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Kram YE, Sato M, Yamamoto-Hanada K, Toyokuni K, Uematsu S, Kudo T, Yamada Y, Ohtsuka Y, Matsumoto K, Arai K, Fukuie T, Nomura I, Ohya Y. Development of an action plan for acute food protein-induced enterocolitis syndrome in Japan. World Allergy Organ J 2023; 16:100772. [PMID: 37351271 PMCID: PMC10282562 DOI: 10.1016/j.waojou.2023.100772] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/30/2023] [Accepted: 04/02/2023] [Indexed: 06/24/2023] Open
Abstract
Reports of food protein-induced enterocolitis syndrome (FPIES) in Japan have been increasing. However, the disease itself and the treatment options are poorly understood by both patients and medical professionals. The objective of this study is to develop an action plan for acute FPIES in Japan. We prepared a single-sheet action plan that describes the management of acute FPIES episodes for caregivers on one side and medical professionals on the reverse side. To evaluate the content of the action plan, we distributed a questionnaire to caregivers of patients with FPIES and to physicians who would encounter patients with FPIES. Changes to the FPIES action plan were made based on the feedback from the participants. The Delphi method was utilized to finalize the action plan. The participants of the initial survey found the action plan to be useful but the process for determining severity to be impractical. After discussion, the authors made appropriate improvements. By the Delphi method, consensus was reached on the revised FPIES action plan. In conclusion, this Japanese FPIES action plan was created by physicians from multiple subspecialties and caregivers of patients with FPIES. The action plan may improve the management of acute FPIES reactions in the Japanese community.
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Affiliation(s)
- Yuri E. Kram
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | | | - Kenji Toyokuni
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Satoko Uematsu
- Division of Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshiyuki Yamada
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Yoshikazu Ohtsuka
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Katsuhiro Arai
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuki Fukuie
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Ichiro Nomura
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
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2
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Ahmadzadeh K, Bahrami M, Zare-Farashbandi F, Adibi P, Boroumand MA, Rahimi A. Patient education information material assessment criteria: A scoping review. Health Info Libr J 2023; 40:3-28. [PMID: 36637218 DOI: 10.1111/hir.12467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 10/13/2022] [Accepted: 11/03/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patient education information material (PEIM) is an essential component of patient education programs in increasing patients' ability to cope with their diseases. Therefore, it is essential to consider the criteria that will be used to prepare and evaluate these resources. OBJECTIVE This paper aims to identify these criteria and recognize the tools or methods used to evaluate them. METHODS National and international databases and indexing banks, including PubMed, Scopus, Web of Science, ProQuest, the Cochrane Library, Magiran, SID and ISC, were searched for this review. Original or review articles, theses, short surveys, and conference papers published between January 1990 and June 2022 were included. RESULTS Overall, 4688 documents were retrieved, of which 298 documents met the inclusion criteria. The criteria were grouped into 24 overarching criteria. The most frequently used criteria were readability, quality, suitability, comprehensibility and understandability. CONCLUSION This review has provided empirical evidence to identify criteria, tools, techniques or methods for developing or evaluating a PEIM. The authors suggest that developing a comprehensive tool based on these findings is critical for evaluating the overall efficiency of PEIM using effective criteria.
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Affiliation(s)
- Khadijeh Ahmadzadeh
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Student Research Commitee, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Masoud Bahrami
- Department of Adult Health Nursing, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firoozeh Zare-Farashbandi
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Payman Adibi
- Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Ali Boroumand
- Department of Medical Library and Information Sciences, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Rahimi
- Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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3
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Wongtaweepkij K, Sup-adulchai N, Chanachoat J, Krska J, Jarernsiripornkul N. Evaluation of Medicine Information Leaflets for Omeprazole, Safety Knowledge, and Perceptions of Taking the Medication in Thailand. Patient Prefer Adherence 2023; 17:883-893. [PMID: 37009429 PMCID: PMC10064870 DOI: 10.2147/ppa.s397557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE This study aimed to compare package inserts and patient information leaflets for omeprazole in terms of the quality of and satisfaction with the written medicine information, medication safety knowledge, and perceived benefits and risks. PATIENTS AND METHODS A cross-sectional, comparative study was conducted at a university hospital in Thailand. Outpatients visiting the pharmacy departments prescribed omeprazole were randomly selected to receive either a package insert or a patient information leaflet. Medication safety knowledge was measured using a set of eight questions. The quality of the written medicine information was measured by the Consumer Information Rating Form. Perceived benefits and risks of the medication were rated using a visual analog scale. Linear regression was used to determine factors associated with perceived benefits and risks. RESULTS Of the 645 patients, 293 agreed to answer the questionnaire. 157 and 136 patients were given patient information leaflets and package inserts, respectively. Most respondents were female (65.6%), over half had a degree (56.2%). Patients reading the patient information leaflets had slightly higher overall safety knowledge scores than those reading the package inserts (5.88 ± 2.25 vs 5.25 ± 1.84, p=0.01). Using the Consumer Information Rating Form, the patient information leaflets were given significantly higher scores compared to the package inserts for comprehensibility (19.34±3.92 vs 17.32±3.52, p<0.001) and design quality (29.25 ± 5.00 vs 23.81 ± 5.16, p<0.001). After reading the leaflets, patients receiving the patient information leaflets had significantly higher satisfaction with the information provided (p=0.003). In contrast, those receiving the package inserts rated the risks of omeprazole higher (p=0.007). CONCLUSION Demonstrable differences were found from the patient perspective between a package insert and a patient information leaflet for the same medicine, mostly in favour of patient information leaflets. Medicine safety knowledge after reading PI and PIL was similar. However, receiving package inserts provided higher perceived risks from taking the medicine.
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Affiliation(s)
- Kamonphat Wongtaweepkij
- Division of Clinical Pharmacy, Faculty of Pharmacy, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Nutchwarang Sup-adulchai
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Jirath Chanachoat
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Janet Krska
- Medway School of Pharmacy, University of Kent, Kent, UK
| | - Narumol Jarernsiripornkul
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Correspondence: Narumol Jarernsiripornkul, Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand, Tel +66-4334-8353, Fax +66-4320-2379, Email
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Picou EM, McAlexander SN, Day BC, Jirik KJ, Morrison AK, Tharpe AM. An evaluation of newborn hearing screening brochures and parental understanding of screening result terminology. Int J Audiol 2022:1-11. [PMID: 35522833 DOI: 10.1080/14992027.2022.2068082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the suitability of newborn hearing screening brochures by evaluating current state-level brochures and pregnant people's understanding of screening result terminology. DESIGN In Study 1, state-level brochures were evaluated based on readability, design, picture appropriateness, and use of the word "refer." In Study 2, pregnant people completed a questionnaire that queried their understanding of and expected anxiety about three newborn hearing screening outcomes ("refer," "did not pass," and "pass"). STUDY SAMPLE In Study 1, 59 newborn hearing screening brochures were analysed. In Study 2, 43 pregnant people completed surveys during a prenatal appointment. RESULTS Most of the brochures were found deficient on at least one element. Thirty percent of brochures used the word "refer" to indicate a hearing screening failure; yet, fewer than half of participants understood its meaning. Ratings of expected anxiety were highest in response to the term "did not pass." CONCLUSIONS Based on four study criteria of brochure suitability, 88% of available state-level newborn hearing screening brochures should be modified to make them readily understandable by a broad educational demographic. Discretion in use of the term "refer" should be made when indicating screening results, because the term is not readily understood.
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Affiliation(s)
- Erin M Picou
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA
| | - Sarah N McAlexander
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA
| | - Brittany C Day
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karina J Jirik
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA
| | - Alison Kemph Morrison
- Department of Communication Sciences and Special Education, University of Georgia, Athens, GA, USA
| | - Anne Marie Tharpe
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, TN, USA
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Reeves PT, Kovacic K, Rogers PL, Sanghavi R, Levinthal DJ, Echelmeyer S, Li BUK. Development and Assessment of a Low Literacy, Pictographic Cyclic Vomiting Syndrome Action Plan. J Pediatr 2022; 242:174-183.e1. [PMID: 34740589 DOI: 10.1016/j.jpeds.2021.10.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/04/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop and assess an evidence-based, individualized Cyclic Vomiting Syndrome Action Plan (CVSAP) to optimize both preventative and acute care. STUDY DESIGN This implementation science project synthesized a combination of clinical practice guidelines, published literature, and clinical experience by a team of CVS clinicians to develop the CVSAP. The tool was developed to include validated pictograms and an automatic, embedded, weight-based dosing calculator to output acute management recommendations. The final version of the CVSAP was tested by patients/caregivers, readability calculators, medical librarians, and clinicians using validated metrics. RESULTS All pictograms met the criteria for inclusion in the CVSAP. A composite readability score of 5.32 was consistent with a fifth-grade level. Patients/caregivers (n = 70) judged the CVSAP to be of high quality with consumer information rating form rating of 84.2%. Six medical librarians rated the CVSAP to have 93% understandability and 100% actionability, and 33 clinicians completing the SAM generated a suitability rating of 87.5%. CONCLUSIONS The CVSAP visually highlights individualized care plan components to facilitate optimized preventative and acute CVS care. Further investigation will determine if CVSAP increases caregiver confidence and compliance in home management and improves quality of life and clinical outcomes for patients with CVS.
