Patient sources of drug information and attitudes to their provision: a corticosteroid model

Perceptions of conflicting information about long-term medications: a qualitative in-depth interview study of patients with chronic diseases in the Swiss ambulatory care system

OBJECTIVE

Patients with multiple long-term conditions visit various healthcare professionals and are exposed to medication information from various sources causing an increased risk of patients perceiving contradictory medication information. The aims of this study are to: (1) characterise conflicting medication information perceived by patients with long-term conditions, (2) better understand the related impact on patients' medication self-management and healthcare system navigation and (3) explore ways in which such events could be prevented.

DESIGN

This study was conducted through qualitative semistructured interviews. Data were analysed using thematic analysis.

SETTING

Community pharmacies and medical centres in Geneva, Switzerland.

PARTICIPANTS

This study included outpatients from April 2019 to February 2020. Patients were included after participating in a quantitative survey of perceived conflicting information about medications for long-term diseases.

METHODS

Semistructured audiotaped interviews of 20 to 60 min following a pre-established interview guide to explore participants' perceptions of conflicting information. Interviews were transcribed verbatim, and a thematic analysis was conducted with inductive and deductive coding using MAXQDA (2018, Release 18.2.3).

RESULTS

Twenty-two patients were interviewed, until data saturation, mentioning indication or need for a medication as the main topic of conflicting information between two healthcare professionals. Perceived conflicting information often resulted from insufficient information provided and poor communication leading to confusion, doubts and medication non-adherence. Patients expected more information and more interprofessional communication on their medications. As a result of conflicting information, most participants learnt or were learning to take an active role and become partners of the healthcare providers.

CONCLUSION

The need to strengthen and improve communication and interprofessional collaborative practice among healthcare professionals and with the patient is emerging to increase the quality and consistency of information about medications, and consequently, to ensure better use and experience of medications.

Inpatients' information needs about medication: A narrative systematic literature review

OBJECTIVE

To provide an overview of inpatients' information needs about medication, including the best moment to provide this information, how, by whom and what patient characteristics influence these needs.

METHODS

A systematic literature review was conducted. Studies that reported the information needs from inpatients about medication were included from Medline and Embase. The Crowe critical appraisal tool (CCAT) was used to assess the quality of the studies.

RESULTS

Initially, 710 records were retrieved from Medline and Embase. After the forward search, another 609 records were screened and in total, 26 articles were included. The CCAT scores ranged from 17 to 34 points on a 40 point scale and two articles received 0 points.

CONCLUSION

Inpatients main needs about medicine information are information about adverse and beneficial effects of medication, and general rules about how to take medication. Preferably, this information is printed and provided at the time of prescribing by a physician that already has a relationship with the patient. The most recent studies show that patients are open to the use of modern technology.

PRACTICE IMPLICATIONS

This review provides a starting point for providing medicine information to inpatients. Further research should focus on patient characteristics influencing these information needs.

Patients' perceptions of conflicting information on chronic medications: a prospective survey in Switzerland

OBJECTIVE

The number of patients with chronic diseases and subsequent visits to various healthcare professionals has been rising over the past decades, exposing patients to potential risks of receiving conflicting medication information. This study aims to investigate the prevalence of conflicting information on medications perceived by chronic patients in Switzerland and to understand its impact on patients' medication self-management and navigation in the healthcare system.

PARTICIPANTS

This cross-sectional study included adult patients taking at least one prescribed medication for at least 6 months, who had visited at least two physicians in the past 3 months.

MAIN OUTCOME MEASURES

Data on patients' perceptions of conflicting information were collected in person through a 17-item questionnaire available on paper and electronically with four domains: (1) whether the patient had perceived any conflicting information, (2) categories of conflicting information, (3) impact and (4) sources involved in the conflicting information.

RESULTS

Of the 405 included patients, 47% perceived conflicting information related to one or more medication topics including indication, schedule, dosage, risk, severity or duration of side effects. Patients who perceived conflicting information were prescribed more drugs than those perceiving no conflicting information (p<0.01). Consequently, 65% of the participants modified their navigation of the healthcare system and 34% reported medication non-adherence. General practitioners (82%), specialist physicians (74%) and pharmacists (49%) were the healthcare professionals most often involved in conflicting information. Experience with the medication, its package insert and significant others were more frequently involved in conflicting information than internet or social media.

