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Today, when consumers receive prescription drug pharmacy leaflets (also known as ‘consumer medication information’ or CMI), they often appear in small font size, with cluttered layouts, and distracting information. This problem has attracted the attention of the U.S. Food and Drug Administration in advocating for more comprehendible, accurate, and easy-to-access CMI formats. Our study of four different CMI prototypes shows that an expanded Over-the-Counter (OTC) Drug Facts prototype is the best for improving comprehension accuracy, and is especially effective for those with lower health literacy and health motivation. A simpler OTC prototype did not aid accuracy scores due in part to its lack of complexity; whereas the most complex prototype (the revised medication guide – similar to most CMI today) reduced leaflet likability and usage intentions. Finally, continued leaflet availability improved accuracy scores for lower health literacy and health motivation respondents. Implications for marketing and pub...

Recent studies have linked patient misunderstanding of label instructions for as needed (PRN) medications to dosing errors. This study conducted a preliminary field test of patient-centered PRN label instructions. Patients participated in a hypothetical dosing experiment and were randomized to a patient-centered label (referred to as “Take-Wait-Stop”) or standard label. Participants were asked to demonstrate dosing the medicine over 24 hours. Three types of independent dosing errors were measured: (a) taking more than two pills at one time, (b) exceeding the maximum daily dose, and (c) waiting fewer than 4 hours between doses. Generalized linear models were used to assess the association between label type, health literacy, and sociodemographic characteristics. Participants' mean age was 39.8 years, 62.1% were female, 43.7% were White, and 72.4% had adequate literacy. Of participants, 31.8% who were shown the standard label demonstrated taking in excess of 6 pills in 24 hours compared with only 14.0% of participants who were shown the Take-Wait-Stop label (p = .05). Overall, only 1 person demonstrated he would take more than 2 pills in a single dose. Of the standard label group, 20.5% demonstrated dosing intervals of fewer than 4 hours compared with 23.3% of the Take-Wait-Stop label group (p = .75). In a multivariate model, participants who were exposed to the standard label were 2.5 times more likely to exceed the recommended maximum daily dose (95% CI [1.05, 7.70], p = .03). The Take-Wait-Stop label was beneficial in preventing participants from exceeding the maximum dose in 24 hours, although it did not significantly reduce other dosing errors.

Understanding and organizing medication regimens can be challenging, and many patients struggle to properly dose prescribed medicine, potentially leading to less effective treatment or even harm. Generic prescriptions are increasingly common and may change in appearance, adding further complexity. The authors aimed to investigate familiarity with the drug regimen among a cohort of patients with diagnosed hypertension. Specifically, they determined the prevalence of patients' knowledge of their prescribed drug names and dosages compared to those who relied only on physical characteristics (size, shape, color) of their medications. The relationship between patients' identification strategies, self-reported adherence, and health outcomes (blood pressure control, hospitalization) were investigated. Patients who were dependent on the visual identification of their prescription medicine reported worse adherence. In addition, they had significantly lower rates of blood pressure control and greater risk of hospitalization. The ability to identify prescribed medicines by name may be helpful for screening and responding to patients at greater risk of making medication errors or being less engaged with their regimen for adherence purposes.

This article examines the relationship between literacy and colorectal cancer (CRC) screening knowledge, beliefs, and experiences, with a focus on fecal occult blood tests (FOBTs). Participants were 975 patients in 8 Louisiana federally qualified health centers. Participants were 50 years of age or older and not up to date with CRC screening; approximately half (52%) had low literacy (less than a 9th-grade level). Participants with low literacy were less likely than were those with adequate literacy to be aware of advertisements promoting CRC screening (58.7% vs. 76.3%, p < .0001) or to believe it was very helpful to find CRC early (74.5% vs. 91.9%, p < .0001). The majority of participants had positive beliefs about the benefits of CRC screening using FOBTs. Participants with low literacy had more perceived barriers to FOBT completion and were more likely to strongly agree or agree that FOBTs would be confusing, embarrassing, or a lot of trouble; however, none of these remained significant in multivariate analyses controlling for relevant covariates. Confidence in being able to obtain an FOBT kit was high among those with low and adequate literacy (89.8% vs. 93.1%, respectively, p = .20); yet multivariate analyses revealed a significant difference in regard to literacy (p = .04) with low-literacy participants indicating less confidence. There was no significant difference by literacy in ever receiving a physician recommendation for CRC screening (38.4% low vs. 39.0% adequate, p = .79); however, multivariate analyses revealed significant differences in FOBT completion by literacy (p = .036). Overall, findings suggest that literacy is a factor in patients’ CRC knowledge, beliefs, and confidence in obtaining a FOBT.