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Affiliation(s)
- Patrick T Reeves
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD.
| | - Katja Kovacic
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Philip L Rogers
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rinarani Sanghavi
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, U T Southwestern Medical Center, Dallas, TX
| | - David J Levinthal
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Sofia Echelmeyer
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - B U K Li
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
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Wongtaweepkij K, Krska J, Pongwecharak J, Pongpunna S, Jarernsiripornkul N. Development and psychometric validation for evaluating written medicine information in Thailand: The Consumer Information Rating Form. BMJ Open 2021; 11:e053740. [PMID: 34598992 PMCID: PMC8488703 DOI: 10.1136/bmjopen-2021-053740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To translate and validate the consumer information rating form (CIRF) for use in Thai populations. DESIGN The development of the CIRF was carried out in two phases: translation process and cognitive interview, and psychometric testing. SETTING A university hospital and a tertiary hospital in northeast Thailand. PARTICIPANTS 150 outpatients from medicine department: 30 for phase 1 and 120 patients for phase 2 study. METHODS The CIRF was translated with cultural adaptation into Thai using cognitive interview technique in a sample of outpatients. A larger sample of outpatients then completed the CIRF in relation to either a package insert (PI) or a patient information leaflet (PIL) for one of three medicines: atorvastatin, celecoxib and metformin. Construct validity was assessed using principal component analysis (PCA) and internal consistency using Cronbach's α coefficient. Known group validity was assessed by comparing mean consumers' ratings for PIs and PILs. RESULTS Thirty participants engaged in the cognitive interview and 120 participants completed the CIRF. The PCA found the 17 items of the CIRF were extracted into three factors: comprehensibility, utility and design quality scales, mirroring the original. Cronbach's α for the overall scale (0.904) indicated good internal consistency. Known-group validity demonstrated significant differences in consumers' rating between PIs and PILs for almost all items (p<0.001). CONCLUSION Thai version of CIRF had acceptable validity and reliability for Thai consumers' ratings of written medicine information. The CIRF could be of practical use in the process of developing medicine information to ensure consumers' comprehension and their usefulness.
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Affiliation(s)
- Kamonphat Wongtaweepkij
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Janet Krska
- Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Chatham, Kent, UK
| | - Juraporn Pongwecharak
- Division of Pharmaceutical Care, Faculty of Pharmacy, Rangsit Center, Thammasat University, Pathumthani, Thailand
| | - Supawinee Pongpunna
- Pharmacy Department, Queen Sirikit Heart Center of the Northeast, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Narumol Jarernsiripornkul
- Division of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand
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Nualdaisri P, Corlett SA, Krska J. Provision and Need for Medicine Information in Asia and Africa: A Scoping Review of the Literature. Drug Saf 2021; 44:421-437. [PMID: 33666901 PMCID: PMC7994240 DOI: 10.1007/s40264-020-01038-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/23/2022]
Abstract
Published reviews of written medicine information (WMI) have mainly drawn on studies published in high-income countries, including very few Asian or African studies. We therefore set out to scope the research literature to determine the extent and type of studies concerning WMI for patients/consumers across these two continents. We sought empirical studies published between January 2004 and December 2019, conducted in any Asian or African country, as defined by the United Nations, in English or with an English abstract. The majority of the 923 papers identified were from high-income countries. We retained 26 papers from Africa and 99 from Asia. Most African studies (n = 20) involved patients in the development of PILs, in the assessment of the effectiveness of PILs or in surveys. In contrast, the highest proportion of Asian studies concerned the content of WMI (n = 42). WMI is desired, but needs to be in local languages, and there needs to be more use made of pre-tested pictograms. Existing WMI frequently does not meet local regulatory requirements, particularly locally manufactured products. A number of studies reported potentially positive impacts of providing WMI on knowledge and medicine use behaviours. Provision of medicine information is essential for safe use of medicines in all countries. Internationally agreed guidelines, incorporating good design principles, are needed to ensure the optimal content and design of WMI. The World Health Organization should support African and Asian regulatory bodies to share best practice in relation to WMI for patients/consumers and to develop and implement pan-continental guidelines that take into account consumer needs and preferences.
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Affiliation(s)
- Pitchaya Nualdaisri
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hatyai, Thailand
- Medway School of Pharmacy, Universities of Kent and Greenwich, Chatham Maritime, Kent, UK
| | - Sarah A Corlett
- Medway School of Pharmacy, Universities of Kent and Greenwich, Chatham Maritime, Kent, UK
| | - Janet Krska
- Medway School of Pharmacy, Universities of Kent and Greenwich, Chatham Maritime, Kent, UK.
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Reeves PT, Kolasinski NT, Yin HS, Alqurashi W, Echelmeyer S, Chumpitazi BP, Rogers PL, Burklow CS, Nylund CM. Development and Assessment of a Pictographic Pediatric Constipation Action Plan. J Pediatr 2021; 229:118-126.e1. [PMID: 33068567 PMCID: PMC7557278 DOI: 10.1016/j.jpeds.2020.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/16/2020] [Accepted: 10/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the Uniformed Services Constipation Action Plan (USCAP) as an evidence-based, personalized, clinical action tool with pictograms to aid clinicians and families in the management of functional constipation. STUDY DESIGN The USCAP facilitates the management functional constipation by using a health literacy-informed approach to provide instructions for pharmacotherapies and lifestyle modifications. This study included part 1 (pictogram validation) and part 2 (assessment). For part 1, pictogram transparency, translucency, and recall were assessed by parent survey (transparency ≥85%, mean translucency score ≥5, recall ≥85% required for validation). For part 2, the USCAP was assessed by parents, clinical librarians, and clinicians. Parental perceptions (n = 65) were assessed using the Consumer Information Rating Form (17 questions) to gauge comprehensibility, design quality and usefulness. Readability was assessed by 5 formulas and a Readability Composite Score was calculated. Clinical librarians (n = 3) used the Patient Education Materials Assessment Tool to measure understandability (19 questions) and actionability (7 questions) (>80% rating was acceptable). Suitability was assessed by clinicians (n = 34) using Doak's Suitability Assessment of Materials (superior ≥70% rating). RESULTS All 12 pictograms demonstrated appropriate transparency, translucency, and recall. Parental perceptions reflected appropriate comprehensibility, design quality, and usefulness. The Readability Composite Score was consistent with a fifth-grade level. Clinical librarians reported acceptable understandability and actionability. Clinicians reported superior suitability. CONCLUSIONS The USCAP met all criteria for clinical implementation and future study of USCAP implementation for treating children with chronic functional constipation.
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Affiliation(s)
- Patrick T. Reeves
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD,Reprint requests: Patrick T. Reeves, MD, 8901 Rockville Pike, Bethesda, MD, 20814
| | - Nathan T. Kolasinski
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - H. Shonna Yin
- Departments of Pediatrics and Population Health, New York University School of Medicine, Bellevue Hospital Center, New York, NY
| | | | - Sofia Echelmeyer
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Bruno P. Chumpitazi
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX,Children's Nutrition Research Center, United States Department of Agriculture, Houston, TX
| | - Philip L. Rogers
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Carolyn Sullivan Burklow
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Cade M. Nylund
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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Guidance on Expedited Partner Therapy: A Content Analysis of Informational Materials for Providers, Pharmacists, Patients, and Partners. Sex Transm Dis 2020; 47:136-142. [PMID: 31935209 DOI: 10.1097/olq.0000000000001099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The rates of sexually transmitted infections have steadily increased in the United States over the last 5 years. The Centers for Disease Control and Prevention has endorsed the use of expedited partner therapy (EPT) as an evidence-based practice to prevent chlamydial reinfection in index patients and lower barriers to treatment for partners. State health departments release guidance on EPT for providers, but it is unclear if information is available for other key stakeholders, for example, pharmacists, patients, and partners. The primary objective of this study was to conduct a review of state and territory health department websites to ascertain the availability, readability, utility, and content of EPT informational materials. METHODS A content analysis of 84 EPT informational materials was conducted using validated tools to measure readability, adherence to design standards, and EPT content inclusion. Results were stratified for each target audience. RESULTS Only 64% of states where EPT is allowable had informational materials available. The materials targeted providers (51.2%) and partners (35.7%). Little information targeted pharmacists (7.1%) or index patients (4.8%). The average reading level was 11th grade. Mean design score was 9.57 points of a possible 13 points. Most provider and pharmacist materials did not meet the content criteria; index and partner materials did not thoroughly describe cost of EPT, how to communicate with sex partners about EPT/chlamydia, or how to fill an EPT prescription. CONCLUSIONS To better support the uptake of EPT, existing resources for EPT should be improved in their design, readability, content, and availability for all target audiences.
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Alqurashi W, Awadia A, Pouliot A, Cloutier M, Hotte S, Segal L, Barrowman N, Irwin D, Vaillancourt R. The Canadian anaphylaxis action plan for kids: development and validation. PATIENT EDUCATION AND COUNSELING 2020; 103:227-233. [PMID: 31383563 DOI: 10.1016/j.pec.2019.07.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/02/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We designed a written Canadian Anaphylaxis Action Plan for Kids (Kids' CAP) which incorporates validated pictograms with written instructions. Using a patient-centered approach, we aimed to validate the Kids' CAP and assess its impact on anaphylaxis recognition and treatment, and to determine its' perceived usefulness. PATIENT INVOLVEMENT Children and their parents were involved in appraising the design and written contents of the Kids' CAP. METHODS The design process consisted of a development phase and clinical validation phase. First, we assessed the readability and understandability of the Kids' CAP using validated instruments. Then, patients (12-17 years of age) and parents of patients (<12 years of age) were given the Kids' CAP during the first consultation with allergy specialists or an Emergency Department visit for anaphylaxis. Subsequently, we conducted a phone interview 2-3 weeks later to assess their comprehension of anaphylaxis management. We also used the Consumer Information Rating Form to measure the participants' perception of the design quality and usefulness of the Kids' CAP. RESULTS Of the 230 participants enrolled, 205 (89%) completed the follow-up interview. The written contents of the Kid's CAP were modified to match grade 7 readability level. The total mean score of the Consumer Information Rating Form for comprehensibility was 23.1 (SD 2.4), and 25.1 (SD 2.3) for design quality. The mean comprehension score was 11.3 (SD 1.8) (reference range 0-12), with no significant difference between participants with and without previous experience with anaphylaxis, or high vs. low literacy level. CONCLUSION Engaging children and parents in the design and contents of written anaphylaxis action plan is an innovative approach to produce a useful document for the end-users. PRACTICE IMPLICATIONS The Kids' CAP is a valid tool that can be used in emergency departments and allergy clinics to improve patient's comprehension of anaphylaxis manifestations and treatment.
