Seth C. Kalichman

Distinguishing between overlapping somatic symptoms of Depression and HIV disease in people living with HIV-AIDS

HIV-AIDS is a prevalent medical diagnosis in U.S. cities, and symptoms of depression are common in persons with HIV infection. This study examined the effects of overlapping symptoms of HIV disease and somatic depression that can inflate scores on the Beck Depression Inventory (BDI) and the Centers for Epidemiological Studies Depression Scale (CESD). Results from 357 HIV positive men and women identified discrete subsets of depression symptoms that correspond with symptoms of HIV infection. Removing somatic subsets of depression symptoms improved the clinical utility of the BDI and CESD. Clearer symptom separation occurred with the BDI than the CESD, but the CESD may be more sensitive than the BDI to depression associated with progression of HIV disease. Findings suggest that depression scales that include somatic symptoms will inflate depression scores in people living with HIV infection, and available methods for distinguishing overlapping symptoms should be employed when assessing people living with HIV infection.

Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: Preliminary results from a community survey

Widespread Internet use has revolutionized health information and patient education for persons with chronic illnesses. The authors surveyed 147 HIV-positive persons to examine factors associated with Internet use and associations between Internet use and health. Information, motivation, and behavioral skills associated with using the Internet were related to Internet use. The authors found that health-related Internet use was associated with HIV disease knowledge, active coping, information seeking coping, and social support among persons who were using the Internet. These preliminary findings suggest an association between using the Internet for health-related information and health benefits among people living with HIV/AIDS, supporting the development of interventions to close the digital divide in HIV/AIDS care.

Internet access and Internet use for health information among people living with HIV–AIDS

Widespread access to the Internet has the potential to improve the health care and quality of life of people with chronic illnesses, including people living with HIV-AIDS. However, the Internet is not equally accessible to all persons. We surveyed 96 men and 51 women living with HIV-AIDS regarding their experiences using the Internet. Results showed that persons with 12 or fewer years of education were significantly less likely to have used the Internet and were less likely to have been instructed in Internet use. A broad range of health-related Internet activities was reported including searching for health, AIDS-specific information, and using the Internet to communicate with providers. Among current Internet users, individuals who had an Internet connection in their home reported significantly more experiences using the Internet, including Internet use for interpersonal communication and search functions. A digital divide therefore exists among people living with HIV-AIDS, and the benefits of the Internet appear better achieved with home access.

Adherence to antiretroviral therapy assessed by unannounced pill counts conducted by telephone.

BACKGROUNDUnannounced pill counts conducted in patients’ homes is a valid objective method for monitoring medication adherence that is unfortunately costly and often impractical. Conducting unannounced pill counts by telephone may be a viable alternative for objectively assessing medication adherence.PURPOSETo test an unannounced pill count assessment of adherence conducted by telephone.METHODSHIV-positive men and women (Nu2009=u200977) in Atlanta GA completed an unannounced telephone-based pill count immediately followed by a pill count conducted in an unannounced home visit.RESULTSA high degree of concordance was observed between phone and home-based number of pills counted (Intraclass correlation, ICCu2009=u2009.997, 95% CI .995–.998, Pu2009<u2009.001) and percent of pills taken (ICCu2009=u2009.990, 95% CI .986–.992, Pu2009<u2009.001). Concordance between adherence above/below 90% and phone/home counts was 95%, Kappa coefficient = .995. Concordance between pill counts was not influenced by participant education or health literacy and was maintained when the data were censored to remove higher levels of adherence. Analyses of discordant pill counts found the most common source of error resulted from overcounted doses in pillboxes on the telephone.CONCLUSIONSUnannounced phone-based pill counts offer an economically and logistically feasible objective method for monitoring medication adherence.

HIV-AIDS patients evaluation of health information on the internet: the digital divide and vulnerability to fraudulent claims.

