![[ Visit Client Website ]](images/banner.gif)
Theoretical Background and research questions/hypothesis: The extensive reach of the internet enables its use as a venue for improving HIV/AIDS and HIV testing knowledge for an international population. Its utility has promising implications for facilitating global education and HIV testing. We previously created professional quality, animated and live-action, 9.5-minute, equivalent English- and Spanish-language versions of an informational HIV/AIDS and HIV testing video. In a previous study we demonstrated its efficacy in clinical and non-clinical settings when used as part of rapid HIV testing. Our primary objective in this study was to determine if the video improved HIV/AIDS and HIV testing knowledge among a worldwide sample of internet users who are not undergoing HIV testing. Our secondary objective was to discern if this improvement was the same for those who spoke English or Spanish. We further wanted to ascertain if the video was efficacious for those with lower health literacy.
Methods: A worldwide sample of English- or Spanish-speaking internet users was solicited online across 17 online platforms (Facebook, Google, Amazon Mechanical Turk, and other social media sites) over a six-week period July through August 2013. Users were queried about their demographic characteristics and HIV testing history; those who self-reported an HIV infection were excluded. Users with lower health literacy were identified using a previously validated instrument. Participants completed a 25-item questionnaire to measure their HIV/AIDS and HIV testing knowledge before and after watching the video in English or Spanish. Before/after changes in questionnaire mean scores were compared within and across languages. Multivariable linear regression models assessing the impact of health literacy on changes in scores adjusting for demographic characteristics, language and HIV testing history were constructed.
Results: Of the 532 English-speaking participants from 26 countries, 58.1% had been tested for HIV. Of the 364 Spanish-speaking participants from 16 countries, none had been tested for HIV. Mean scores on the questionnaire were improved after watching the video for both English speakers (19.6 vs. 16.4; Δ=3.2; 95% CI: 2.8~3.5) and Spanish speakers (20.7. vs. 17.3; Δ=3.4; 95% CI: 3.0~3.8). There was no difference in improvement of scores between English and Spanish speakers (Δ=-0.24; 95% CI: -0.79~0.31). Participants with lower health literacy had a greater improvement in scores than those with higher health literacy (β 0.25; 95% CI: 0.03-0.46) after adjusting for demographic characteristics, language and HIV testing history.
Conclusions: The video was efficacious for both English and Spanish speakers. Short-term improvement in knowledge was slightly better for those with lower health literacy.
Implications for research and/or practice: This study demonstrates the efficacy of this freely accessible video to increase knowledge about HIV/AIDS and HIV testing through internet-based learning. These findings have encouraging implications for improving knowledge about this topic for both English and Spanish speakers and particularly for those with lower health literacy. The video might be useful for those with reduced access to this information, people wanting to improve their knowledge on this topic with privacy, and for facilitating testing in remote or low resource settings or for home-based HIV testing.