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Affiliation(s)
- Waleed Alqurashi
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Canada; Department of Pediatrics, University of Ottawa, Ottawa, Canada; Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada.
| | - Alisha Awadia
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Annie Pouliot
- Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Michel Cloutier
- Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Simon Hotte
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Lauren Segal
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Nick Barrowman
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Danica Irwin
- Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Quality, Trustworthiness, Readability, and Accuracy of Medical Information Regarding Common Pediatric Emergency Medicine-Related Complaints on the Web. J Emerg Med 2019; 57:469-477. [DOI: 10.1016/j.jemermed.2019.06.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/05/2019] [Accepted: 06/04/2019] [Indexed: 12/25/2022]
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12
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Suka M, Yamauchi T, Yanagisawa H. Perceived effectiveness rating scales applied to insomnia help-seeking messages for middle-aged Japanese people: a validity and reliability study. Environ Health Prev Med 2017; 22:69. [PMID: 29165165 PMCID: PMC5664822 DOI: 10.1186/s12199-017-0676-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Communicating health messages is an important way to influence people's behaviors towards health issues. Providers need to incorporate audience's perspective to design more persuasive messages. This study aimed to develop rating scales for measuring audience's perception of effectiveness of health messages in Japanese people. METHODS The comprehensibility scale including five items and the persuasiveness scale including seven items were designed based on literature review. A cross-sectional web-based survey was conducted among Japanese adults aged 35-45 years to assess the reliability and validity of the scales. Participants were asked to rate a text message that encouraged help-seeking intention for insomnia. All scale items were scored on a 1-to-5 point Likert scale, and they were averaged to produce an overall score for each scale. RESULTS Explanatory factor analysis revealed a two-factor solution that agreed with the comprehensibility and persuasiveness scales, respectively. Correlation coefficients between each set of items ranged between 0.63-0.87 for the comprehensibility scale and 0.37-0.76 for the persuasiveness scale. Cronbach alpha (0.88) indicated satisfactory internal consistency of the set of items. The mean (SD) of the comprehensibility and persuasiveness scores were 3.70 (0.82) and 3.15 (0.61), respectively, without ceiling or floor effects. These scores were significantly associated with intended future use of the message. The proportion of participants who reported a positive help-seeking intention for insomnia was significantly higher in the higher score groups for both scales. Multiple logistic regression analysis showed that the comprehensibility and persuasiveness scores were significantly associated with the help-seeking intention for insomnia. CONCLUSION The proposed rating scales exhibited adequate reliability and validity for measuring the comprehensibility and persuasiveness of insomnia health-seeking message in middle-aged Japanese people. Further studies are needed to confirm the generalizability of the results, but these scales may be useful for pretesting a health message with audience members to make it more acceptable and persuasive to the intended audience. TRIAL REGISTRATION Not applicable; this is not a report of intervention trial.
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Affiliation(s)
- Machi Suka
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Takashi Yamauchi
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroyuki Yanagisawa
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Shrank W, Avorn J, Rolon C, Shekelle P. Medication Safety: Effect of Content and Format of Prescription Drug Labels on Readability, Understanding, and Medication Use: A Systematic Review. Ann Pharmacother 2016; 41:783-801. [PMID: 17426075 DOI: 10.1345/aph.1h582] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective: To evaluate the evidence regarding the optimal content and format of prescription labels that might improve readability, understanding, and medication use. Data Sources: We performed a systematic review of randomized controlled trials, observational studies, and systematic reviews from MEDLINE and the Cochrane Database (1990–June 2005), supplemented by reference mining and reference lists from a technical expert panel. Study Selection: We selected studies that focused on the content of physician–patient communication about medications and the content and format of prescription drug iabels. Data Extraction: Two reviewers extracted and synthesized information about study design, populations, and outcomes, Data Synthesis: Of 2009 articles screened, 36 that addressed the content of physician–patient communication about medications and 69 that were related to the content or format of medication labels met review criteria. Findings showed that patients request information about a drug's indication, expected benefits, duration of therapy, and a thorough list of potential adverse effects. The evidence about label format supports the use of larger fonts, lists, headers, and white space, using simple language and logical organization to improve readability and comprehension. Evidence was not sufficient to support the use of pictographic icons. Little evidence linked label design or content to measurable health outcomes, adherence, or safety. Conclusions: Evidence suggests that specific content and format of prescription drug labels facilitate communication with and comprehension by patients. Efforts to improve the labels should be guided by such evidence, although additional study assessing the influence of label design on medication-taking behavior and health outcomes is needed. Several policy options exist to require minimal standards to optimize medical therapy, particularly in light of the new Medicare prescription drug benefit.
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Affiliation(s)
- William Shrank
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Piñero-López MÁ, Modamio P, Lastra CF, Mariño EL. Readability Analysis of the Package Leaflets for Biological Medicines Available on the Internet Between 2007 and 2013: An Analytical Longitudinal Study. J Med Internet Res 2016; 18:e100. [PMID: 27226241 PMCID: PMC4899622 DOI: 10.2196/jmir.5145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/23/2015] [Accepted: 02/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background The package leaflet included in the packaging of all medicinal products plays an important role in the transmission of medicine-related information to patients. Therefore, in 2009, the European Commission published readability guidelines to try to ensure that the information contained in the package leaflet is understood by patients. Objective The main objective of this study was to calculate and compare the readability levels and length (number of words) of the package leaflets for biological medicines in 2007, 2010, and 2013. Methods The sample of this study included 36 biological medicine package leaflets that were downloaded from the European Medicines Agency website in three different years: 2007, 2010, and 2013. The readability of the selected package leaflets was obtained using the following readability formulas: SMOG grade, Flesch-Kincaid grade level, and Szigriszt’s perspicuity index. The length (number of words) of the package leaflets was also measured. Afterwards, the relationship between these quantitative variables (three readability indexes and length) and categorical (or qualitative) variables were analyzed. The categorical variables were the year when the package leaflet was downloaded, the package leaflet section, type of medicine, year of authorization of biological medicine, and marketing authorization holder. Results The readability values of all the package leaflets exceeded the sixth-grade reading level, which is the recommended value for health-related written materials. No statistically significant differences were found between the three years of study in the readability indexes, although differences were observed in the case of the length (P=.002), which increased over the study period. When the relationship between readability indexes and length and the other variables was analyzed, statistically significant differences were found between package leaflet sections (P<.001) and between the groups of medicine only with regard to the length over the three studied years (P=.002 in 2007, P=.007 in 2010, P=.009 in 2013). Linear correlation was observed between the readability indexes (SMOG grade and Flesch-Kincaid grade level: r2=.92; SMOG grade and Szigriszt’s perspicuity index: r2=.81; Flesch-Kincaid grade level and Szigriszt’s perspicuity index: r2=.95), but not between the readability indexes and the length (length and SMOG grade: r2=.05; length and Flesch-Kincaid grade level: r2=.03; length and Szigriszt’s perspicuity index: r2=.02). Conclusions There was no improvement in the readability of the package leaflets studied between 2007 and 2013 despite the European Commission’s 2009 guideline on the readability of package leaflets. The results obtained from the different readability formulas coincided from a qualitative point of view. Efforts to improve the readability of package leaflets for biological medicines are required to promote the understandability and accessibility of this online health information by patients and thereby contribute to the appropriate use of medicines and medicine safety.
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Affiliation(s)
- María Ángeles Piñero-López
- Clinical Pharmacy and Pharmacotherapy Unit, Department of Pharmacy and Pharmaceutical Technology, University of Barcelona, Barcelona, Spain
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Patient-perceived content and formatting expectations for prescription container labeling. J Am Pharm Assoc (2003) 2016; 56:242-247.e1. [DOI: 10.1016/j.japh.2016.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 01/20/2016] [Indexed: 11/22/2022]
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Readability assessment of package inserts of biological medicinal products from the European medicines agency website. Drug Saf 2014; 37:543-54. [PMID: 24942755 DOI: 10.1007/s40264-014-0188-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Package inserts that accompany medicines are a common source of information aimed at patients and should match patient abilities in terms of readability. OBJECTIVE Our objective was to determine the degree of readability of the package inserts for biological medicinal products commercially available in 2007 and compare them with the readability of the same package inserts in 2010. METHODS A total of 33 package inserts were selected and classified into five groups according to the type of medicine: monoclonal antibody-based products, cytokines, therapeutic enzymes, recombinant blood factors and other blood-related products, and recombinant hormones. The package inserts were downloaded from the European Medicines Agency website in 2007 and 2010. Readability was evaluated for the entire text of five of the six sections of the package inserts and for the 'Annex' when there was one. Three readability formulas were used: SMOG (Simple Measure of Gobbledygook) grade, Flesh-Kincaid grade level, and Szigriszt's perspicuity index. RESULTS No significant differences were found between the readability results for the 2007 package inserts and those from 2010 according to any of the three readability indices studied (p>0.05). However, there were significant differences (p<0.05) between the readability scores of the sections of the package inserts in both 2007 and 2010. The readability of the package inserts was above the recommended sixth grade reading level (ages 11-12) and may lead to difficulties of understanding for people with limited literacy. CONCLUSIONS All the sections should be easy to read and, therefore, the readability of the medicine package inserts studied should be improved.
