Do themes in consumer medicines information literature reviews reflect those important to stakeholders?

Maternal bodies and medicines: a commentary on risk and decision-making of pregnant and breastfeeding women and health professionals

BACKGROUND

The perceived risk/benefit balance of prescribed and over-the-counter (OTC) medicine, as well as complementary therapies, will significantly impact on an individual's decision-making to use medicine. For women who are pregnant or breastfeeding, this weighing of risks and benefits becomes immensely more complex because they are considering the effect on two bodies rather than one. Indeed the balance may lie in opposite directions for the mother and baby/fetus. The aim of this paper is to generate a discussion that focuses on the complexity around risk, responsibility and decision-making of medicine use by pregnant and breastfeeding women. We will also consider the competing discourses that pregnant and breastfeeding women encounter when making decisions about medicine.

DISCUSSION

Women rely not only on biomedical information and the expert knowledge of their health care professionals but on their own experiences and cultural understandings as well. When making decisions about medicines, pregnant and breastfeeding women are influenced by their families, partners and their cultural societal norms and expectations. Pregnant and breastfeeding women are influenced by a number of competing discourses. "Good" mothers should manage and avoid any risks, thereby protecting their babies from harm and put their children's needs before their own - they should not allow toxins to enter the body. On the other hand, "responsible" women take and act on medical advice - they should take the medicine as directed by their health professional. This is the inherent conflict in medicine use for maternal bodies.

SUMMARY

The increased complexity involved when one body's actions impact the body of another - as in the pregnant and lactating body - has received little acknowledgment. We consider possibilities for future research and methodologies. We argue that considering the complexity of issues for maternal bodies can improve our understanding of risk and public health education.

Tools used to evaluate written medicine and health information: document and user perspectives

This study aims to identify and review tools used to evaluate consumer-oriented written medicine (WMI) and health (WHI) information from a document and user perspective. Articles that met the following inclusion criteria were reviewed: studies evaluating readability, presentation, suitability, quality of WMI/WHI. A total of 152 articles were identified, of which 64 satisfied the inclusion criteria. Fifty-nine original studies used evaluation tools and 5 reviewed a specific group of tools. Sixteen detailed the development or validation of an instrument. Fifteen studies evaluated WMI and 28 evaluated WHI. Twenty-three evaluation instruments were identified. Of the seven readability tests, SMOG was predominantly used (12 of 43 studies). Eight tools measured health literacy, with REALM being the most popular instrument (7 of 43). SAM was the most commonly used presentation tool (12 of 43 studies). Many tools are available to evaluate WMI and WHI. However, the majority are researcher focused. Most evaluate readability and presentation, revealing a gap in valid and reliable tools for assessing quality of information, and those that can be used by consumers.

Tailoring advice and optimizing response: a case study of a telephone-based support for patients with type 2 diabetes

BACKGROUND AND AIMS

Health care increasingly incorporates telephone counselling, but the dynamics of interactions supporting its delivery are not well understood. This paper explores how advice was packaged and received by participants with type 2 diabetes within the context of a Pro-Active Call-Centre Treatment Support (PACCTS) system delivered to provide diabetes self-care training over the telephone.

METHODS

The data relate to nine participants who formed part of the qualitative evaluation within the intervention arm of a randomized controlled trial (n = 591) of PACCTS. One consultation call between the tele-carer and the participant was tape recorded towards the end of the 3-year study and each participant was interviewed by telephone within 24 hours of the consultation. The nine calls and interviews were transcribed and analysed using the constant comparative method.

RESULTS

The type of advice the participants received was packaged in six forms: advice as explanation, general information-giving, generic advice, advice in the form of practitioner self-disclosure, personalized advice and responsive advice. Variation was evident in terms of the nature of advice provided, level of generality, form and context.

CONCLUSIONS

As the participants had to make multiple behavioural changes over time, advice needed to be delivered, reiterated and reinforced to achieve understanding and uptake. The more specific and personalized the information and advice, the more likely it was for the participant to give a positive and engaged response. Seizing every opportunity to deliver good quality personalized and/or responsive advice is essential in order to facilitate effective behavioural change.

Written information about individual medicines for consumers

BACKGROUND

Medicines are the most common intervention in most health services. As with all treatments, those taking medicines need sufficient information: to enable them to take and use the medicines effectively, to understand the potential harms and benefits, and to allow them to make an informed decision about taking them. Written medicines information, such as a leaflet or provided via the Internet, is an intervention that may meet these purposes.

OBJECTIVES

To assess the effects of providing written information about individual medicines on relevant patient outcomes (knowledge, attitudes, behaviours and health outcomes) in relation to prescribed and over-the-counter medicines.

