Calculating reading ease score of patient package inserts in Iran

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.

Development and validation of the Nursing Journal Club Perception Scale (NJCPS)

BACKGROUND

The Journal Club is an excellent platform for participants to engage in the critical evaluation of articles and the extraction of evidence to support evidence-based nursing practices. The study aims to develop and validate a reliable instrument, the Nursing Journal club perception scale (NJCPS), for assessing the perceived educational value and the perception of virtual journal club experiences.

MATERIALS AND METHODS

The current study is a scale development and validation study. The scale-level content validity indices (S-CVI) and item-level content validity indices (I-CVI) were assessed by eight experts. Eleven experts from various nursing fields evaluated the instrument regarding its relevance, clarity, meaningfulness, and completeness. Finally, the scale was introduced to 90 clinical nurses from two facilities to assess the internal consistency during the period of March- April 2022.

RESULTS

The content validity of the scale S-CVI/average and S-CVI/UA was 0.97 and 0.86, respectively, which indicates adequate relevance of the questionnaire content. Principal component analysis indicated that the construct validity of the perceived educational value and the perception of the virtual journal club domain was 67.8% and 66.5%, respectively. In the two domains of the perception of educational value (supporting clinical practice and supporting research), Cronbach's Alpha was 0.93 and 0.91, respectively. Similarly, for the two domains of virtual JC (learning experience and benefits of virtual journal club)), Cronbach' Alpha was 0.95 and 0.74, respectively.

CONCLUSIONS

The NJCPS tool is a valid and reliable scale to measure the educational value and virtual journal club experience of the participants from various fields of healthcare.

Worth the paper they're printed on? Findings from an independent evaluation of how understandable patient information leaflets for antiseizure medications are

OBJECTIVE

The Patient Information Leaflet (PIL) is an authoritative document that all people with epilepsy (PWE) in the European Union receive when prescribed anti-seizure medication (ASM). We undertook the first independent, comprehensive assessment to determine how understandable they are. Regulators state that when patients are asked comprehension questions about them, ≥80% should answer correctly. Also recommended PILs have a maximum reading requirement of US Grade 8.

METHODS

Study 1: Obtained 140 current ASM PILs written in English. 'Readability' assessed using 4 tests, with and without adjustment for influence of familiar, polysyllabic words. 179 online materials on epilepsy also assessed. Study 2: Two PILs from Study 1 randomly selected (Pregabalin Focus; Inovelon) and shown to 35 people from UK epilepsy population. Their comprehension was assessed. Study 3: To understand whether student population provides accessible alternative population for future examination of ASM PILs, Study 3 was completed. Used same methods as Study 2 but participants were 262 UK university students.

RESULTS

Study 1: No PIL had a reading level of Grade 8. Median was 11. Adjusting for context, the PILs were still at Grade 10.5. PILs for branded ASMs were most readable. PILs were no more readable than (unregulated) online materials. Study 2: Users struggled to comprehend the PILs key messages. The 8 questions asked about pregabalin were typically answered correctly by 54%. For Inovelon it was 62%. Study 3: Most student participants comprehend the PILs key messages. The questions about Inovelon were answered correctly by 90%; for pregabalin it was 86%.

SIGNIFICANCE

This is the first independent and comprehensive examination of ASM PILs. Found PILs being used fail to meet recommendations and regulatory requirements and risk not being understandable to substantial proportion of users. In finding that people from epilepsy population differ markedly in comprehension of PILs compared to students, study highlights importance of completing user testing with the target population.

Evaluation of Medication Package Inserts in Ethiopia

Background

Patients require accurate and reliable information to help them use their medications safely and effectively. Inadequate patient knowledge may contribute to medication nonadherence which could negatively affect treatment outcomes. The purpose of this study was to evaluate the presentation and completeness of medication package inserts (MPIs) which are available in the Ethiopian market.

Methods

A cross-sectional document review was performed in February and March of 2019. All MPIs which were authorized by EFDA to sell in the Ethiopian market and available during the data collection period were considered.