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Kyle S, Shaw D. Doctor–patient communication, patient knowledge and health literacy: how difficult can it all be? ACTA ACUST UNITED AC 2014. [DOI: 10.1308/rcsbull.2014.96.6.e9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Patients who understand their injuries, the aims and potential of their treatment are likely to experience superior outcomes. We review the literature on positive, encouraging doctor–patient communication, and the impact of health literacy and education on patient knowledge in medicine and surgery, with a particular emphasis on orthopaedic surgery. We also highlight methods of improving doctor–patient communication and patient knowledge.
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Affiliation(s)
| | - D Shaw
- Bradford Teaching Hospitals NHS Foundation Trust
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Farin E, Nagl M, Ullrich A. The comprehensibility of health education programs: questionnaire development and results in patients with chronic musculoskeletal diseases. PATIENT EDUCATION AND COUNSELING 2013; 90:239-246. [PMID: 23127897 DOI: 10.1016/j.pec.2012.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 09/04/2012] [Accepted: 10/07/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The objective was to develop a comprehensive questionnaire for measuring the patient-perceived comprehensibility of health education programs (COHEP questionnaire). According to a conceptual model outlined in the article, comprehensibility is considered a context factor of patient health literacy. METHODS A questionnaire study was carried out on N=577 patients with chronic musculoskeletal diseases. During inpatient rehabilitation, patients participated in standardized, interactive group education programs conducted by clinic personnel. Factorial structure, unidimensionality, reliability, fit to the Rasch model, and construct validity were tested. RESULTS The COHEP consists of 30 items and 4 scales (comprehension-fostering behavior of program trainers, transferability to everyday life, comprehensibility of medical information, amount of information). All scales are reliable, unidimensional, and meet the requirements of the Rasch model. In addition, there are initial indications of validity. The descriptive results show that the overall rating of the comprehensibility of patient education programs in the German rehabilitation system is good, but that there are clear differences between centers. CONCLUSION The COHEP can be used to evaluate health education programs, since it measures an important proximal outcome. PRACTICE IMPLICATIONS An analysis of patient-perceived comprehensibility can help providers adapt education sessions better to the health literacy of patients.
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Affiliation(s)
- Erik Farin
- University Freiburg - Medical Center, Department of Quality Management and Social Medicine, Freiburg, Germany.
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Mira JJ, Lorenzo S, Pérez-Jover V, Navarro I, Martín de Rosales AM, Lara C. Assessment of the quality of medication information for patients in Spain. Expert Opin Drug Saf 2012; 12:9-18. [DOI: 10.1517/14740338.2013.744965] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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20
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Usability of FDA-approved medication guides. J Gen Intern Med 2012; 27:1714-20. [PMID: 22566170 PMCID: PMC3509312 DOI: 10.1007/s11606-012-2068-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 02/08/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Medication guides are required documents to be distributed to patients in order to convey serious risks associated with certain prescribed medicines. Little is known about the effectiveness of this information to adequately inform patients on safe use. OBJECTIVE To examine the readability, suitability, and comprehensibility of medication guides, particularly for those with limited literacy. DESIGN Assessments of suitability and readability of 185 medication guides, and a sub-study examining change in suitability and readability from 2006 to 2010 among 32 of the medication guides (Study 1); 'open book' comprehension assessment of medication guides (Study 2). SETTING Two general internal medicine clinics in Chicago, IL. PATIENTS Four hundred and forty-nine adults seeking primary care services, ages 18-85. MEASUREMENTS For Study 1, the Suitability Assessment of Materials (SAM) and Lexile score for readability. For Study 2, a tailored comprehension assessment of content found in three representative medication guides. RESULTS The 185 analyzed medication guides were on average 1923 words (SD = 1022), with a mean reading level of 10-11th grade. Only one medication guide was deemed suitable in SAM analyses. None provided summaries or reviews, or framed the context first, while very few were rated as having made the purpose evident (8 %), or limited the scope of content (22 %). For Study 2, participants' comprehension of medication guides was poor (M = 52.7 % correct responses, SD = 22.6). In multivariable analysis, low and marginal literacy were independently associated with poorer understanding (β = -14.3, 95 % CI -18.0 - -10.6, p < 0.001; low: β = -23.7, 95 % CI -28.3 - -19.0, p < 0.001). CONCLUSION Current medication guides are of little value to patients, as they are too complex and difficult to understand especially for individuals with limited literacy. Explicit guidance is offered for improving these print materials.
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López-Jornet P, Camacho-Alonso F, Miñano FM, Sanchez-Siles M. Evaluation of the different strategies to oral cancer knowledge: a randomized controlled study. Psychooncology 2012; 22:1618-23. [PMID: 22962026 DOI: 10.1002/pon.3189] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 08/20/2012] [Accepted: 08/20/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Oral cavity and pharyngeal cancer has been well recognized as a public health problem. Prognosis for oral cancer is substantially improved when diagnosed early. A study was made of the impact of different educational strategies upon knowledge of oral cancer, evaluating the intervention after 4 weeks. METHODS Ninety subjects over 40 years of age were consecutively included and randomized to three different groups (video, leaflet, verbal information). All subjects completed a 20-item pre-test on their knowledge of the risk factors, signs, and symptoms of oral cancer, and posteriorly received the video, leaflet, or verbal information, with evaluation of the results after 4 weeks. RESULTS In relation to the items correctly answered at baseline, all subjects showed an increase in knowledge score after 4 weeks: verbal information 4.77 ± 3.31, leaflets 4.53 ± 3.44, and video 3.67 ± 3.31 - no statistically significant differences being observed for any of the three strategies. CONCLUSION The oral cancer knowledge score increased following the educational intervention, which proved successful over the short term.
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Affiliation(s)
- Pia López-Jornet
- Department of Oral Medicine, University of Murcia, Murcia, Spain.
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22
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Vaona A, Marcon A, Rava M, Buzzetti R, Sartori M, Abbinante C, Moser A, Seddaiu A, Prontera M, Quaglio A, Pallazzoni P, Sartori V, Rigon G. Quality evaluation of JAMA Patient Pages on diabetes using the Ensuring Quality Information for Patient (EQIP) tool. Prim Care Diabetes 2011; 5:257-263. [PMID: 21917537 DOI: 10.1016/j.pcd.2011.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 08/15/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
Abstract
CONTEXT Many medical journals provide patient information leaflets on the correct use of medicines and/or appropriate lifestyles. Only a few studies have assessed the quality of this patient-specific literature. OBJECTIVE The purpose of this study was to evaluate the quality of JAMA Patient Pages on diabetes using the Ensuring Quality Information for Patient (EQIP) tool. METHOD A multidisciplinary group of 10 medical doctors analyzed all diabetes-related Patient Pages published by JAMA from 1998 to 2010 using the EQIP tool. Inter-rater reliability was assessed using the percentage of observed total agreement (p(o)). A quality score between 0 and 1 (the higher score indicating higher quality) was calculated for each item on every page as a function of raters' answers to the EQIP checklist. A mean score per item and a mean score per page were then calculated. DATA SUMMARY We found 8 Patient Pages on diabetes on the JAMA web site. The overall quality score of the documents ranged between 0.55 (Managing Diabetes and Diabetes) and 0.67 (weight and diabetes). p(o) was at least moderate (>50%) for 15 of the 20 EQIP items. Despite generally favorable quality scores, some items received low scores. The worst scores were for the item assessing provision of an empty space to customize information for individual patients (score=0.01, p(o)=95%) and patients involvement in document drafting (score=0.11, p(o)=79%). CONCLUSIONS The Patient Pages on diabetes published by JAMA were found to present weak points that limit their overall quality and may jeopardize their efficacy. We therefore recommend that authors and publishers of written patient information comply with published quality criteria. Further research is needed to evaluate the quality and efficacy of existing written health care information.
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Franck MCJ, Foulon V, Van Vaerenbergh L. ABOP, the automatic patient information leaflet optimizer: evaluation of a tool in development. PATIENT EDUCATION AND COUNSELING 2011; 83:411-416. [PMID: 21621946 DOI: 10.1016/j.pec.2011.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 04/12/2011] [Accepted: 04/15/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE We developed a semi-automated leaflet optimizer (ABOP) to improve the readability of Dutch patient information leaflets (PILs). Our aim was to assess whether or not revisions made with ABOP have an effect on traceability and comprehension of PIL information. METHODS Two leaflets (one for oxazepam and one for tetracycline) were revised with the ABOP tool and both the original versions and ABOP versions were tested for readability, according to the EC guideline. RESULTS The ABOP version for oxazepam (p<.0001) scored significantly better than its original counterpart in readability tests. Although the results showed that the ABOP version of the tetracycline antibiotic outperformed the original version the difference in scores was not statistically significant. Terminology improvements had the greatest effect on information retrieval and comprehension. Improvements to instructions and warnings did not affect retrieval and comprehension scores. Overall improvements did not ensure full compliance with EC requirements, but results are not far off. CONCLUSION This study shows that even though ABOP does not solve all text quality issues, it does largely prepare a PIL for readability testing. PRACTICE IMPLICATIONS Using ABOP as a revision tool for PILs can optimize PIL quality and hence reduce readability testing time and costs.