The concept of health literacy evolved from a history of defining, redefining, and quantifying the functional literacy needs of the adult population. Along with these changes has come the recognition that sophisticated literacy skills are increasingly needed to function in society and that low literacy may have an effect on health and health care. We present a brief history of literacy in the United States, followed by a discussion of the origins and conceptualization of health literacy. Increased attention to this important issue suggests the need to review existing definitions of the term "health literacy," because despite the growing interest in this field, one question that persists is, "What is health literacy?"

Despite growing evidence of the magnitude and consequences of low health literacy, little, if any, work has explored how federal health agencies or other organizations are responding to this proble...

Successful management of HIV requires patient understanding and ability to act on treatment information. We examined the relationship between patient literacy and understanding of HIV treatment. Literacy, knowledge of CD4 count and viral load, and correct identification of HIV medications in regimen were evaluated in 204 patients receiving care in Shreveport, Louisiana and Chicago, Illinois. One-third of patients had limited literacy skills. These patients were less able to describe CD4 count (p0.001), viral load (p0.001) and to correctly identify medications in their regimen (p0.001). In the multivariate analysis, limited literacy was an independent predictor of poor understanding of CD4 count (OR 2.9, 95% CI: 1.3-6.3) and viral load (OR 4.1, 95% CI: 1.9-8.8). For correct medication identification, a significant interaction was found between number of HIV medications and literacy level. Among patients taking only 1-2 HIV medications, 100% of higher literate patients were able to identify their medications, compared to none of the lower literate patients prescribed three or more HIV medications. Patients with limited literacy skills may lack essential knowledge related to their HIV treatment. Clinicians may require additional training for improving communication with these patients.

The purpose of this study was to elicit patient feedback regarding the perceived clarity and level of difficulty associated with self-report human immunodeficiency virus (HIV) medication adherence measurement tools. HIV-infected patients from clinics in Shreveport, Louisiana, and Chicago, Illinois, were recruited to participate in four focus group discussions. Three groups consisted of patients with limited literacy skills (ninth-grade reading ability), and one group contained patients with adequate literacy skills (or = ninth-grade reading ability). Five themes emerged: (1) respondent understanding of the term "adherence," (2) recall, (3) question format, (4) visual aids, and (5) instrument administration. Participants struggled to define adherence, relied on visual cues to identify medications, and had a short recall time frame for missed doses (or =3 days). Most preferred simple question formats and for their physician to assess adherence orally. Patients receiving treatment for HIV infection, especially those with limited literacy skills, may find it difficult to respond to existing HIV medication adherence questionnaires.

For optimal outcomes, the older patient must be able to understand oral instructions and read and understand written instructions, prescription labels, educational brochures, and consent forms. Low literacy skills in these patients may complicate adequate health care maintenance. Specially designed patient education programs are needed for many older patients with complex medical regimens and limited low literacy. Health care professionals must first assess patients’ educational needs. Patients can then be given oral instructions and written materials suitable for their needs and level of reading ability. These materials could help promote healthy aging and independent health care maintenance.

Adult inpatients in state-supported (public) and private substance misuse treatment settings were tested for reading ability. Patient education materials and consent forms were assessed for readability levels. Public patients' mean reading levels were significantly lower than those of private patients, and were 4 to 5 years below the level needed to read and understand standard treatment materials. More than half of the public and almost one-third of the private patients tested were reading below a 9th grade level. Standard treatment materials were written on 11th to 12th grade reading levels; admission and consent forms were written on 12th to 18th grade levels. Patients in substance misuse settings should be tested for literacy levels upon admission and provided with materials commensurate with their reading ability.