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Senior Citizen Health & Medicine
Prescription Drug Information Found Difficult to
Read and Understand
Literacy skills a stronger predictor of health
status than age or other factors
 March 27, 2007 – Evidence continues to mount that
the lack of health literacy – the ability to read and comprehend medical
instructions – is a serious problem in America, especially among senior
citizens. A new review of the evidence by the Health Behavior News
Service finds that information provided with prescription drugs are
especially hard for many to read and understand.
Patients Say Drug Leaflets Are Hard to Read,
Understand
By Laura Kennedy, Contributing Writer
Health Behavior News Service
Patients report that leaflets provided with
prescription drugs do not meet their needs, according to a new
systematic review. Instead, poor layout and complex language often
hinder communication.
Review studies confirm that written drug
information does not improve patient understanding of their medications.
Many people would like information that better helps them evaluate
potential benefits and harms of a drug treatment.
“If you’re going to have safe and effective
medicines use, then we need to give patients the tools to do that job,”
says lead author D.K. Raynor, Ph.D., of the University of Leeds in
England.
The reviewers emphasize that patients want written
information in addition to — not instead of — spoken instructions from
their health care professionals.
According to the Partnership for Clear Health
Communication, nearly half of all American adults have difficulty
understanding and using health information.
In fact, the organization says, literacy skills are
a stronger predictor of an individual’s health status than age, income,
employment status, education level or racial/ethnic group.
The review is published in the latest issue of
Health Technology Assessment, the international journal series of the
Health Technology Assessment programme, part of the National Institute
for Health Research in the United Kingdom.
The authors reviewed 70 quantitative and
qualitative studies carried out in the United Kingdom, Europe, Australia
and the United States. They also conducted two patient workshops and
delved into texts on information design to identify best practices.
The studies varied considerably in setting and
timing, and reporting of interventions and methodological quality was
often poor, the review authors say. For this reason, the experts
detailed their findings in a nearly 200-page monograph rather than
pooling the data for statistical analysis.
One key finding was an apparent dichotomy between
prescriber and patient views of the fundamental purpose of drug
leaflets, the authors say.
Some providers see increasing treatment compliance
as a primary function. In contrast, patients say an informed decision
not to take a medicine is also an acceptable result.
“Patients see the role of written medical
information as guiding them in terms of which medicine is right for them
and, if they take the medicine, how best they can use it,” Raynor said.
To that end, patients would also like to see more balance between
benefit and harm information.
Current drug information focuses too heavily on
warnings and adverse effects of the medication, Raynor said. “Patients
also need to know how it might benefit them and how likely it is to
benefit them.”
Exactly how to convey the likelihood of benefits
and harms most clearly remains in question. Verbal descriptors like
“rare” or “common” are too vague, according to the review.
Yet, more scientific terminology like percentages
or “numbers needed to treat” can also confuse the lay public. More
research is needed in how best to communicate probability data to
consumers, the reviewers say.
Raynor said that studies showed that poor layout of
drug leaflets is a particular problem in the United States: “The
information can be very dense, and the headings can be very indistinct.
It can be very difficult to navigate.”
To help drug companies produce more user-friendly
consumer information, the authors reviewed six texts recommended by
experts in information design to identify best practices.
Recommendations include
• Use short, familiar words and short sentences.
• Use short headings that stand out.
• Use the largest possible type size.
• Leave plenty of white space.
• Use bullet points to organize lists.
“That’s probably one of the most important parts of
the review,” Raynor said.
“This resource can help make leaflets in the way that patients find them
useful.”
In 2005, the European Union took an important step
forward by requiring pharmaceutical companies to test their leaflets on
patients before they begin marketing a product.
“Some [European] companies have started to realize
how important the leaflets are,” Raynor said. “Changing them and making
them more valued for patients really is in their interests.”
One U.S. company that is following suit is Pfizer,
Inc.
“We moved all of our patient education materials
around our brand down to the sixth-grade reading level,” said Barbara
DeBuono, M.D., the company’s senior medical advisor for public health.
She is also board chair at the Partnership for Clear Health
Communication.
“Health literacy is not only the ability to read
and understand information, but to act on the information,” DeBuono
added. “There’s nothing more de-motivating for a patient than to find
the information confusing, unintelligible and inaccessible.”
The review authors call for more robust,
patient-focused research on improving content, delivery and layout of
written drug information. They add that none of the studies in the
current review covered Web-based medicines information, which will
surely be an emerging field of study in the future.
More information:
>>
Partnership for Clear Health Communication
>>
Health Literacy Consulting
>> If you or someone you know needs basic health
literacy information, the Society for Women’s Health Research maintains
a Web site called “Her Healthy Life,” which features information for
women on diet, exercise and smoking in both English and Spanish.
Information can be downloaded at
http://www.herhealthylife.org/.
>> Brochures can also be requested by calling
toll free 1-877-332-2636 or by emailing
info@womenshealthresearch.org.
>> American Medical Association Foundation's
Health Literacy Kit
www.ama-assn.org/ama/pub/category/9913.html
>> Medline Plus Interactive Health Tutorials
http://www.nlm.nih.gov/medlineplus/tutorial.html
>> California Health Literacy Initiative
http://cahealthliteracy.org/
>> Harvard School of Public Health's Health
Literacy Studies
www.hsph.harvard.edu/healthliteracy/links.html
>> Health Literacy Month
www.healthliteracymonth.org
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