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Affiliation(s)
- Maarten Charles J Franck
- Department for Translation and Interpretation, Artesis University College Antwerp, Antwerp, Belgium
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Barney LJ, Griffiths KM, Banfield MA. Explicit and implicit information needs of people with depression: a qualitative investigation of problems reported on an online depression support forum. BMC Psychiatry 2011; 11:88. [PMID: 21592335 PMCID: PMC3123271 DOI: 10.1186/1471-244x-11-88] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 05/18/2011] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Health management is impeded when consumers do not possess adequate knowledge about their illness. At a public health level, consumer knowledge about depression is particularly important because depression is highly prevalent and causes substantial disability and burden. However, currently little is known about the information needs of people with depression. This study aimed to investigate the explicit and implicit information needs of users of an online depression support forum. METHODS A sample of 2680 posts was systematically selected from three discussion forums on an online depression bulletin board (blueboard.anu.edu.au). Data were examined for evidence of requests for information (reflecting explicit needs) and reports of past or current problems (implicit needs). Thematic analysis was conducted using a data-driven inductive approach with the assistance of NVivo 7, and instances of questions and people reporting particular types of problems were recorded. RESULTS A total of 134 participants with personal experience of depression contributed to the data analysed. Six broad themes represented participant queries and reported problems: Understanding depression; disclosure and stigma; medication; treatment and services; coping with depression; and comorbid health problems. A variety of specific needs were evident within these broad thematic areas. Some people (n = 46) expressed their information needs by asking direct questions (47 queries) but the majority of needs were expressed implicitly (351 problems) by the 134 participants. The most evident need for information related to coping with depression and its consequences, followed by topics associated with medication, treatment and services. CONCLUSIONS People with depression have substantial unmet information needs and require strategies to deal with the difficulties they face. They require access to high quality and relevant online resources and professionals; thus, there is a need to rectify current gaps in the provision of information and limitations of dissemination. Greater knowledge about depression and its treatment is also needed at the general community level.
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Affiliation(s)
- Lisa J Barney
- Centre for Mental Health Research, Australian National University, Canberra, ACT, 0200, Australia.
| | - Kathleen M Griffiths
- Centre for Mental Health Research, Australian National University, Canberra, ACT, 0200, Australia
| | - Michelle A Banfield
- Australian Primary Health Care Research Institute (APHCRI), Australian National University, Canberra, ACT, 0200, Australia
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Luk A, Aslani P. Tools used to evaluate written medicine and health information: document and user perspectives. HEALTH EDUCATION & BEHAVIOR 2011; 38:389-403. [PMID: 21490309 DOI: 10.1177/1090198110379576] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Alice Luk
- University of Sydney, New South Wales, Australia
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Abstract
SummaryProviding information to older adults is essential for informed decision-making and good health. Because there are significant deficits in providing information verbally, health professionals must use written information as well. Most studies have focused on the content and literacy of documents. However, the legibility and formatting are critically important for older adults, who are more likely to suffer with visual impairment. Providing written information that is tested for appropriate reading level and for presentation is necessary to ensure that older adults can use the information given. There are a number of tools available that test these aspects of written information, but not one tool that is universally accepted. Further research regarding the design and presentation of written information for older adults is necessary.
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Thompson AE, Goldszmidt MA, Schwartz AJ, Bashook PG. A randomized trial of pictorial versus prose-based medication information pamphlets. PATIENT EDUCATION AND COUNSELING 2010; 78:389-393. [PMID: 20153597 DOI: 10.1016/j.pec.2010.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 01/17/2010] [Accepted: 01/18/2010] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The goal of this study was to compare prose and pictorial-based information pamphlets about the medication methotrexate in the domains of free recall, cued recall, comprehension and utility. METHODS A single blind, randomized trial of picture versus prose-based information pamphlets including 100 participants aged 18-65 years of age, who had not completed high school, could read English, and had no prior knowledge about methotrexate. Superiority of pamphlet type was assessed using immediate free recall, cued recall and comprehension. RESULTS There were no differences between picture and prose pamphlets in free recall, cued recall, and comprehension either immediately or after a 1-week interval. Immediate free recall of important information was 17-26%; free recall fell even lower to 7-16% after 1 week. The pictorial pamphlet was preferred over the prose-based pamphlet. CONCLUSION This study found no benefit in free recall, cued recall, or comprehension through the addition of pictograms to a simple prose-based medication pamphlet. PRACTICE IMPLICATIONS In order for them to be effective in clinical practice, even simple medication information pamphlets that have been assessed for patients' ability to comprehend them cannot be used as the sole means for conveying important medication-related information to patients.
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Affiliation(s)
- Andrew E Thompson
- Department of Medicine, University of Western Ontario, London, Canada.
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Luk A, Tasker N, Theo Raynor DK, Aslani P. Written Medicine Information from English-Speaking Countries—How Does It Compare? Ann Pharmacother 2010; 44:285-94. [DOI: 10.1345/aph.1m402] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: There has been an increasing drive from consumers for more information to be available about their medicines. However, the layout and presentation of such written information is variable, and the poor format and design discourages people from reading the documents. Objective: To identify, collate, and evaluate different formats of written medicine information (WMI). Methods: Three researchers evaluated 157 samples of WMI for 10 prescription and 3 over-the-counter medicines from 6 English-speaking countries compared with the United States Keystone Consensus Criterion 8 (USKCC8) and the Ten Key Principles (TKP) of Consumer Medicine Information. Readability was measured using Flesch-Kincaid Grade Level (FKGL) and Fog tests. Compliance (%) with the criteria was computed and examined using the median test. Results: Overall median compliance with USKCC8 was 70%, and 74% to TKP. New Zealand leaflets achieved the highest compliance with USKCC8 (83%, Interquartile range (IQR) 70–89%), with US leaflets the lowest (55%. IQR 45–70%). Australian and New Zealand leaflets showed the highest compliance with TKP (90%, IQR 80–100% and 87–97%, respectively), while UK leaflets demonstrated the lowest (60%, IQR 52–71%). Overall median reading grades for the leaflets were 10 (Flesch-Kincaid Grade Level) and 11 (Fog). Conclusions: Compliance with USKCC8 and TKP varied greatly between countries, with readability grades exceeding the recommended range. International examples of WMI show wide variation in compliance with guidelines on recommended format and presentation. These examples of WMI require high literacy to read. Future WMI development should use more recommended formats and increase comprehensibility.
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Affiliation(s)
- Alice Luk
- The University of Sydney, Broadway, NSW, Australia
| | | | | | - Parisa Aslani
- Associate Professor in Pharmacy Practice, Faculty of Pharmacy, The University of Sydney
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Harris M, Wildgoose D, Veale AJ, Smith BJ. Providing reviews of evidence to COPD patients: qualitative study of barriers and facilitating factors to patient-mediated practice change. Chron Respir Dis 2009; 7:19-28. [PMID: 20032003 DOI: 10.1177/1479972309358634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to identify barriers and facilitating factors to people with COPD performing the following actions: (a) reading a manual that contained summaries of evidence on treatments used in chronic obstructive pulmonary disease (COPD) and (b) at a medical consultation, asking questions that were provided in the manual and were designed to prompt doctors to review current treatments in the light of evidence. The manual was developed using current best practice and was designed to facilitate reading and discussion with doctors. In-depth interviews were held with patients who had received the manual. Of 125 intervention participants from a controlled clinical trial of the manual, 16 were interviewed in their homes in and around Adelaide, South Australia. Plain language writing and a simple layout facilitated reading of the manual by participants. Where the content matched the interests of participants this also facilitated reading. On the other hand, some participants showed limited interest in the evidence summaries. Participant comments indicated that they did not see it as possible or acceptable for patients to master research evidence or initiate discussions of evidence with doctors. These appeared to be the main barriers to effectiveness of the manual. If evidence summaries for patients are to be used in disease management, they should be understandable and relevant to patients and provide a basis for discussion between patients and doctors. Work is now needed so that we can both present evidence summaries in a way that is relevant to patients and reduce the barriers to patient-initiated discussions of evidence.
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Affiliation(s)
- Melanie Harris
- Flinders Human Behaviour & Health Research Unit, Flinders University, Adelaide, Australia.
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Desplenter F, Laekeman G, Demyttenaere K, Simoens S. Medication information for Flemish inpatients with major depression: evaluation and construct validity of the Consumer Information Rating Form. J Clin Pharm Ther 2009; 34:645-55. [DOI: 10.1111/j.1365-2710.2009.01039.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chubaty A, Sadowski CA, Carrie AG. Typeface legibility of patient information leaflets intended for community-dwelling seniors. Age Ageing 2009; 38:441-7. [PMID: 19483246 DOI: 10.1093/ageing/afp065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND there are guidelines available from a number of countries and organisations regarding the design of written information, as appropriate design is essential for effective communication. The design of leaflets should be evaluated, as written information that does not adhere to guidelines may not be effective for seniors. OBJECTIVE to use current typeface guidelines to describe the design of health information leaflets. DESIGN this was a cross-sectional study of leaflets from pharmacies and seniors' clinics. SETTING community pharmacies, seniors' clinics in Edmonton, Canada. METHODS health information leaflets and hydrochlorthiazide information sheets were collected. The body of each was evaluated, based on guidelines (from Canada, UK and USA). Adherence to recommendations was assessed descriptively. RESULTS a total of 388 unique leaflets and 10 hydrochlorthiazide sheets were collected from 21 pharmacies and 3 clinics. Most leaflets were produced by pharmaceutical companies (42.8%) and contained disease information (43.8%). Only one-third of all leaflets used the minimum recommended point size (12 point), 18.6% followed American guidelines for line spacing (1.5 lines), but 77.1% had appropriate contrast. CONCLUSIONS although guidelines are available, most leaflets did not meet recommendations. Improvements in the leaflet design should be considered to aid seniors in the uptake of information.
