Introduction Correct interpretation of drug labels instructions (DLIs) is needed for safe use and better adherence to prescribed drugs. DLIs are often too difficult for patients, especially for those with limited health literacy. What is yet unknown, is how specific textual elements in DLIs (e.g., the presentation of numbers, or use of medical jargon) and patients’ health literacy skills are related to the comprehension of DLIs. In order to provide concrete directions for health professionals on how to optimize drug prescriptions, we performed a systematic review to summarize the available research findings on which textual elements facilitate or hinder the correct interpretation of DLIs in relation to patients’ health literacy. Method A systematic search was performed in PubMed, EMBASE, PsychINFO, and Smartcat (until April 2019) to identify studies investigating textual elements that facilitate or hinder the correct interpretation of DLIs in relation to patients’ health literacy. Results A total of 434 studies were identified of which 28 studies met our inclusion criteria. We found that textual elements contributing to the correct interpretation of DLIs were: using explicit time periods in dosage instructions, using plain language, presenting numbers in a numerical format, and providing DLIs in patients’ native language. Multistep instructions per instruction line, using abbreviations and medical jargon seem to hinder the correct interpretation of DLIs. Although health literacy was taken into account in a majority of the studies, none of them assessed the effectiveness of specific textual elements on patients’ comprehensibility of DLIs. Conclusion Based on our findings, we provide an overview of textual elements that contribute to the correct interpretation of DLIs. Optimizing the textual instruction on drug labels may increase the safety and adherence to prescribed drugs, taking into account that a significant proportion of patients has low health literacy.
This protocol describes a mixed-method research to compose and implement comprehensible prescription label instructions and will lead to knowledge about the comprehensibility of textual elements in these labels, with specific attention for patients with limited health literacy. Implementation of optimized prescription label instructions will lead to a better understanding of them, which may contribute to improved medication adherence. A limitation is that non-textual aspects of prescription labels are not investigated.
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Dutch Research Council (NWO) Background Limited Health Literacy affects about 3 in 10 persons in the Netherlands. Especially for people with chronic conditions like heart failure, adequate health literacy is needed to maintain, monitor and manage their health and their chronic condition. While nurses are expected to meet the specific support needs of their patients, many find it difficult to recognize and assess the level of health literacy of their patients. Purpose To examine and compare health literacy in patients with heart failure patients from the nurses’ perspective against two health literacy measurement tools. Methods Patients with heart failure were recruited in the outpatient cardiology departments of four different hospitals in the Netherlands. Information about health literacy of the patients was collected with a self-reported questionnaire (Set of Brief Screening Questions - SBSQ) and with the Newest Vital Sign-Dutch (NVS-D). Finally, nurses and nurse practitioners assessed health literacy of the patients on a visual analogue scale from 0-6. Additionally, demographic data (gender, age, level of education and native language) and clinical data (NYHA class and medication use) were collected. Results 61 patients with heart failure were recruited during 2022. Mean age was 68.5 (±14.6), 66% were men, 61% had a lower educational level. Most patients (86%) were native Dutch speakers and had a NYHA classification between II-III (46%). The mean number of used cardiac medication was 5.8 (±1.7). 55 patients completed the SBSQ, fifteen (27%) scored an average ≤ 2, indicating inadequate health literacy. The NVS-D was completed by 53 patients. Twenty-seven patients (51%) scored 0-1, suggesting limited health literacy. Fourteen patients (26%) scored 2-3, indicating possible limited health literacy. The nurses’ assessments (using >3 on the visual analogue scale as adequate health literacy), indicated 35 patients (63%) as having adequate health literacy. There was only poor to slight agreement with the results of the SBSQ (Kappa: 0.198). For comparison with the NVS-D, the visual analogue scale was divided into three groups (limited health literacy (<2), possibly limited health literacy (2-4) and adequate health literacy (>4). This resulted in 10 patients (18%) with limited health literacy according to nurses, 23 (41%) with possibly limited health literacy and 23 (41%) with adequate health literacy. There was also poor agreement between the nurses’ assessment and the NVS-D results (Kappa: 0.133). Conclusion(s) Health literacy is vital for patients with heart failure to process and apply health related information. Alhough there is no gold standard measuring health literacy yet, this study shows that nurses’ assessment does not agree with the SBSQ and the NVS-D. To take health literacy into account during communication, nurses can use the SBSQ, noting that the SBSQ seems to underestimate limited health literacy, while the NVS-D seems to overestimate it.Table 1:Characteristics of patientsTable 2:HL of heart failure patients
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