CONCLUSION

Nearly half the patients in our study perceived conflicting information in the outpatient healthcare system, which can decrease medication effectiveness and pose safety issues. This issue is widely overlooked and unaddressed. Consistency of information among healthcare providers in partnership with patients should be reinforced through guidelines and new models of interprofessional care.

Patient expectations and awareness of information regarding adverse reactions in drug labelling in China

Background The misunderstanding of adverse drug reaction labelling information is not conducive to the rational use of drugs. There has been no research on how doctors can effectively transmit information on adverse drug reactions to patients in China. Objective To assess how well patients understand the adverse reactions presented in the labelling of drugs and how much information they want from their doctor regarding the adverse reactions. Setting The study was conducted in secondary medical institutions, tertiary medical institutions and community healthcare centres in Shanghai. Method A cross-sectional self-administered survey was conducted from November 2018 to March 2019. Mixed methods involving paper questionnaires and online surveys (scan a QR code by the WeChat app) were used. Main outcome measure Participants' demand for adverse reaction information. Results A total of 295 people completed the questionnaires, of which 31.8% of people thought that the greater the number of adverse reactions listed on the label of a drug, the more insecure they felt about that drug. At the same time, 30.13% of people thought that if the adverse reactions listed on a label were undefined, then the drug was safe for use (for example, some Chinese patent medicines). Most of the respondents (45.4%) thought that it was better to give a brief description of possible adverse reactions and to answer patients' questions in detail only if necessary. Conclusions Most patients wanted doctors to give them a brief introduction to serious and common adverse reactions when they prescribed drugs, and only a small percentage of people wanted to obtain all the information about adverse reactions. It was found that many people misunderstood the contents of the adverse reactions provided on the labels and equated the number of adverse reactions with drug safety.

Patients' views on electronic patient information leaflets

Background:

Information in society and in health care is currently undergoing a transition from paper to digital formats, and the main source of information will probably be electronic in the future.

Objective:

To explore patients’ use and perceptions of the patient information leaflet included in the medication package, and their attitude towards a transition to an electronic version.

Methods:

The data was collected during October to November 2014 among individuals in South-Eastern Sweden, using a questionnaire (n=406, response rate 78%) and interviews (n=15).

Results:

The questionnaire showed that the majority of the respondents (52%) occasionally read the patient information leaflet, 37% always read it, and 11% never read it. Almost half of the patients (41%) were positive towards reading the patient information leaflet electronically while 32% were hesitant and 26% neutral. A majority of the patients would request to get the patient information leaflet printed at the pharmacy if it was not included in the package. There were differences in attitude related to age and gender. The interviews showed that patients had mixed views on a transition to an electronic patient information leaflet. The patients perceived several positive aspects with an electronic patient information leaflet but were concerned about elderly patients.

Conclusion:

Although many were positive towards reading the patient information leaflet electronically, the majority prefer the patient information leaflet in paper form. Providing appropriate and useful eHealth services for patients to access the patient information leaflet electronically, along with education, could prepare patients for a transition to electronic patient information leaflet.

Patient Experiences Using an Inpatient Personal Health Record

OBJECTIVE

To investigate patients' experience using an inpatient personal health record (PHR) on a tablet computer to increase engagement in their hospital care.

METHODS

We performed observations and conducted semi-structured interviews with 14 post-operative cardiac surgical patients and their family members who received an inpatient PHR. Themes were identified using an inductive coding scheme.

RESULTS

All participants responded favorably to having access to view their clinical information. A majority (85.7%) of participants used the application following an initial training session. Patients reported high satisfaction with being able to view their hospital medications and access educational materials related to their medical conditions. Patients reported a desire to view daily progress reports about their hospital stay and have access to educational information about their post-acute recovery. In addition, patients expressed a common desire to view their diagnoses, laboratory test results, radiology reports, and procedure notes in language that is patient-friendly.

CONCLUSION

Patients have unmet information needs in the hospital setting. Our findings suggest that for some inpatients and their family members, providing personalized health information through a tablet computer may improve satisfaction, decrease anxiety, increase understanding of their health conditions, and improve safety and quality of care.

Experiences of and attitudes towards receiving information about non-steroidal anti-inflammatory drugs: a cross-sectional survey of patients in Thailand

OBJECTIVE

To determine sources of information about NSAIDs used by out-patients, factors related to receipt of information and patient attitudes towards receiving safety information.