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Abstract
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.
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Affiliation(s)
- Donald J Nicolson
- University of HullHull York Medical School (HYMS)Hertford BuildingHullUKHU6 7RX
| | - Peter Knapp
- University of YorkDepartment of Health SciencesYorkUKYO10 5DD
| | - David K Raynor
- University of LeedsSchool of HealthcareBaines WingLeedsUKLS2 9UT
| | - Pat Spoor
- University of LeedsHealth Sciences LibraryLeedsUKLS2 9JT
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THOMPSON ANDREWE, GRAYDON SARAL. Patient-Oriented Methotrexate Information Sites on the Internet: A Review of Completeness, Accuracy, Format, Reliability, Credibility, and Readability. J Rheumatol 2009; 36:41-9. [DOI: 10.3899/jrheum.080430] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ObjectiveWith continuing use of the Internet, rheumatologists are referring patients to various websites to gain information about medications and diseases. Our goal was to develop and evaluate a Medication Website Assessment Tool (MWAT) for use by health professionals, and to explore the overall quality of methotrexate information presented on common English-language websites.MethodsIdentification of websites was performed using a search strategy on the search engine Google. The first 250 hits were screened. Inclusion criteria included those English-language websites from authoritative sources, trusted medical, physicians’, and common health-related websites. Websites from pharmaceutical companies, online pharmacies, and where the purpose seemed to be primarily advertisements were also included. Product monographs or technical-based web pages and web pages where the information was clearly directed at patients with cancer were excluded. Two reviewers independently scored each included web page for completeness and accuracy, format, readability, reliability, and credibility. An overall ranking was provided for each methotrexate information page.ResultsTwenty-eight web pages were included in the analysis. The average score for completeness and accuracy was 15.48 ± 3.70 (maximum 24) with 10 out of 28 pages scoring 18 (75%) or higher. The average format score was 6.00 ± 1.46 (maximum 8). The Flesch-Kincaid Grade Level revealed an average grade level of 10.07 ± 1.84, with 5 out of 28 websites written at a reading level less than grade 8; however, no web page scored at a grade 5 to 6 level. An overall ranking was calculated identifying 8 web pages as appropriate sources of accurate and reliable methotrexate information.ConclusionWith the enormous amount of information available on the Internet, it is important to direct patients to web pages that are complete, accurate, readable, and credible sources of information. We identified web pages that may serve the interests of both rheumatologists and patients.
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Wolf MS, Davis TC, Shrank W, Rapp DN, Bass PF, Connor UM, Clayman M, Parker RM. To err is human: patient misinterpretations of prescription drug label instructions. PATIENT EDUCATION AND COUNSELING 2007; 67:293-300. [PMID: 17587533 DOI: 10.1016/j.pec.2007.03.024] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 03/28/2007] [Accepted: 03/30/2007] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To examine the nature and cause of patients' misunderstanding common dosage instructions on prescription drug container labels. METHODS In-person cognitive interviews including a literacy assessment were conducted among 395 patients at one of three primary care clinics in Shreveport, Louisiana, Jackson, Michigan and Chicago, Illinois. Patients were asked to read and demonstrate understanding of dosage instructions for five common prescription medications. Correct understanding was determined by a panel of blinded physician raters reviewing patient verbatim responses. Qualitative methods were employed to code incorrect responses and generate themes regarding causes for misunderstanding. RESULTS Rates of misunderstanding for the five dosage instructions ranged from 8 to 33%. Patients with low literacy had higher rates of misunderstanding compared to those with marginal or adequate literacy (63% versus 51% versus 38%, p<0.001). The 374 (19%) incorrect responses were qualitatively reviewed. Six themes were derived to describe the common causes for misunderstanding: label language, complexity of instructions, implicit versus explicit dosage intervals, presence of distractors, label familiarity, and attentiveness to label instructions. CONCLUSION Misunderstanding dosage instructions on prescription drug labels is common. While limited literacy is associated with misunderstanding, the instructions themselves are awkwardly phrased, vague, and unnecessarily difficult. PRACTICE IMPLICATIONS Prescription drug labels should use explicit dosing intervals, clear and simple language, within a patient-friendly label format. Health literacy and cognitive factors research should be consulted.
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Affiliation(s)
- Michael S Wolf
- Health Literacy and Learning Program, Institute for Healthcare Studies, Division of Internal Medicine, Northwestern University, Chicago, IL 60611, USA.
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Mai A, Aslani P. Impact of Vietnamese written and verbal medicine information on Vietnamese-speaking Australians' knowledge and satisfaction. Br J Clin Pharmacol 2007; 64:527-35. [PMID: 17610525 PMCID: PMC2048560 DOI: 10.1111/j.1365-2125.2007.02968.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AIMS To develop three Vietnamese medicine information leaflets and to evaluate their impact in combination with verbal counselling (in Vietnamese) on consumers' medicine knowledge and satisfaction with the written information received. METHODS Leaflets in Vietnamese were developed for three drug classes: biguanides, calcium channel blockers and HMG-CoA reductase inhibitors. A two-group (comparison and intervention), randomized, repeated measures design was used. The comparison group (n = 51) received routine verbal counselling in English. The intervention group (n = 44) received verbal and written information in Vietnamese. Australian Vietnamese-speaking consumers were recruited. Data on consumer knowledge and satisfaction were collected from both groups at three time points: baseline (prior to receiving leaflets and verbal counselling), at 1-2 weeks (first postintervention) and 8 weeks after receiving the information. RESULTS All intervention group respondents were satisfied with the information. Mean medicine knowledge and satisfaction scores increased with time in the intervention group, and were significantly higher than in the comparison group (knowledge, F = 18.5, d.f. = 2, P < 0.0001; satisfaction, F = 19.8, d.f. = 2, P < 0.0001). The increases observed in the intervention group's mean knowledge and satisfaction scores at first postintervention were significantly higher compared with baseline for all drug classes. CONCLUSIONS Delivery of written and verbal medicine information in Vietnamese resulted in an increase in consumers' medicine knowledge and satisfaction with written information. This study highlights the importance of providing information in languages other than English and in consumers' native tongue to aid in the quality use of medicines.
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Affiliation(s)
- Anh Mai
- Faculty of Pharmacy, The University of Sydney, NSW, Australia
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Koo MM, Krass I, Aslani P. Evaluation of written medicine information: validation of the Consumer Information Rating Form. Ann Pharmacother 2007; 41:951-6. [PMID: 17488832 DOI: 10.1345/aph.1k083] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The Consumer Information Rating Form (CIRF) was developed as a direct method for measuring consumers' perceptions of the comprehensibility, utility, and design quality of written medicine information. The validity and reliability of the CIRF were evaluated in a small convenience consumer sample in the US. Its validity and reliability have yet to be established in a larger sample of consumers who are on chronic therapy in different settings. OBJECTIVE To determine the validity and reliability of the CIRF in Australian consumers on chronic therapy. METHODS Consumers read and subsequently evaluated a Consumer Medicine Information (CMI) leaflet for one of their own medications, using an adapted version of the CIRF. The construct validity and internal reliability of the adapted version of the CIRF were tested using principal components analysis (PCA) and Cronbach's alpha, respectively. RESULTS The adapted CIRF was completed by 282 consumers (aged 19-90 y; median 66; interquartile range 53-75 y; 60.3% females). Most respondents spoke primarily English at home (85.5%), had attained at least secondary education (84%), and had adequate health literacy levels (88.2%). Consumers rated CMI easy to read, understand, and navigate, but less easy to remember and keep. Most also found it to be useful and to contain the right amount of information. The design aspects also scored favorably, although CMI did score relatively poorly in terms of its attractiveness and tone (whether alarming or not). PCA yielded 3 factors (explaining 59.3% of the total variance) identical to those in the original CIRF: comprehensibility, utility, and design quality. All factors demonstrated good reliability (Cronbach's alpha 0.74, 0.92, and 0.75, respectively). CONCLUSIONS The CIRF appears to be a robust instrument for assessing consumers' perceptions of written medicine information. However, validity always needs to be reestablished when using a previously validated measure in a different population.
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Affiliation(s)
- Michelle M Koo
- Faculty of Pharmacy, University of Sydney, Sydney, Australia.
