Users' preferences and perceptions of the comprehensibility and readability of medication labels

OBJECTIVE

To evaluate the labeling preferences of medication users and characterize their perceptions of the comprehensibility and readability of medication labels.

METHODS

We conducted a population-based cross-sectional study of medication users aged 18 years or older in 10 Brazilian capital cities. Perceptions of the comprehensibility and readability of medication labels in relation to sociodemographic characteristics were evaluated by Poisson regression models with robust variance. Labeling preferences were assessed through questions addressing possible improvements and through the use of digitally simulated packages.

RESULTS

Of 6,255 medication users interviewed, more than half found it difficult or very difficult to read (50.8%) and/or understand (52.0%) medication labels. Difficulties were more pronounced for participants aged 40 years or older, with lower levels of education, and non-whites. Increasing the font size (93.7%), describing the indications for use (95.9%) and contraindications (95.6%) on the label, and highlighting the expiration date (96.3%) were the most widely accepted improvements. In the evaluation of simulated packages, users preferred factors that improved readability, such as increased font size, use of graphic elements and color to highlight the concentration of the active ingredient, and contrast between the font color and background. The new simulated package design, with increased font size, color to highlight the concentration and contrast between the font color and background, was preferred over the standard design by 77.0% of participants.

CONCLUSION

Based on users' perceptions, increased font size and use of graphic elements and color to emphasize critical information, such as expiration date and concentration, are factors that contribute to making medication labels clearer to users. Pharmaceutical industries and policy makers should consider these items when developing labels and defining policies on this issue.

Effect of warning placement on the information processing of college students reading an OTC drug facts panel

OBJECTIVE

To compare three over-the-counter (OTC) Drug Facts panel versions for information processing optimization among college students.

PARTICIPANTS

University of Houston students (N = 210) participated in a cross-sectional survey from January to May 2010.

METHODS

A current FDA label was compared to two experimental labels developed using the theory of CHREST to test information processing by re-positioning the warning information within the Drug Facts panel. Congruency was defined as placing like information together. Information processing was evaluated using the OTC medication Label Evaluation Process Model (LEPM): label comprehension, ease-of-use, attitude toward the product, product evaluation, and purchase intention.

RESULTS

Experimental label with chunked congruent information (uses-directions-other information-warnings) was rated significantly higher than the current FDA label and had the best average scores among the LEPM information processing variables.

CONCLUSION

If replications uphold these findings, the FDA label design might be revised to improve information processing.

Medication Safety: Effect of Content and Format of Prescription Drug Labels on Readability, Understanding, and Medication Use: A Systematic Review

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.

Age Differences in Search Time for Two Over-Thecounter (OTC) Drug Label Formats

This study compared older and younger adults' knowledge acquisition and search times for information on older and newer over-the-counter (OTC) drug label formats. The results showed that younger adults were faster than older adults. The younger group performed significantly faster with the newer formatted labels than the older formatted labels, whereas the older adults yielded no difference between the two formats. Potential directions for future research are discussed.

Over-The-Counter (OTC) Drug Labeling: Format Preferences

The present research examines two different consumer groups' perceptions of the readability of OTC medication labels. Twelve labels depicting an OTC medication with a fictitious name were constructed and attached to bottles. The labels varied in (a) print size (4 point, 7 point, 10 point), (b) amount of white space between lines or sections of text (no spacing; label section spacing; and line spacing), and (c) label design (standard vs. extended/pull-out). Ninety-nine older adults and 102 undergraduates rank-ordered the labels according to overall ease of reading. In general, participants preferred the labels printed with larger type and line spacing. White space appeared to have less influence over the rankings than print size for older adults. However, the use of both a larger print size and increased white spacing appeared to influence the undergraduates' ratings. Also, there was no clear preference between the extended and standard label designs but their evaluation was only conducted with for the small print conditions. The implications of these results for the design of OTC medication labels and other consumer products are discussed.