Results

The mean overall completeness score of 200 MPIs was 18.39 ± 4.30. Of the 200 MPIs, only 20% were from domestic pharmaceutical companies. Antimicrobials represented 24% of the total MPIs. Topical preparations, cardiovascular drugs, gastrointestinal drugs, and nonsteroidal anti-inflammatory drugs, accounted for 12.5%,12.5%, 11%, and 9% of the MPIs, respectively. The majority of the MPIs presented information about the drug's use during pregnancy and lactation, 77.0% and 74.0%, respectively. However, only half of the MPIs, 49.5%, gave information about special warnings and precautions. Only a few of the MPIs provided information about instructions to convert tablets or capsules into liquid forms and the possibility of tablet splitting, 4.8% and 8.7%, respectively. Furthermore, only 1.0% had local language translation.

Conclusion

The MPIs available in Ethiopia provide inadequate information including about the safety of drug products and local language translation. Regulatory authorities should implement stringent regulations to ensure the provision of vital information which extends beyond checking the mere presence of an MPI. They should also act to the possible standardization of MPIs.

Provision and Need for Medicine Information in Asia and Africa: A Scoping Review of the Literature

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.

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.

Patients' Experiences and Perspectives of Receiving Written Medicine Information About Medicines: A Qualitative Study

PURPOSE

Written medicine information informs patients about the benefits and risks of medicines and supports their safe and effective use. In Thailand, patient information leaflets (PILs) are not obligatory and therefore not routinely supplied. This study aimed to explore the experiences and information needs of patients, their views on PILs and the likely impact of PILs on their knowledge, perceptions and behaviors towards medicines. These factors are important to establish the value of PILs.

METHODS

Semi-structured interviews with outpatients who received simvastatin or atorvastatin were conducted exploring their experiences of receiving medicine information, their views on the utility of and need for PILs, the impact of PILs on their behaviors, and recommendations for how PILs could be improved. All interviews were audio-recorded, transcribed verbatim, and analyzed using a framework approach.

RESULTS

Thirty interviews were conducted from which four themes emerged: experience of receiving medicine information, views of package inserts and PILs, impact of PILs on knowledge, perceptions and behaviors, and patients' need for medicine information. Most participants received verbal information from healthcare professionals, as well as written information. Verbal information was perceived as being particularly useful to inform about changes to medicine regimens or the long-term adverse effects of medicines. Patients perceived that the PILs had influenced their knowledge about medicines, and also their behaviors including safety awareness, adherence, and engagement with healthcare professionals. Participants suggested that the information in electronic format could provide an additional resource. Some changes to improve the content and general format of the PIL were identified.

CONCLUSION

PILs are perceived as useful by patients and met their information needs, although they were viewed as an adjunct to verbal advice provided by healthcare professionals. PILs influenced patients' medicine taking behaviors and encouraged sharing of information with their physicians.

Do drug package inserts meet the rules and regulations of Iran's Food and Drug Administration in terms of informing patients?

Background: Drug package inserts (PIs) are the most accessible source of information for users and are designed to aid the safe use of medicines and avert adverse events. This study measured the conformity of PIs with the health communications standards of Iran’s Food and drug Administration (FDA).

Methods: This descriptive cross-sectional study evaluated 92 PIs related to 22 best-selling neurological and psychiatric drugs in Iran based on criteria approved by Iran’s FDA. Six categories of criteria were considered in evaluating the extent of conformity: I) writing and formatting, II) references, III) drug description, IV) warnings and precautions, V) interactions, and VI) side effects. Each PI was scored based on observation of standards; data was analyzed using Microsoft Excel pivot tables.

Results: In total, 2929 items from 92 PIs were evaluated, of which 37 (40.2%) were related to antidepressants, 31 (33.7%) to sedatives and hypnotics, and 24 (26%) to anticonvulsant drugs. The PI content was insufficient in various aspects of conformity with standards in each category. Among the six categories, the best match was found in warnings and precautions with 667items (72.5%), followed by writing and formatting with 663 (69.1%). The lowest conformity was found in the reference category with 194 (26.4%) items.

Conclusion: The PIs of Iranian neurological drugs do not fully meet Iran’s FDA standards. It is strongly recommended that smart PIs be developed using mobile apps to overcome this problem.