Readability assessment of package leaflets of biosimilars

Pharmaceutical pictograms to improve textual comprehension: A systematic review

INTRODUCTION

Written instructive information for the patient is key in pharmaceutical care. However, the preexisting literature agrees on the discordance between the readability of written medication messages intended for patients. The aim of our work was to systematically review the available evidence on the effect of pharmaceutical pictograms as elements that facilitate understanding of the text in primary or secondary medication packaging.

METHODS

A parallel systematic search was conducted of the literature covering evidence of the effect of including pictograms in primary or secondary packaging on comprehension by potential users or caregivers up to April 9, 2023. The databases consulted were Scopus, MEDLINE and Web of Science. Only randomized controlled studies, whose main outcome measure was comprehension, were included.

RESULTS

Only 8 papers met our search criteria. In most of the included studies, the intervention of including pictograms improved participants' performance in comprehending instructions. A debatable methodological quality, and differences in the target population, textual complexity of the materials or the cultural affinity of the pictograms with the target population in each study, could have had a decisive influence on the results.

CONCLUSION

The heterogeneity in the design of each study poses a significant barrier to establishing commonalities and generalizing the results. This heterogeneity also prevented us from conclusively confirming the usefulness of pictograms complementary to instructional text in improving the comprehension of instructions for the rational use of medicines.

Incidence and Impact of Missing Functional Elements on Information Comprehension using Audio and Text

Audio is increasingly used to communicate health information. Initial evaluations have shown it to be an effective means with many features that can be optimized. This study focuses on missing functional elements: words that relate concepts in a sentence but are often excluded for brevity. They are not easily recognizable without linguistics expertise but can be detected algorithmically. Two studies showed that they are common and affect comprehension. A corpus statistics study with medical (Cochrane sentences, N=44,488) and general text (English and Simple English Wikipedia sentences, N=318,056 each) showed that functional elements were missing in 20-30% of sentences. A user study with Cochrane (N=50) and Wikipedia (N=50) paragraphs in text and audio format showed that more missing functional elements increased perceived difficulty of reading text, with the effect less pronounced with audio, and increased actual difficulty of both written and audio information with less information recalled with more missing elements.

Assessing the Readability of Medicine Information Materials: The Case of Tikur Anbessa Specialized Hospital - Mixed Approach

BACKGROUND

Patients are frequently provided with medicine information materials (MIMs). Rendering medicine information through written material is a reliable method. Readability is an important attribute of written material that can affect the reader's ability to comprehend. Patient's perception can also affect the comprehensibility of written MIMs.

OBJECTIVE

The objectives of the study were to assess the readability of medicine information in Tikur Anbessa Specialized Hospital (TASH); and assessing patients' perception and understanding of medicine information materials.

METHODS

This was a cross-sectional study conducted from September 21, 2019 to November 24, 2020, at TASH. Quantitative and qualitative data collection approaches were used in this research. The readability value of each material was determined in accordance with the Flesch Reading ease scores (FRE) and Flesch-Kincaid Grade Level (FKGL). The tools compute readability based on an average number of syllables per word and an average number of words per sentence. FRE provides scores from 0 to 100; higher scores mean easily comprehensible while FKGL sets grade levels for written texts. A structured interview was administered with questions about how MIMs had been used, and was analyzed qualitatively.

RESULTS

The results of this research showed low readability scores of MIMs found in TASH. Most patients do not get MIMs and are unaware of how to use them. They are interested to receive and read medicines information from pharmacists and physicians. Moreover, most of them preferred information through both verbal and written forms.

CONCLUSION

The readability levels of selected MIMs obtained from TASH are found to be not compliant with the patients' needs. This might be worsening their health outcomes and resulting in poorer use of healthcare services.