A Comparison of Older vs. Newer Over-the-Counter (OTC) Nonprescription Drug Labels on Search Time Accuracy

The present study evaluated response time and accuracy to answer a series of questions of information in 16 (8 older and 8 newer ‘Drug Facts’) over-the-counter (OTC) drug labels. The newer labels include aspects, based on previous research, which should benefit performance. The results indicated that participant's response times were significantly faster with the newer labels compared to the older ones. However, this was not true of all OTC product samples. Accuracy was high (error rate low) for both label formats. Response times for females were significantly faster than males for both label types. The benefits of formatting text for facilitating information acquisition from drug labels and other kinds of printed information are discussed.

Communicating Benefit and Risk Information in Direct-to-Consumer Print Advertisements: A Randomized Study

BACKGROUND

Previous research demonstrated that providing qualitative and quantitative information in a "drug facts box" may help individuals understand prescription drug information in print-based direct-to-consumer advertisements. The authors sought to determine whether qualitative, quantitative, or a combination thereof best communicates benefit and risk information.

METHODS

To replicate and extend previous research, the authors used simple quantitative drug information. A randomized controlled study was conducted with 5067 Internet panelists with heartburn. Participants viewed a drug facts box with benefit and risk information that varied the presence or absence of qualitative summaries and absolute frequencies, percentages, and absolute differences. Measures included knowledge of drug benefits and risks, perceptions, and intentions.

RESULTS

Providing absolute frequencies and percentages most improved participants' drug knowledge and affected perceptions and intentions.

CONCLUSIONS

The study findings suggest that, for simple drug information, adding absolute frequencies and percentages to direct-to-consumer advertisements may benefit consumers. Absolute differences and qualitative labels may not be needed.

'It's all there in black and white' - or is it? Consumer perspectives on the proposed Australian Medicine Information Box over-the-counter label format

Background

Over‐the‐counter (OTC) labels help support safe medication use by consumers. In 2012, the Australian Therapeutic Goods Administration (TGA) released a consultation paper proposing OTC label standardization to improve label quality via implementation of the Medicine Information Box (MIB) label. However, consumer opinions of the MIB and standardization of OTC labelling remain unexplored.

Objective

To explore consumer perspectives of OTC label standardization and the proposed MIB.

Design

Mock MIB labels were developed by the research team, guided by the TGA consultation paper, and used as interview stimulus material.

Participants and setting

Semi‐structured interviews were conducted with 38 Australian and 39 UK adult participants. Participant perspectives on OTC label standardization, opinions on the MIB and perceived improvements were explored. All interviews were audio‐recorded with permission, transcribed verbatim, and the content thematically analysed.

Results

Participants expressed a range of opinions towards OTC label standardization, from welcoming standardization to concern that important details may be overlooked. The MIB was generally positively received due to its perceived good information design and ease of navigation. Participants requested reordering of information‐specifically, for the active ingredient to be moved to a less prominent position. Suggested improvements centred on content and design changes, for example colour, pictograms, bolding.

Conclusions

Participants felt positively towards OTC label standardization and saw the MIB as a feasible standardized format to implement for OTC labels. Although they appreciated its good information design, they felt further improvements to its content and design are required to enhance its quality and usability.

Examining the conspicuousness and prominence of two required warnings on OTC pain relievers

The labeling of over-the-counter (OTC) drugs is critical to their safe and effective use, and certain warnings are meant to be read at the point of purchase (POP). Examples include (i) warnings that alert consumers to the fact that the package is not child-resistant and (ii) warnings that alert consumers to potential product tampering. U.S. law mandates these warnings be "conspicuous" and "prominent" so that it is likely that consumers will read them before leaving the store. Our objective was to quantify the relative prominence and conspicuousness of these warnings. Sixty-one participants reviewed the packages of 5 commercially available analgesics to evaluate the prominence and conspicuousness of these warnings. Evaluated data included (i) the time spent examining the warnings compared with other areas of the label (using a bright pupil eye tracker), (ii) the ability to recall information from the OTCs viewed, and (iii) the legibility of the warnings relative to other elements of the labels (as measured by ASTM D7298-06). Eye-tracking data indicated that warnings were viewed by fewer participants and for less time than other elements of the packages. Recall and legibility data also indicated that the warning statements compared unfavorably with other elements of the labels tested. Evidence presented in this study suggests that 2 required warnings on 5 different OTCs are not prominent or conspicuous when compared with other elements of tested labels.