RESEARCH DESIGN AND METHODS

Cross-sectional survey, using self-completed questionnaires distributed directly to 500 outpatients prescribed any NSAIDs from an orthopaedic clinic in Thailand, over a 4-month period.

RESULTS

There were 548 patients approached and 474 completed questionnaires returned (94.8%). The most frequent aspects of medicines information that were provided related to administration (97.2%), mostly provided by pharmacists, and indication (85.8%), mostly provided by physicians. Information on identifying, monitoring and managing adverse effects was received by fewer than 50% of patients. Safety information was received significantly more frequently by younger patients (P<0.01), those using non-selective COX-2 inhibitors (P<0.001), intermittent NSAIDs (P<0.05) and fewer concomitant medicines (P<0.05). Only 14.1% patients used additional information sources. Attitudes towards receiving medicines safety information were positive. Most patients agreed they should know about ADRs (98.1%) and receive information leaflets with first prescription (96.8%).

CONCLUSIONS

Patients received medicines information mostly from healthcare professionals, but safety information was limited. Type of NSAIDs, regularity of NSAID use and age affected receipt of safety information about NSAIDs. Provision of more medicine information is needed, particularly written documents.

Norwegian elderly patients' need for drug information and attitudes towards medication use reviews in community pharmacies

OBJECTIVES

Medication use review (MUR) is a community pharmacy service in several countries. Knowledge about what patients want from such a service is limited. The aim of this study was therefore to investigate Norwegian elderly patients' need for drug information and their attitudes towards MURs.

METHODS

In Norway's two largest cities, 162 patients (72% women; mean age: 78.9 years) who used at least one prescription drug were recruited from 18 senior centres. They were interviewed personally with a structured questionnaire (29 closed and 4 open-ended questions).

KEY FINDINGS

The average number of prescription drugs used was 4.4. Seventy per cent also used over-the-counter drugs. The main source of drug information was the general practitioner (GP) followed by package inserts and pharmacy staff. For drug-related problems, 62% would contact the GP compared with 24% who preferred the pharmacist. Fifty per cent remembered no information when collecting prescriptions. However, 56% wanted to know more about their medication and 55% were interested in a MUR. The main topics they wished to address were effect/side effects and interactions. Lack of privacy was reported to be a major obstacle in the current situation.

CONCLUSIONS

This study shows that community pharmacies in Norway play a minor role regarding drug information to elderly polypharmacy patients. The GP is both their main information source and whom they contact for drug-related problems. However, half of the patients would like to know more about their medication. More than half were positive towards taking part in a MUR.

Patients with rare diseases using pharmacists for medication information

OBJECTIVES

To determine whether patients with a rare illness (1) use pharmacists for medication information more or less frequently than physicians and the Internet, (2) perceive pharmacists as a more or less credible medical information resource than physicians and the Internet, and (3) obtain different types of medication information from pharmacists, physicians, and the Internet.

DESIGN

Cross-sectional survey.

SETTING

Online data collected between 2008 and 2009.

PATIENTS

Adult, English-proficient vasculitis patients (n = 232) who were taking at least one medication to treat their vasculitis.

INTERVENTION

Administration of online survey.

MAIN OUTCOME MEASURES

Patient use of pharmacists, physicians, and the Internet for medication information; perceived credibility of pharmacists, physicians, and the Internet as sources of medication information; and types of medication information obtained from pharmacists, physicians, and the Internet.

RESULTS

Participants consulted physicians and the Internet more than pharmacists for medication information; only 96 participants (41.4%) ever used pharmacists for vasculitis medication information. Females and participants who used community pharmacies were significantly more likely to consult pharmacists for medication information as compared with males and patients who did not use community pharmacies. Participants perceived pharmacists were a less credible source of medication information than physicians and the Internet. Participants used physicians and/or the Internet more than pharmacists for five of eight types of medication information, including adverse effects and drug effectiveness.

CONCLUSION

Vasculitis patients consulted sources other than pharmacists for medication information. Several factors, including perceived pharmacist credibility and a noncommunity-based pharmacy, may contribute to infrequent patient use of pharmacists as a medication information source. Future qualitative research should document how patients with rare disease perceive and interact with pharmacists to understand why many view pharmacists as only moderately credible sources of medication information.

EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases

To develop recommendations for the management of medium to high-dose (ie, >7.5 mg but ≤100 mg prednisone equivalent daily) systemic glucocorticoid (GC) therapy in rheumatic diseases. A multidisciplinary EULAR task force was formed, including rheumatic patients. After discussing the results of a general initial search on risks of GC therapy, each participant contributed 10 propositions on key clinical topics concerning the safe use of medium to high-dose GCs. The final recommendations were selected via a Delphi consensus approach. A systematic literature search of PubMed, EMBASE and Cochrane Library was used to identify evidence concerning each of the propositions. The strength of recommendation was given according to research evidence, clinical expertise and patient preference. The 10 propositions regarded patient education and informing general practitioners, preventive measures for osteoporosis, optimal GC starting dosages, risk-benefit ratio of GC treatment, GC sparing therapy, screening for comorbidity, and monitoring for adverse effects. In general, evidence supporting the recommendations proved to be surprisingly weak. One of the recommendations was rejected, because of conflicting literature data. Nine final recommendations for the management of medium to high-dose systemic GC therapy in rheumatic diseases were selected and evaluated with their strengths of recommendations. Robust evidence was often lacking; a research agenda was created.

Patient decision making in the face of conflicting medication information

When patients consult more than one source of information about their medications, they may encounter conflicting information. Although conflicting information has been associated with negative outcomes, including worse medication adherence, little is known about how patients make health decisions when they receive conflicting information. The objective of this study was to explore the decision making strategies that individuals with arthritis use when they receive conflicting medication information. Qualitative telephone interviews were conducted with 20 men and women with arthritis. Interview vignettes posed scenarios involving conflicting information from different sources (e.g., doctor, pharmacist, and relative), and respondents were asked how they would respond to the situation. Data analysis involved inductive coding to identify emergent themes and deductive contextualization to make meaning from the emergent themes. In response to conflicting medication information, patients used rules of thumb, trial and error, weighed benefits and risks, and sought more information, especially from a doctor. Patients relied heavily on trial and error when there was no conflicting information involved in the vignette. In contrast, patients used rules of thumb as a unique response to conflicting information. These findings increase our understanding of what patients do when they receive conflicting medication information. Given that patient exposure to conflicting information is likely to increase alongside the proliferation of medication information on the Internet, patients may benefit from assistance in identifying the most appropriate decision strategies for dealing with conflicting information, including information about best information sources.

A survey on the knowledge, beliefs and behaviour of a general adult population in Malaysia with respect to the adverse effects of medicines

OBJECTIVE

The aim of the study was to explore, in the Malaysian general population: knowledge and beliefs of the characteristics in general of medication-related side effects and side effects associated with different types of medicines; behaviour related to the safe use of drugs before and after taking a medication; and behaviour in the event of a medication-related side effect.

METHODS

A 24-item self-administered questionnaire was developed and used to survey the general public living or working in suburban Kuala Lumpur, Malaysia. Eight hundred questionnaires were distributed, face to face, by researchers using quota sampling. Respondents' knowledge, belief and behaviour were analysed and correlated with demographics, medical history and experience of side effects.

KEY FINDINGS

Six hundred and ten respondents completed the questionnaire giving a response rate of 76.3%. The mean knowledge score for the respondents was 18.4±3.6 out of the maximum possible score of 26. Educational level and experience of side effect had an influence on the knowledge score obtained. Respondents had misconceptions regarding the safety of complementary and alternative medicines (CAMs) and over-the-counter medications. Medication history and previous experience with side effects had a significant influence on the higher behaviour score obtained.

CONCLUSION

The survey has shown moderate results with regard to the knowledge of public regarding safety of medications, and there was evidence of under-estimating the risk of medications, especially CAMs. The misconceptions among the public, and inappropriate behaviour on drug safety-related aspects, is a concern which needs to be addressed in the interventions designed.

