Evidence suggests that health literacy plays a significant role in determining how well patients interpret medication labels and whether patients take nonprescription and prescription drugs safely and appropriately. Research summaries on this page focus on improving medication labels, improving the way patients receive medication instructions, and exploring how patients manage their medication regimens.
A study published in 2013external icon finds a patient-centered label was better at preventing participants from exceeding the maximum dose in 24 hours, compared to a standard label. The patient-centered label did not significantly reduce other dosing errors such as taking more than two pills at a time and waiting fewer than four hours between doses.
A study investigating how parents use active ingredient informationexternal icon found many parents, especially those with low health literacy, do not use active ingredient information as part of decision-making related to administering multiple medications. Overlapping active ingredients across multiple medications put children at risk for overdose.
A 2012 reviewexternal icon of 200 top-selling pediatric oral liquid nonprescription medications found that labeling was often variable and in a format that may impair parent understanding of key medication information, including active ingredient information and dosing instructions. Although most products listed active ingredients on the Drug Facts panel, 18.5% did not list active ingredients on the principal display panel. Most products included directions in chart form, while few products expressed dosing instructions in pictographic form.
In a 2011 studyexternal icon, less than 50% of focus group participants reported routinely examining product label information. Only 31% were aware that acetaminophen is in Tylenol. Participants achieved consensus on an icon to identify products that contain acetaminophen and on a written statement warning of potential liver damage. In addition, participants indicated a preference for an icon and wording for maximum daily dose.
Medication instructions are often the most tangible, frequently used source of information for patients on proper medication use. However, they are often vague and unnecessarily complex. Several studies explore how to improve patients’ comprehension of safe and appropriate medication use.
Patient preferences for how best to display patient medication information (PMI) were assessed in a study published in 2014external icon. PMI handouts are intended to help all consumers understand key information about their prescription medicine. Participants in one-on-one interviews noted their preference for new PMI handouts over existing medication guides or consumer medication information. Although many preferences varied by patients’ age, education, and health status, most patients preferred to see drug information in a chunked format that is printed in a sans serif font, such as Arial.
Another 2014 study examined 48 patient medication leaflets on heart disease and type 2 diabetes to identify relevant information for older adults. Researchers found most of the materials were written at a high reading level and the font size on most of the materials was too small for ease of reading. Also, few materials described side effects specific to older adults, and when they did, it was rarely broken down by age group (over 65, over 80). Health professionals, such as pharmacists, can help older adults review these types of materials to ensure older adults understand how the medication may affect them.
Medication guides were assessed by Wolf et al 2012external icon to determine their effectiveness in adequately informing patients on safe use. Current medication guides were found to be of little value to patients, as they are too complex and difficult to understand especially for individuals with limited literacy. In a follow-up studyexternal icon, the format and layout of three typical medication guides were modified to promote information accessibility. Comprehension was significantly greater for all three prototypes compared with the current standard, and the guide modified according to health literacy best practices consistently demonstrated the highest scores and reduced the effects of age and literacy disparities.
In another 2012 study, Martin and colleagues provided 20 participants of an adult day center with a personalized, illustrated medication schedule and six weeks later re-assessed how confident they felt managing their medications. Findings demonstrate a significant increase in self-efficacy and medication adherence after using the illustrated medication cards. Participants also reported the design of the medication cards helped them remember what each medicine was for and what time to take the medicine. Working with older adults, health professionals can reinforce medication adherence using images and plain language principles.
In a 2012 study on medication adherence, researchers divided older adult participants into two groups. The first group received usual care, while the second received health topic-specific materials and education from the clinic pharmacist over 9 months. Additionally, the pharmacist communicated with clinic doctors and nurses about any relevant medication issues. The authors found that, for patients who had low health literacy, medication adherence was significantly higher among those who received the pharmacist intervention than those who received usual care. This suggests that a tailored approach for patients with low health literacy can improve important health outcomes such as medication safety.
Results from a study published in 2011external icon show the benefit of including pictographic dosing diagrams as part of written medication instructions for infant acetaminophen. Parents receiving text-plus-pictogram instructions had higher dosing accuracy than parents receiving standard text-only instructions. These differences were observed among parents with low health literacy, but not for parents with adequate health literacy.
Greater complexity in medication regimens may lead to poorer regimen adherence, which in turn, may lead to worse health outcomes. How patients manage their medication regimens and how medication literacy plays a role are explored in the studies summarized below.
In 2018, Pouliot and colleagues published an updated definition of medication literacy (also known as pharmacy health literacy): the degree to which individuals can obtain, comprehend, communicate, calculate and process patient-specific information about their medications to make informed medication and health decisions in order to safely and effectively use their medications, regardless of the mode by which the content is delivered (e.g., written, oral, and visual).
Gentizon and colleagues (2022) went further and attempted to identify, compare, and summarize the attributes, antecedents (associated factors), and consequences of medication literacy among hospitalized older adults. During their research, which included a literature review and focus groups with hospital nurses, they noted the importance of the medication literacy skills of informal caregivers, not just the skills of the patients. An example of an informal caregiver is a family member who provides care at home, usually without pay. That care includes preparing (e.g., measuring) medication and giving it to the older adult. As a result of their research, Gentizon and colleagues propose an expanded definition of medication literacy of hospitalized older adults that includes the skills of informal caregivers. It also includes many attributes not mentioned in Pouliot’s definition, such as the degree to which older adults and their informal caregivers remember information, an attribute that’s just as important among younger populations.
Lenahan et al 2013external icon investigated drug regimen familiarity among a cohort of patients with hypertension. Specifically, the authors determined the prevalence of patients’ knowledge of their prescribed drug names and dosages compared to those who relied only on physical characteristics such as pill size, shape and color. Patients dependent on the visual identification of their medicine reported worse adherence, lower rates of blood pressure control, and greater risk of hospitalization.
A study published in 2013external icon explores the relationship between functional health literacy, medication-taking self-efficacy, and adherence to HIV/AIDS antiretroviral therapy. Functional health literacy was not significantly related to either medication adherence or self-efficacy beliefs. The authors suggest their measurement strategy as a possible explanation for this unexpected finding.