Effects of label format on knowledge acquisition and perceived readability by younger and older adults

This research examines consumers' information acquisition and preference for labels of a simulated over-the-counter (OTC) medication. Twelve otherwise identical OTC drug bottles were compared with different back labels varying in (a) print size, (b) amount of white space between text, and (c) label design (standard vs extended/pull-out). A no back label condition served as a control. Older (mean age=77.7 years) and younger (mean age=21 years) adults were given one of the 12 bottles and asked to perform one of two information acquisition tasks: (a) they examined the bottle for 3 minutes and then completed a questionnaire with the bottle absent, or (b) they answered the same questionnaire while the bottle was present. Afterwards, participants were given all of the bottles and asked to rank them according to perceived readability. The younger adults' information acquisition performance was significantly better than the older adults' for all label conditions except the control condition where both groups' low performance did not differ. Specifically, the older adults' performance was significantly better in the medium and large print conditions than in the small print conditions--with the latter conditions not differing from the control condition. Younger adults showed no performance differences among the different print-size conditions. No substantial effects on knowledge acquisition performance from the white space manipulations were found. However, the perceived readability ranks showed that both groups preferred larger print size and white space. The white space effect was smaller than for print size, particularly for older adults. The extended/pull-out label design was facilitative for older adults in that it allowed the use of larger print. The results suggest that older consumers may be unable to acquire information in the 'fine' print frequently found in various kinds of product literature.

The suitability of United States Pharmacopoeia Dispensory Information psychotropic drug leaflets for urban patients with limited reading skills

Although considerable research exist on the readability of patient education materials, few studies have focused on the efficacy of information drug leaflets used for psychopharmacology education of patients with limited reading skills. The purpose of this investigation was to evaluate the suitability of United States Pharmacopoeia Dispensary Information (USP-DI) drug leaflets (N = 42) for educating urban in-patients at a psychiatric unit using measurement criteria of the Suitability Assessment for Materials (SAM) instrument. The findings showed the USP-DI information drug leaflets were unsuitable as an educational tool for psychiatric in-patients with poor reading ability.

Enhancing Information Acquisition for Over-the-Counter Medications by Making Better Use of Container Surface Space

Most over-the-counter (OTC) pharmaceutical container labels are printed in very small type. Consequently, people with visual impairments (e.g., presbyopia in older adults) have difficult reading the material. Some OTC drugs are packaged in containers with easy-open caps. This design increases the surface area that could be used to enhance the labeling. In Experiment 1, older adults (M = 75.1 years, SD = 8.1) evaluated six container label variants for an actual OTC product. Besides having a multipanel main label, four containers had labels attached to the cap that displayed the most important information in large print but differed in color. Two control containers lacked a cap label; one had only a four-panel main label, and the other had only the front label. Participants ranked the containers on six dimensions (e.g., label noticeability, willingness to read). Results showed greater preference for containers with the cap labels. Experiment 2 again examined preferences but also measured information-acquisition performance after participants (M = 79 years, SD = 5.8) were briefly exposed to a realistic-appearing, but fictitious, OTC medication. Results showed greater knowledge and preference for containers with the cap labels. Experiment 2 showed that one of the cap colors (yellow) that was different from the main label was preferred over the white and orange (the same colors as on the main label), but color distinctiveness as an explanation was not fully supported because the green cap was not significantly different from the other cap labels. Implications for communicating information about OTC drugs using expanded labels are discussed.