SEARCH STRATEGY

We searched MEDLINE, EMBASE, CINAHL, The Cochrane Library, PsycINFO and other databases to March 2007. We handsearched five journals' tables of contents, and the reference lists of included studies, and contacted experts in the field.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of medicine users, comparing written medicines information with no written medicines information; or trials that compared two or more styles of written medicines information. We only included trials that measured a knowledge, attitudinal or behavioural outcome. There were no language restrictions.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data relating to the interventions, methods of the trials, and outcome measures; and reconciled differences by discussion. Heterogeneity of interventions and outcomes measured meant that data synthesis was not possible. The results are presented in narrative and tabular format.

MAIN RESULTS

We included 25 RCTs involving 4788 participants. Six of twelve trials showed that written information significantly improved knowledge about a medicine, compared with no written information. The inability to combine results means we cannot conclude whether written information was effective for increasing knowledge. The results for attitudinal and behavioural outcomes were mixed. No studies showed an adverse effect of medicines information.

AUTHORS' CONCLUSIONS

The combined evidence was not strong enough to say whether written medicines information is effective in changing knowledge, attitudes and behaviours related to medicine taking. There is some evidence that written information can improve knowledge. The trials were generally of poor quality, which reduces confidence in the results. Trials examining the effects of written information need to be better designed and use consistent and validated outcome measures. Trials should evaluate internet-based medicines information. It is imperative that written medicines information be based on best practice for its information design and content, which could improve its effectiveness in helping people to use medicines appropriately.

Promoting patient engagement with self-management support information: a qualitative meta-synthesis of processes influencing uptake

Background

Patient information has been viewed as a key component of self-management. However, little attention has been given to methods of dissemination or implementation of effective information strategies. Previous problems identified with the use and implementation of patient information point to the need to explore the way in which patients engage with and use information to support self-management for chronic conditions.

Methods

Four published qualitative studies from a programme of research about self-management were analysed as a group; these included studies of the management of inflammatory bowel disease (IBD); self-help in anxiety and depression (SHADE); menorrhagia, treatment, information, and preference (MENTIP) study; and self-help for irritable bowel syndrome (IBS). For the analysis, we used an adapted meta-ethnographic approach to the synthesis of qualitative data in order to develop an evidence base.

Results

The ontological status and experience of the condition in everyday life was the most dominant theme to emerge from this synthesis. This, coupled with access to and experience of traditional health services responses, shaped the engagement with and use of information to support self-management. Five key elements were found which were likely to influence this: the perception and awareness of alternative self-management possibilities; the prior extent and nature of engagement with information; the extent of and ability to self-manage; opportunities for use of the information and the stage of the illness career; and congruence and synergy with the professional role.

Conclusion

People with chronic conditions need support from providers in both supply and engagement with information, in a way which gives legitimacy to the person's own self-management strategies and possible alternatives. Thus, a link could usefully be made between information offered, as well as patients' past experiences of self-management and engagement with services for their condition. The timeliness of the information should be considered, both in terms of the illness career and the type of condition (i.e., before depression gets too bad or time to reflect on existing knowledge about a condition and how it is to be managed) and in terms of the pre-existing relationship with services (i.e., options explored and tried).

More considered use of information (how it is provided, by whom, and at what point it should be introduced) is key to facilitating patients' engagement with and therefore use of information to support self-management.

The role and value of written information for patients about individual medicines: a systematic review

OBJECTIVE

To review research on the role and value of written medicines information for patients from the perspective of patients and health professionals.

CONTEXT

Providing written information to patients about their medicines is acknowledged as a priority but there is poor understanding of how best to meet patients' needs.

METHOD

A sensitive search strategy was developed to maximize the identification of relevant studies. We used a data extraction form designed to appraise qualitative research. Findings were synthesized into a narrative account.

MAIN RESULTS

There were three broad categories of study: those which related to policy initiatives; those where the aim was to increase compliance; and those concerned with using information to support decision-making ('informed patient' studies). While the policy initiative and compliance studies reported that, mostly, patients were positive about written information, the 'informed patient' studies showed a more complex picture. Patients valued medicines information tailored to their condition. They did not want it to be a substitute for spoken information from their doctor. Not everyone wanted written information but those who did wanted sufficient detail to meet their need. Need varied over time and between patients. The small number of studies relating to health professionals showed widespread ambivalence towards using written information. Some thought it should be brief and simple, only partially disclose side-effects and saw its main role as being to increase compliance.

CONCLUSION

The different perspectives of patients and health professionals, and the diverse and changing information needs of patients pose a challenge to providers of written medicines information.