Access to health information on the Internet has revolutionized how medical patients learn about their illnesses. Valuable information can be found online; however, many health Web sites contain inaccurate or misleading information. The authors surveyed 324 adults with HIV concerning their Internet use for obtaining health information. Health information found online was then rated for quality by participants and by medical professionals. Participants were less critical of health information found online than medical professionals and made smaller distinctions between high-quality and low-quality information. Assigning credibility to low-quality information was predicted by lower incomes and educational attainment, poorer reading comprehension, lower literacy levels, and irrational health beliefs. Results suggest that patients do not always evaluate online information critically and may be vulnerable to misinformation.

Internet-based health information consumer skills intervention for people living with HIV/AIDS.

Medical information can improve health, and there is an enormous amount of health information available on the Internet. A randomized clinical trial tested the effectiveness of an intervention based on social- cognitive theory to improve information use among people living with HIV/AIDS. Men and women (N = 448) were placed in either (a) an 8-session intervention that focused on Internet information consumer skills or (b) a time-matched support group and were followed to 9 months postintervention. The Internet skills group demonstrated greater Internet use for health, information coping, and social support compared with the control group. The authors conclude that people with HIV infection may benefit from increased access to health information on the Internet and that vulnerability to misinformation and fraud can be reduced through behavioral interventions.

Closing the digital divide in HIV/AIDS care: development of a theory-based intervention to increase Internet access.

Abstract Advances in information technology are revolutionizing medical patient education and the Internet is becoming a major source of information for people with chronic medical conditions, including HIV/AIDS. However, many AIDS patients do not have equal access to the Internet and are therefore at an information disadvantage, particularly minorities, persons of low-income levels and individuals with limited education. This paper describes the development and pilot testing of a workshop-style intervention designed to close the digital divide in AIDS care. Grounded in the Information-Motivation-Behavioral Skills (IMB) model of health behaviour change, we developed an intervention for persons with no prior history of using the Internet. The intervention included instruction in using hardware and search engines, motivational enhancement to increase interest and perceived relevance of the Internet, and skills for critically evaluating and using health information accessed via the Internet. Participants were also introduced to communication and support functions of the Internet including e-mail, newsgroups and chat groups. Pilot testing demonstrated feasibility, acceptability and promise for closing the digital divide in HIV/AIDS care using a relatively brief and intensive theory-based intervention that could be implemented in community settings.

Health information on the Internet and people living with HIV/AIDS: information evaluation and coping styles.

Individuals who seek information on the Internet to cope with chronic illness may be vulnerable to misinformation and unfounded claims. This study examined the association between health-related coping and the evaluation of health information. Men (n = 347) and women (n = 72) who were living with HIV/AIDS and reported currently using the Internet completed measures assessing their Internet use. Health Web sites downloaded from the Internet were also rated for quality of information. HIV-positive adults commonly used the Internet to find health information (66%) and to learn about clinical trials (25%); they also talked to their physicians about information found online (24%). In a multivariate analysis, assigning higher credibility to unfounded Internet information was predicted by lower incomes, less education, and avoidant coping styles. People who cope by avoiding health information may be vulnerable to misinformation and unfounded claims that are commonly encountered on the Internet.

Use of dietary supplements among people living with HIV/AIDS is associated with vulnerability to medical misinformation on the internet

BackgroundUse of dietary supplements is common among people living with HIV/AIDS. Because dietary supplements are used in the context of other health behaviors, they may have direct and indirect health benefits. However, supplements may also be associated with vulnerability to medical misinformation and unfounded health claims. We examined use of dietary supplements among people living with HIV/AIDS (PLWH) and the association between use of dietary supplements and believing medical misinformation.MethodsA convenience sample of 268 men and 76 women living with HIV was recruited from AIDS services and clinics in Atlanta, GA. Participants completed measures of demographic and health characteristics, dietary supplement use, beliefs about dietary supplements, internet use, and an internet evaluation task designed to assess vulnerability to medical misinformation.ResultsOne out of four PLWH currently used at least one dietary supplement product excluding vitamins. Dietary supplement use was associated with higher education and greater use of the internet for health-related information. Dietary supplement users also endorsed greater believability and trust in unfounded claims for HIV cures.ConclusionsDietary supplement use is common among PLWH and is associated with a broad array of health information seeking behaviors. Interventions are needed to reduce the vulnerability of PLWH, particularly dietary supplement users, to medical misinformation propagated on the internet.