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Wolf MS, Davis TC, Shrank WH, Neuberger M, Parker RM. A critical review of FDA-approved Medication Guides. PATIENT EDUCATION AND COUNSELING 2006; 62:316-22. [PMID: 16884888 DOI: 10.1016/j.pec.2006.06.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2006] [Revised: 06/02/2006] [Accepted: 06/07/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To investigate whether consumer-directed, FDA-approved Medication Guides issued for potentially harmful medications are likely to be useful to patients with limited literacy. METHODS Lexile analysis and the suitability assessment of materials (SAM) were conducted on the 40 currently issued Medication Guides to evaluate reading difficulty, content, and format. Structured interviews with a literacy assessment were also conducted among 251 primary care patients at a public hospital clinic in Louisiana to determine if patients directed attention to Medication Guides and other accompanying patient information materials. RESULTS The average Lexile score estimated an 11th-12th grade reading level for the guides (M=1223, S.D.=200). None of the 40 Medication Guides met federal recommendations (6th-8th grade level). Most Medication Guides were deemed unsuitable because they did not provide a summary of content (90.0%) or limit the scope of information (77.5%). Only 23.0% of patients reported having looked at Medication Guides or accompanying patient information materials; patients with low literacy were less likely to have looked at them (16.7% versus 32.9%, p=0.03). CONCLUSION Medication Guides in their current form are not likely to be useful to patients with limited literacy skills. PRACTICE IMPLICATIONS Reading level of text in Medication Guides should be reduced, summaries or "highlights" provided, and the scope of information limited to increase the likelihood of use among individuals with limited literacy. Consumers should be involved in their development.
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Affiliation(s)
- Michael S Wolf
- Institute for Healthcare Studies, Division of General Internal Medicine, Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 200, Chicago, IL 60611, USA.
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Koo MM, Krass I, Aslani P. Patient Characteristics Influencing Evaluation of Written Medicine Information: Lessons for Patient Education. Ann Pharmacother 2005; 39:1434-40. [PMID: 16046486 DOI: 10.1345/aph.1g118] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: Written medicine information (WMI) is considered an important component of patient education. Despite the wealth of information on many aspects of WMI, there is a paucity of studies examining how patient characteristics influence use and evaluation of WMI. OBJECTIVE: To investigate the influence of patient characteristics on the evaluation and intended future use of consumer medicine information (CMI), a form of WMI. METHODS: A questionnaire was administered to patients from 3 rheumatology/pain clinics in teaching hospitals and 40 community pharmacies. The questionnaire examined patients' perceptions of CMI (comprehension, perceived usefulness, design rating) and likelihood of using CMI in the future. Information on patient characteristics (demographic data, health literacy level) was also collected. Multiple regression analysis was used to examine associations between patient characteristics and their evaluation and intended future use of CMI. RESULTS: A total of 479 patients participated. Comprehension of CMI was associated with speaking primarily English at home, having attained secondary education or higher, and having adequate health literacy levels. Perceived usefulness of CMI was influenced by age and number of medications. Design rating was influenced by type of CMI, patient age, gender, and highest level of education. Intended future use was affected by health literacy level. In addition to individual patient characteristics, overall comprehension and perceived usefulness of CMI also influenced its intended future use. CONCLUSIONS: Patient characteristics were found to influence evaluation and intended future use of CMI. These findings should be taken into consideration in future research, development of WMI, and education of patients in everyday practice.
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Affiliation(s)
- Michelle M Koo
- Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia.
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Svarstad BL, Mount JK, Tabak ER. Expert and Consumer Evaluation of Patient Medication Leaflets Provided in U.S. Pharmacies. J Am Pharm Assoc (2003) 2005; 45:443-51. [PMID: 16128499 DOI: 10.1331/1544345054475586] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Evaluate the distribution and quality of patient medication leaflets provided in U.S. pharmacies. DESIGN Observational. SETTING United States. PARTICIPANTS 384 randomly selected community pharmacies in 44 states. INTERVENTIONS Professional shoppers (acting as patients) presented four new prescriptions to study pharmacies. MAIN OUTCOME MEASURES Medication leaflets obtained by shoppers were evaluated by expert and consumer raters using criteria specified in federal law mandating distribution of useful written information to 95% of individuals receiving new prescriptions by 2006. RESULTS Leaflets were provided by pharmacies with 89% of 1,536 prescriptions presented by professional shoppers posing as patients. Leaflet quality varied: 95% of leaflets received high ratings on accuracy, but only 19% received high ratings on the specificity of directions. Fewer than 10% of all leaflets met quality criteria regarding contraindications, precautions, and how to avoid harm. One fourth of all leaflets had poor print size, according to the shoppers. CONCLUSION Additional efforts are needed to meet federally mandated information distribution and quality goals by 2006.
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Affiliation(s)
- Bonnie L Svarstad
- School of Pharmacy, University of Wisconsin-Madison, 777 Highland Ave., Madison, WI 53705, USA.
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Kaphingst KA, Rudd RE, DeJong W, Daltroy LH. Literacy demands of product information intended to supplement television direct-to-consumer prescription drug advertisements. PATIENT EDUCATION AND COUNSELING 2004; 55:293-300. [PMID: 15530767 DOI: 10.1016/j.pec.2003.11.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2003] [Revised: 10/27/2003] [Accepted: 11/01/2003] [Indexed: 05/24/2023]
Abstract
The US Food and Drug Administration (FDA) allows television direct-to-consumer (DTC) prescription drug advertisements that do not fully disclose drug risks if the ads include "adequate provision" for dissemination of the drug's approved labeling. This requirement can be met in part by referring consumers to multiple text sources of product labeling. This study was designed to assess the materials to which consumers were referred in 23 DTC television advertisements. SMOG assessments showed that the average reading grade levels were in the high school range for the main body sections of the materials and college-level range for the brief summary sections. The Suitability Assessment of Materials (SAM) instrument identified specific difficulties with the materials, including content, graphics, layout, and typography features. Stronger plain language requirements are recommended. Health care providers should be aware that patients who ask about an advertised drug might not have the full information required to make an informed decision.
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Affiliation(s)
- Kimberly A Kaphingst
- Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
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Humphris GM, Freeman R, Clarke HMM. Risk perception of oral cancer in smokers attending primary care: a randomised controlled trial. Oral Oncol 2004; 40:916-24. [PMID: 15380170 DOI: 10.1016/j.oraloncology.2004.04.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2004] [Accepted: 04/21/2004] [Indexed: 12/13/2022]
Abstract
To encourage the public to attend and accept oral cancer screening, further understanding is required of the ability of structured information to alter patient knowledge and risk perceptions. Previous work has shown the benefit of written information for those at high risk of oral cancer, especially for tobacco smokers. This study investigated three hypotheses: first that a patient information leaflet (PIL) would enhance risk perceptions, and second that the effect of the leaflet on knowledge would be confirmed as in previous studies and third that these improvements would be associated with smoking behaviour. Patients (N = 995) attending 20 general dental practices in Northern Ireland were invited to participate, 28 refused (response rate = 97%). Patients were randomised into two groups. The experimental group received a PIL and then completed a self-report questionnaire, whereas the control group followed same procedure without the PIL. Measures included a 36 item oral cancer knowledge scale and two items to assess risk perception. Usable data were available from 944 patients; mean (SD) age = 42 (15), 65% female. Risk perceptions of oral cancer were minimally effected by the PIL (p = 0.023). This effect was demonstrable in smokers. Smokers were sixteen (95% CI: 8-30) times more likely to believe that they were at greater risk of oral cancer than non-smokers. A clear benefit of the PIL on patients' oral cancer knowledge was found, particularly for smokers and those with a history of smoking. These findings demonstrate that public awareness of smokers can be raised with written information although health beliefs such as risk perceptions require more intensive intervention.
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Affiliation(s)
- G M Humphris
- Bute Medical School, University of St Andrews, Fife, Scotland KY16 9TS, UK.
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Moult B, Franck LS, Brady H. Ensuring quality information for patients: development and preliminary validation of a new instrument to improve the quality of written health care information. Health Expect 2004; 7:165-75. [PMID: 15117391 PMCID: PMC5060233 DOI: 10.1111/j.1369-7625.2004.00273.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite the recent focus on improving the quality of patient information, there is no rigorous method of assessing quality of written patient information that is applicable to all information types and that prescribes the action that is required following evaluation. OBJECTIVE The aims of this project were to develop a practical measure of the presentation quality for all types of written health care information and to provide preliminary validity and reliability of the measure in a paediatric setting. METHODS The Ensuring Quality Information for Patients (EQIP) tool was developed through a process of item generation, testing for concurrent validity, inter-rater reliability and utility. Patient information managers and health care professionals tested EQIP in three annual audits of health care leaflets produced by a children's hospital. RESULTS The final tool comprised 20 items. Kendall's tau B rank correlation between EQIP and DISCERN was 0.56 (P = 0.001). There was strong agreement between intuitive rating and the EQIP score (Kendall's tau B = 0.78, P = 0.009). Internal consistency using Cronbach's alpha was 0.80. There was good agreement between pairs of raters (mean kappa = 0.60; SD = 0.18) with no differences based on types of leaflets. Audits showed significant improvement in the number of leaflets achieving a higher quality EQIP rating over a 3-year period. CONCLUSIONS EQIP demonstrated good preliminary validity, reliability and utility when used by patient information managers and healthcare professionals for a wide variety of written health care information. EQIP uniquely identifies actions to be taken as a result of the quality assessment. Use of EQIP improved the quality of written health care information in a children's hospital. Wider evaluation of EQIP with written information for other populations and settings is recommended.
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Affiliation(s)
- Beki Moult
- Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Raynor DK, Savage I, Knapp P, Henley J. We are the experts: people with asthma talk about their medicine information needs. PATIENT EDUCATION AND COUNSELING 2004; 53:167-174. [PMID: 15140456 DOI: 10.1016/s0738-3991(03)00126-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Revised: 02/22/2003] [Accepted: 03/23/2003] [Indexed: 05/24/2023]
Abstract
People with chronic illness are being encouraged to become more involved in their care. For this, they need to be well informed about their medicines, and more written medicines information is becoming available. However, there is little data about its effectiveness and impact. This study examined the patient perspective of medicines information through focus groups of people with asthma. Most participants actively sought medicines information from a variety of professional and lay sources. There were some positive experiences but many examples of partial or total information failure. Individualised information was valued and medicine leaflets were generally seen as less helpful than face-to-face advice. Some felt strongly that patients with long experience should be involved in the development of medicine information leaflets. We conclude that medicine information leaflets do not currently meet the needs of users and that people who take medicines should be involved in their development and testing.
