of lower health literacy, are needed to improve HIV testing practices. We developed an animated and live-action short-feature video, “What do you know about HIV and HIV testing?” that employed easy-to-understand language to inform Spanish-speaking Latinos about HIV testing.  As described in this investigation, we then assessed the equivalence of the video to an in-person discussion with an HIV counselor regarding patient comprehension of HIV and HIV testing fundamentals, and evaluated if the video was more effective for those with lower health literacy.

Methods: Through a multi-step, iterative process, we created a professional quality, animated and live-action video that addressed fundamental concepts needed to explain HIV/AIDS and HIV testing. During the development phase of the video, we conducted two rounds of cognitive-based assessments and pilot testing of HIV/AIDS health literacy among 120 18-64-year-old Latino patients or clients at three non-clinical community-based organization study sites (Chicago, Miami, and San Antonio), and three clinical study sites at an ambulatory medical clinic (Providence), an ED (Los Angeles), and a department of health clinic (San Juan). In addition, we conducted interviews of 30 bilingual (English- and Spanish-speaking) Latino HIV test counselors at the respective HIV testing community-based organizations. We revised the video based upon our review of the results of the cognitive-based assessments and the pilot testing. Next, Spanish-speaking Latinos from an emergency department, a clinic, and community-based organizations in Providence were randomly assigned in a non-inferiority trial to receive pre-test information from a video or an in-person discussion prior to being HIV tested. Random assignment was stratified by health literacy level (lower vs. higher). Comprehension of the pre-test information was measured using a questionnaire, and health literacy was measured using the SAHL-S. The non-inferiority criterion for the video would be met if the 95% CI of the difference (Δ=“video”-“in-person”) in questionnaire mean scores was less than a 10% decrease in the in-person discussion group’s mean score. Wilcoxon rank-sum testing was used to evaluate the effectiveness of the video among lower health literacy participants.

Results:  Of the 150 participants, 63% were female, 78% had ≤ 12 years of formal education, 39% met criteria for lower health literacy, and 75% had previously been tested for HIV. The mean scores on the questionnaire for the video (20.4; 95% CI: 19.5~21.3) and in-person discussion (20.6; 95% CI: 19.7~21.5) groups (Δ = -0.15; 95% CI: -1.4~1.1) were similar, which satisfied the non-inferiority criterion. However, mean scores among lower health literacy participants were not greater for the video group (18.3 (video) vs. 19.6 (in-person); p<0.30).

Conclusions: Among Spanish-speaking Latinos the video is a reasonable substitute for an in-person discussion in terms of patient comprehension of HIV pre-test fundamentals, but does not demonstrate an advantage among those with lower health literacy.

Implications for research and/or practice: This Spanish-language video is appropriate for use to provide HIV pre-test information, however, persons of lower health literacy may require additional assistance with understanding fundamental information about HIV and HIV testing.