Bilingual infographics improve clinical communication and health outcomes among Latino persons with HIV: A multi-site mixed methods study with a randomized controlled trial.

Abstract

During our Info Viz for Health® intervention, clinicians use bilingual (English/Spanish) infographics to support clinical communication with Latino persons with HIV (LPWH). In this study, we assessed intervention efficacy at improving HIV-related outcomes and explored perceptions of infographic use. We conducted a multi-site (Colorado, USA/Dominican Republic) randomized controlled trial paired with qualitative interviews. Intervention-trained clinicians delivered health information to intervention participants using infographics housed in a mobile application (app) and control participants received standard education at routine visits during the ~9-month study. We collected outcomes (HIV RNA level [viral load/primary outcome], CD4 T-cell count, HIV-related knowledge, experience with clinic/clinician, medication adherence, self-efficacy, and mental/physical health status) through surveys and medical records. We interviewed interventionists and a subsample of LPWH to explore perceptions of infographic use. We analyzed demographics with descriptive statistics and assessed changes in outcomes over time with linear mixed-effects models. We iteratively analyzed interviews with directed qualitative content analysis. We enrolled 8 interventionists(N = 5/Colorado; N = 3/Dominican Republic) and randomized 164 LPWH(N = 82/site). Viral load decreased in intervention and control groups(p < .001), without significant between group differences. Both groups showed improvements in HIV-related knowledge and pharmacy refill data-based adherence, with significantly higher improvements in the intervention group (p < .001, p = .009, respectively). All other outcomes, except self-reported mental health status, demonstrated significant within, but not between, group improvements. Interview participants identified high intervention acceptability and usability, and requested infographics on additional topics. They also indicated future electronic health record integration would be beneficial. Infographic use led to significantly higher improvements in adherence and HIV-related knowledge in intervention participants. Viral load improved in both groups, without significant between group differences. These positive outcomes, combined with interview data, support the efficacy of the intervention to enhance education with LPWH. Clinicians and organizations may consider using visual aids to enhance patient education.