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Affiliation(s)
- David K Raynor
- Pharmacy Practice and Medicines Management Group, University of Leeds, Leeds LS2 9JT, UK.
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Humphris GM, Field EA. An oral cancer information leaflet for smokers in primary care: results from two randomised controlled trials. Community Dent Oral Epidemiol 2004; 32:143-9. [PMID: 15061863 DOI: 10.1111/j.0301-5661.2004.00129.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate whether primary care patients who claim to smoke tobacco gain greater benefit of a patient information leaflet (PIL) on oral cancer than nonsmokers. METHODS Two studies were conducted. Study 1 examined the research question initially, and Study 2 acted as a replication and inclusion of additional secondary outcome measures. The leaflet was designed and tested in an earlier study. Knowledge of oral cancer was assessed by a previously validated 36-dichotomous-item scale. A single-item question ascertained self-reported smoking status (kappa = 0.94). Study 1 participants were drawn from 14 practices (6 medical, 8 dental). A randomised control group design was adopted. The experimental group received the leaflet on attendance to the practice and then completed the questionnaire. The control group received the questionnaire only. Complete data were collected from 739 respondents. The design of Study 2 was identical; 786 new respondents from 16 practices (7 medical, 9 dental) were collected. RESULTS Both studies confirmed that smokers knew less about oral cancer than nonsmokers (P < 0.05) when access to the leaflet had been denied. On receipt of the leaflet, there was no distinction in oral cancer knowledge between the smoking status categories of respondents. Evidence of reassurance about screening from leaflet exposure was supported by the second study. CONCLUSION This programmed research has demonstrated an effect of a brief PIL to offset the decrement in oral cancer knowledge observed in primary care patients who use tobacco in comparison to their nonsmoking counterparts. The leaflet reduced anxiety about oral health screening in smokers.
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Affiliation(s)
- G M Humphris
- Bute Medical School, University of St Andrews, Bute Medical Buildings, St Andrews, Fife KY16 9TS, Scotland.
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Boundouki G, Humphris G, Field A. Knowledge of oral cancer, distress and screening intentions: longer term effects of a patient information leaflet. PATIENT EDUCATION AND COUNSELING 2004; 53:71-77. [PMID: 15062907 DOI: 10.1016/s0738-3991(03)00118-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2002] [Revised: 01/18/2003] [Accepted: 03/04/2003] [Indexed: 05/24/2023]
Abstract
Study aim was to determine the influence of a patient information leaflet (PIL) on mouth cancer to improve knowledge, reduce distress and increase intention to accept a mouth screen over a 2-month period. The design was a randomised controlled trial. Two dental practices in the northwest of England participated. Standardised multi-item scales of the three outcome measures were employed. The PIL was given to a randomised intervention group of patients in waiting room. Single sheet questionnaire was completed by both groups of patients at baseline in waiting room (immediately following leaflet administration in intervention arm of study). Repeat questionnaire completion at 8 weeks by all patients through postal system. Mann-Whitney U-tests comparing outcome variables between patients with and without access to the leaflet at baseline and 8 weeks were performed. Multiple logistic regression was used to predict re-reading of the leaflet at home. Useable replies were received from 317 patients (60% response rate). All measures showed some benefit of immediate exposure to the leaflet at follow up. Older patients, less initial knowledge, and self-reported smoking positively predicted the re-reading of the leaflet. The introduction of a mouth cancer PIL into dental practice may help to inform patients about oral cancer, moderate distress and encourage acceptance of an oral health screen.
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Johansson K, Salanterä S, Katajisto J, Leino-Kilpi H. Written orthopedic patient education materials from the point of view of empowerment by education. PATIENT EDUCATION AND COUNSELING 2004; 52:175-181. [PMID: 15132523 DOI: 10.1016/s0738-3991(03)00036-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Written patient education materials are one way of supporting patient empowerment. The aim of this study was to evaluate written orthopedic patient education materials (n = 25) drawn from a university hospital's electronic databank. In the absence of suitable tools for evaluation, an analytic framework was developed by a panel of nursing scientists and clinical experts. The materials were evaluated from the point of view of empowerment by their external appearance, content and instructiveness. In terms of their external appearance the materials were well prepared, but much was left to be desired with regard to contents and instructiveness. Development needs to focus on making better use of methods of visual representation, on increasing the coverage of content areas that so far have received less attention, like social, experiential, ethical and financial empowerment, and on providing a more focused perspective on the patient.
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Affiliation(s)
- Kirsi Johansson
- Department of Nursing Science, University of Turku, FIN-20014 Turku, Finland.
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Humphris GM, Field EA. The immediate effect on knowledge, attitudes and intentions in primary care attenders of a patient information leaflet: a randomized control trial replication and extension. Br Dent J 2003; 194:683-8; discussion 675. [PMID: 12830193 DOI: 10.1038/sj.bdj.4810283] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2002] [Accepted: 02/12/2003] [Indexed: 11/09/2022]
Abstract
AIM To determine whether the influence of a leaflet on mouth cancer improves knowledge, related attitudes and intention to accept a mouth screen. DESIGN Randomized controlled trial. SETTING Dental and medical waiting rooms in the North West of England. SAMPLE Nine hundred and forty nine patients from 16 practices were invited to participate. MEASURES Standardized multi-item scales of six outcome measures including knowledge, beliefs and intention to accept an oral cancer screen. PROCEDURE A patient information leaflet was given to a randomized intervention group of patients. A single sheet questionnaire was completed by both groups of patients (immediately following leaflet administration in the intervention arm of study). STATISTICAL ANALYSIS t tests were used to compare outcome variables between patients with and without access to the leaflet with Boneferroni correction. RESULTS Participation rate was high (91%). Knowledge (P <0.001) and intentions (P = 0.003) benefited from patient access to leaflet. Anxiety was not raised with leaflet exposure. Some beliefs about the screening procedure appeared to be slightly improved by reading the leaflet (p <0.05). CONCLUSION This study supports previous findings of an immediate positive effect of an information leaflet on patients' knowledge of oral cancer and willingness to accept an oral cancer screen.
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Affiliation(s)
- G M Humphris
- Division of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL.
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Svarstad BL, Bultman DC, Mount JK, Tabak ER. Evaluation of written prescription information provided in community pharmacies: a study in eight states. J Am Pharm Assoc (2003) 2003; 43:383-93. [PMID: 12836789 DOI: 10.1331/154434503321831102] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To develop three tools for assessing the quality of written information provided with new prescriptions in community pharmacies and to identify pharmacy, pharmacist, and patient characteristics associated with the dissemination and quality of that information. DESIGN Observational study. Regression techniques were used to analyze the influence of pharmacy, pharmacist, and shopper (acting as patient) characteristics on outcome measures. PARTICIPANTS Trained shoppers (acting as patients) visited 306 randomly selected pharmacies in 8 states. Each shopper presented three prescriptions, answered questions according to a standard scenario, accepted the information offered, and paid for the prescriptions. MAIN OUTCOME MEASURES Percentage of shoppers receiving any written information; quality of written information as judged by an expert panel using explicit criteria. RESULTS Shoppers received an information leaflet with 87% of the 918 prescriptions dispensed. Although most leaflets provided unbiased information, leaflet length and quality of information varied greatly. A majority of leaflets did not include adequate information about contraindications, precautions, and how to avoid harm. Shoppers were more likely to receive leaflets in chain pharmacies and pharmacies with more staff. Information quality also was higher in chain pharmacies. Shopper and pharmacist demographic characteristics were unrelated to the level or quality of written information after controlling for other factors. CONCLUSION The provision of patient leaflets is becoming a routine practice in the states studied. However, most leaflets do not meet quality criteria. It is important for pharmacists to become familiar with criteria for evaluating these leaflets and to take necessary action to improve their quality.
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Abstract
OBJECTIVE To provide an overview of the use and impact of written drug information (WDI) on consumers, and to review the literature on the factors influencing the use of WDI by consumers. DATA SOURCES Relevant articles published in English since the late 1970s were identified based on searches of on-line databases, texts, and cited references in published articles. STUDY SELECTION Articles reporting findings on the origin, use, and impact of WDI were included. Due to limited literature, articles reporting findings on factors influencing the use of written drug as well as disease information were included. DATA EXTRACTION Due to the lack of design consistency between studies and the comparatively small volume of work, subjective assessment rather than a criteria-based objective review was deemed more appropriate. DATA SYNTHESIS To date, research on WDI has focused on its use and impact. WDI has the potential to increase patients' knowledge, compliance, and satisfaction. However, there is also the potential for anxiety or premature cessation of therapy due to fear of possible adverse effects. Multiple factors may potentially influence the use of WDI by consumers including those associated with the written information document (readability, presentation), the patient (health literacy, role of caregiver, demographic factors, health locus of control, coping style, health belief model), and the environment (timing of provision, experience). CONCLUSIONS WDI has the potential to impact consumers positively and negatively. Although not widely investigated, a number of factors can potentially influence the use of WDI by consumers. The findings of this review can form the basis for much needed further research.
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Affiliation(s)
- Michelle M Koo
- Faculty of Pharmacy, The University of Sydney, Sydney NSW, Australia.
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