Use and perceived credibility of medication information sources for patients with a rare illness: differences by gender

Patients with rare illnesses may use medication information sources that are appreciably different from those used by patients with more common illnesses. This article's purpose is to describe vasculitis patients' most frequently used medication information sources, determine which sources patients perceive as credible, and explore gender differences in source use and perceived credibility. Using an online questionnaire, patients (n = 232) indicated how often they obtained medication information from 12 sources during the previous year and rated the credibility of 6 sources. The authors used multivariate analysis of covariance and follow-up contrasts to test for gender differences in source use and conducted t tests to compare patients' perceived credibility ratings. Patients used physicians and the Internet most often to obtain medication information and rated them as the most credible sources. Male patients used their spouse/partner more often and rated them as more credible than did female patients. Female patients were more likely to use medication package inserts and the Internet and were less likely to use nurses than were male patients. There appear to be similarities and differences between the information-seeking behaviors of vasculitis patients and other patient populations. Because male patients view their spouse/partner as a credible information source, providers may want to involve the spouse/partner in prescription decision making.

The effect of conflicting medication information and physician support on medication adherence for chronically ill patients

OBJECTIVE

This article explores the effect of conflicting information, defined as contradictory information about medication topics from different sources, on medication adherence in a sample of chronically ill patients. We specifically investigate whether conflicting information and physician support directly affect medication adherence or whether the effect is mediated by adherence self-efficacy and outcome expectations for medications.

METHODS

Vasculitis patients (n = 228) completed two on-line questionnaires which contained measures of conflicting information, adherence self-efficacy, outcome expectations, physician support, and medication adherence. We conducted a mediation analysis using a bootstrapping approach to generate point estimates and 95% confidence intervals to test the significance of each mediated effect.

RESULTS

A majority of patients (51.3%) received conflicting medication information. Conflicting information had a direct negative effect on medication adherence, which was not mediated by self-efficacy or outcome expectations. Alternatively, self-efficacy mediated the positive effect of physician support on medication adherence.

CONCLUSION

Patients who encounter conflicting medication information are less adherent to their medications. The presence of a supportive physician may counteract the negative effect of conflicting medication information.

PRACTICE IMPLICATIONS

Physicians should initiate conversations about conflicting medication information with their patients. Consensus-based guidelines that address medication discrepancies may also reduce the availability of conflicting information.

Evaluation of a nursing intervention project to promote patient medication education

AIM AND OBJECTIVE

The purpose of this study was to evaluate patients' knowledge regarding their medication regime following a nursing interventional project in patient medication education.

DESIGN

Evaluation.

BACKGROUND

Educating patients during their hospital stay regarding their medical treatment is an issue which the medical staff deals with on a daily basis. The hospitalisation period is a known critical point in the provision of influential information to the patient and related family members, probably because the hospitalised patient and family members have unique learning needs that cannot be postponed.

METHODS

The study was conducted in three internal medicine wards in a large university tertiary hospital in Jerusalem, Israel. The intervention project used structured written materials and verbal patient education related to highly potent drugs. The study evaluated patients' knowledge regarding their medication as the main interventional outcome. In addition, the rate of patients receiving verbal and written education, rate of patient intention to take the medication and adequacy of nursing interventions according to the patients' educational needs were also assessed. Data collection was carried out by a short structured tool that examined patient knowledge. With this tool, the nurse interviewed the patients and recorded the patient's response and her recommended intervention.

RESULTS

Two hundred and fifty-one patients participated in the study. Most of the patients (71-93%) reported that they had received instructions from nurses. The majority of the patients demonstrated a high level of knowledge regarding their medications and planned on taking their medications on a regular basis. Lack of knowledge was observed mostly on issues related to dietary recommendations. In these cases, the nurses' intervention was not always documented and did not necessarily match the problem identified.

CONCLUSIONS

The findings show that patients, who received medication education, demonstrated satisfactory level of knowledge and intended to take their medication. Patients' knowledge feedback enables the nurse to assess her intervention.

RELEVANCE TO CLINICAL PRACTICE

Patient medication education in the hospital is a challenging task. This article suggests an applicable tool to assure that patients receive appropriate medication education, while assessing the effectiveness of this education. This tool also enables the nurses to modify their intervention according to patient response.

Patient sources for drug information in Iran: a questionnaire-based survey

OBJECTIVES

To identify sources used by patients to obtain drug-related information and to find which portion of patients study the Patient Information Leaflet (PIL).

METHODS

A cluster random sampling was used to select 19 community pharmacies in Shiraz, Iran, from 192 pharmacies registered by Food and Drug Office of Shiraz University of Medical Sciences. Using a questionnaire, an independent assessor surveyed outpatients immediately after their prescriptions were dispensed. Results were subjected to statistical analysis.

