Readability evaluation of nine patient drug education sources

Development and Evaluation of Patient Information Leaflets (PIL) Usefulness

A prospective study was conducted to develop, validate and assess the usefulness of the patient information leaflets for selected diseases among the patient population. Flesch readability ease score, Baker Able leaflet design criteria were applied to develop the patient information leaflets. The leaflets were validated for both content and translation. Eligible patients meeting the study criteria were enrolled in the study. Suitably designed knowledge, attitude and practice questionnaire was administered at base line followed by patient education complimented with an information leaflet. After a month, knowledge, attitude and practice questionnaire was administered once again to assess the influence of education and usefulness of patient information leaflets on knowledge, attitude and practice scores. The mean readability score of the information leaflets is 80 and Baker Able leaflet design criteria score is 22. Post education knowledge, attitude and practice scores were significantly (P<0.0001) improved in all the enrolled patients in all disease. The study concludes that patient education complemented with suitably designed information leaflet has greater impact on knowledge, attitude and practice of the patients towards their disease management.

Using alternative methodologies for evaluating patient medication leaflets

A variety of direct and indirect methods have been used to evaluate written medication information; however, no published research has validated assessment tools or presented direct consumer assessment of patient information leaflets (PILs) provided in US community pharmacy (CP). We report on two new instruments: the medication information design assessment scale (MIDAS), an indirect measure of design quality administered by the investigators, and the consumer information rating form (CIRF), a direct measure of comprehensibility, utility, and overall design quality applied by a consumer panel. These were used to assess two types of PILs: 36 CP-PILs obtained from community pharmacies and 3 Model-PILs incorporating recommended design characteristics. The validity of the MIDAS was demonstrated in two ways. First, as predicted, the Model-PILs were rated more positively by consumers. We also found a significant positive correlation between the number of design criteria incorporated in a CP-PIL (as measured by the MIDAS score) and the consumers rating of design quality (CIRF). In conclusion, we confirmed the importance of design characteristics in the production of written medication information and have also developed and validated two easy-to-use tools for the assessment of written medication information.

Literacy assessment in a cardiovascular nutrition education setting

We assessed functional literacy of hypercholesterolemic or hypertensive African Americans (n = 339) prior to their participation in a nutrition education program. A word pronunciation and recognition test using 20 common cardiovascular or nutrition terms was first developed based on correlations with standardized reading achievement test scores, then administered to program participants. Nearly half (48%) had word recognition scores equivalent to a < or = 8th grade reading level. Lower scores were associated with less education, lower income, unemployment, heavier work activity if employed, less healthy diets, history of heart disease or diabetes, and higher depression scores (all P < 0.01); several of these associations were independent of education. The educational materials were geared to a 5th to 8th grade reading level. However, when both audiotaped and printed instruction were provided, individuals with reading scores < or = 8th grade preferentially used the tapes. This brief and relatively unobtrusive literacy assessment may help to identify persons who can benefit most from audiovisual approaches to cardiovascular nutrition education.

Patients' use of health-teaching materials at three readability levels

The extent to which patients use and learn from drug literature written at three different readability levels was examined. A two-way analysis of variance showed an interaction effect on knowledge score between the readability level of the leaflet and the amount of schooling subjects reported: persons with higher education learned most from the hardest pamphlet and persons with the least formal education learned the most from the easiest pamphlet. A similar interaction was found in testing the likelihood that patients had read the leaflet. The results suggest that persons with little formal education would benefit from teaching materials with a readability level considerably lower than even many "easy-to-read" health-teaching materials available today.

Social pharmacology: unresolved critical issues

This article describes and analyzes decision-making by patients, physicians, and drug information providers about registered medical drugs. Based on a cognitive psychology perspective, cognitive variables (the individual's mediating system) are assumed to be critical factors determining both patient and physician behavior. The individual's psychological functioning is seen as a continuous reciprocal interaction between behavioral, cognitive, and environmental influences; i.e., an interactional paradigm is applied. The importance of research models including cognitive and situation variables to guide the search for appropriate research methods is stressed. An intensive research strategy with a small sample of respondents will often be necessary. Also, respondents should be asked to describe their reactions to specific medical situations. The drug information sender has to select a set of goals for disseminating information to patients. Among the goals most often selected are: message comprehension, receiver satisfaction, changes in knowledge, attitudes, and drug behavior, as well as health effects. More research is needed on how the patient's mediating system, the actual situation, and the perceived situation steer his search for the use of new drug information. A different set of factors influence the patient's decision to start a medicinal or drug treatment than the factors that influence his decision to continue a treatment. The latter factors include forgetfulness, misunderstandings, and the patient's interpretation of physiological signs. More cognitive-oriented research about drug compliance must be undertaken. In such studies the mediating systems of a group of patients could be considered before and after intervention. There are a great number of types of inappropriate (irrational) prescribing. However, a physician may prescribe rationally in one area but irrationally in another. Face-to-face education of physicians has been shown to be effective in reducing inappropriate prescribing in a number of studies. "Overprescribing" of benzodiazepine has been an issue of intensive professional debate during the last decades. The two groups who criticize and defend the existing use of benzodiazepines build their views on different assumptions about the interaction between mind and brain as well as making different value assumptions regarding the use of a psychotropic drug. There is a need for prescription studies where a cognitive and interactional perspective is combined with an information-processing and a normative perspective. The benzodiazepines dependency problem has provoked lively discussion among professionals and the general public. Long-term benzodiazepine use and personality disorders increase the risk of the patient becoming dependent. A great number of research models have been suggested for the analysis of prescription drug dependency and as guides to the treatment of dependency.(ABSTRACT TRUNCATED AT 400 WORDS)