RESULTS

Total of 671 patients were interviewed, of which 188 patients (28%) reported they received no information from pharmacists or physicians and 169 patients (25%) received their medications without prescription. Nearly half of the patients (46%) were informed on the frequency of use and dose of their medications. Very few patients (6%) were appropriately informed about the frequency of use, dosage, duration of treatment, and potential side effects, allergies and drug interactions. Patients with college education used PILs as a source of information more than those with lower education levels.

CONCLUSION

A significant portion of patients obtained medicines without a prescription. Only a few portion of patients in Shiraz received adequate drug information from their physician or pharmacist. A considerable portion of patients did not study PILs.

Concordance-based adherence support service delivery: consumer perspectives

OBJECTIVES

To explore consumers' attitudes towards, and expectations of, adherence support services in primary health care, specifically in community pharmacy; and to explore consumers' attitudes towards the concept of concordance.

SETTING

An exploratory qualitative study conducted in Metropolitan Sydney, Australia.

METHOD

Three focus group discussions with consumers on chronic therapy (n = 22) and two focus groups with consumer representatives (n = 15) were conducted in 2002. Consumer representatives were peer educators volunteering in an association which promotes quality use of medicines among elderly patients. All discussions were audio-taped, transcribed verbatim and thematically content analysed.

MAIN OUTCOME MEASURES

Consumers' experiences with adherence support services delivered by general practitioners and pharmacists, their expectations towards general practitioners' and pharmacists' role in adherence support; and attitudes towards concordance in consultations.

RESULTS

Participants expected an increased provision of medicine information and a reduction in the number of medications taken as the main strategies to promote adherence. They believed that once understandable information had been delivered, it was their responsibility to take their medications as prescribed. Yet participants frequently complained about the information received, especially from doctors. Only a subgroup of participants expected pharmacists to be involved in adherence support services. These participants generally relied on pharmacists for medicine information and were satisfied with the communication process when interacting with the pharmacists. All participants were positive about concordance, because they valued two-way communication and increased consideration of their needs and beliefs by healthcare professionals. However, they were hesitant about being involved in a shared treatment decision-making process. Many participants focused on concordance with doctors and identified barriers to the establishment of concordance: time pressures, financial constraints, the gap of competence and power between patients and doctors.

CONCLUSIONS

Pharmacists should consider consumers' needs for information and establishing concordance, as well as their expectations of the pharmacy profession, in delivering concordance based adherence support services. Given participants' high demand for medicine information, an opportunity might exist for pharmacists to influence consumers' expectations by offering information which is tailored towards their needs.

Ascertaining consumer perspectives of medication information sources using a modified repertory grid technique

OBJECTIVE

To establish the range of medicine information sources used by consumers and their perception of the reliability of these, using the repertory grid technique.

METHOD

Consumers visiting three community pharmacies in Brisbane, Australia, were interviewed using the repertory grid technique. During the interview, consumers were asked to name up to three medicine information sources that they used for a supermarket medicine, an over-the-counter medicine and a prescription medicine. They were then presented with their named information sources in groups of three and asked to discriminate between these in terms of their perceived reliability of the information source. The descriptors used by the consumer to discriminate between the information sources are known as constructs and these were recorded. The consumer was then asked to rate each of their information sources against each generated construct.

MAIN OUTCOME MEASURE

The range of information sources generated was determined along with the perceived reliability of these from the calculated median score of each information source when rated on each generated construct.

RESULTS

A total of 110 consumers were interviewed and identified 648 information sources that they would use. The most frequent information sources cited by the 110 consumers were their doctor (83%), written information (90%) and the pharmacist (78%). There were a total of 299 constructs generated by 88 of the consumers and these were themed into 16 discrete categories. The most common generated constructs themes were "good knowledge" (15%), "training" (14%) and "trustworthiness" (13%). The consumer perception of their information sources were that the doctor and pharmacist have good knowledge (median score 1) and are trained (median score 1) and were perceived to be trustworthy (median score 3 and 2, respectively).

CONCLUSION

The repertory grid technique was successful in identifying the information sources consumers accessed to find out about their medicines and in identifying the perception of these sources in terms of their reliability. The repertory grid technique offers a novel method for future research into consumer preferences for different treatment options.