Literacy and Misunderstanding Prescription Drug Labels

Davis, Terry C.; Wolf, Michael S.; Bass, Pat F.; Thompson, Jason A.; Tilson, Hugh H.; Neuberger, Marolee; Parker, Ruth M.

doi:10.7326/0003-4819-145-12-200612190-00144

Cited by 551 publications

(473 citation statements)

References 30 publications

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“…This criticism can also be directed at many seminal health literacy studies that have examined associations with the ability to perform common self-management tasks. 4,[57][58][59] In fact, assessments of health literacy closely resemble cognitive tests, supporting the primary assertion of the LitCog study. The most notable similarity can be seen between the REALM and the American-National Adult Reading Test (AM-NART); both require individuals to correctly pronounce lists of words (r= 0.73).…”

Section: Discussionmentioning

confidence: 66%

Literacy, Cognitive Function, and Health: Results of the LitCog Study

et al. 2012

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BACKGROUND: Emerging evidence suggests the relationship between health literacy and health outcomes could be explained by cognitive abilities. OBJECTIVE:To investigate to what degree cognitive skills explain associations between health literacy, performance on common health tasks, and functional health status. DESIGN: Two face-to-face, structured interviews spaced a week apart with three health literacy assessments and a comprehensive cognitive battery measuring 'fluid' abilities necessary to learn and apply new information, and 'crystallized' abilities such as background knowledge. SETTING: An academic general internal medicine practice and three federally qualified health centers in Chicago, Illinois. PATIENTS: Eight hundred and eighty-two Englishspeaking adults ages 55 to 74. MEASUREMENTS: Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), Test of Functional Health Literacy in Adults (TOFHLA), and Newest Vital Sign (NVS). Performance on common health tasks were globally assessed and categorized as 1) comprehending print information, 2) recalling spoken information, 3) recalling multimedia information, 4) dosing and organizing medication, and 5) healthcare problem-solving. RESULTS: Health literacy measures were strongly correlated with fluid and crystallized cognitive abilities (range: r=0.57 to 0.77, all p<0.001). Lower health literacy and weaker fluid and crystallized abilities were associated with poorer performance on healthcare tasks. In multivariable analyses, the association between health literacy and task performance was substantially reduced once fluid and crystallized cognitive abilities were entered into models (without cognitive abilities: β=−28.9, 95 % Confidence Interval (CI) -31.4

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Section: Discussionmentioning

confidence: 66%

Literacy, Cognitive Function, and Health: Results of the LitCog Study

et al. 2012

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“…Prior research examining medication misunderstanding, use and non-adherence to prescription and non-prescription drugs have reported similar findings. [23][24][25][26] Our study provides additional evidence of the problem of confusing OTC medication labeling, especially for the large proportion of Americans who have inadequate health literacy skills. Interestingly, we also found that one in five adults in our sample self-reported heavy acetaminophen use over the past six months.…”

Section: Discussionmentioning

confidence: 81%

Risk of Unintentional Overdose with Non-Prescription Acetaminophen Products

et al. 2012

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BACKGROUND: There is increasing concern over the risk of consumer unintentional misuse of non-prescription (a.k.a. 'over-the-counter') medications containing acetaminophen, which could lead to acute liver failure. OBJECTIVE: To determine the prevalence of potential misuse and overdose of over-the-counter medications containing acetaminophen, either alone or in combination. DESIGN: Cross-sectional, structured interviews with literacy assessment. SETTING: One academic and one community-based general internal medicine practice in Chicago, IL, and one academic general internal medicine practice and a public hospital clinic in Atlanta, GA. PATIENTS: Five hundred adults seeking primary care, ages 18-80. MEASUREMENT: Demonstration of how and when patients would take over-the-counter medications containing acetaminophen, alone or in combination with one another, over a 24-hour period. RESULTS: Overall, 23.8 % of participants demonstrated they would overdose on a single over-the-counter acetaminophen product by exceeding a dose of four grams in a 24-hour period; 5.2 % made serious errors by dosing out more than six grams. In addition, 45.6 % of adults demonstrated they would overdose by 'double-dipping' with two acetaminophen-containing products. In multivariable analyses, limited literacy (Relative Risk Ratio (RR) 1.65, 95 % Confidence Interval (CI) 1.03-2.66) and heavy acetaminophen use in the past six months (RR 1.70, 95 % CI 1.10-2.64) were independently associated with overdosing over-the-counter products. CONCLUSION: Misunderstanding of the active ingredient and proper instructions for over-the-counter medications containing acetaminophen is common. The potential for errors and adverse events associated with unintentional misuse of these products is substantial, particularly among heavy users of acetaminophen and those with limited literacy.

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“…In calculating the ROC curve for each possible cut point of the MMSE (25)(26)(27)(28)(29), the greatest area under the ROC curve for the TOFHLA, REALM and NVS was 0.84, 0.86, and 0.82 respectively (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…1 While a 'universal precautions' approach for using clear health communication practices has been recommended by the American Medical Association, 25 some studies have shown that simply using plain language and 'teach back' methods to confirm understanding may not be sufficient. 26 Therefore, creating, identifying, and validating rapid assessment tools that measure health literacy for clinical purposes has become of increasing interest. Currently, routinely collected patient information cannot adequately identify those with limited health literacy.…”

Section: Discussionmentioning

confidence: 99%

The Mini Mental Status Exam as a Surrogate Measure of Health Literacy

Dahlke¹,

Curtis

Federman

et al. 2013

J GEN INTERN MED

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BACKGROUND: Studies have documented strong associations between cognitive function, health literacy skills, and health outcomes, such that outcome performance may be partially explained by cognitive ability. Common cognitive assessments such as the Mini Mental Status Exam (MMSE) therefore may be measuring the same latent construct as existing health literacy tools. OBJECTIVES: We evaluated the potential of the MMSE as a surrogate measure of health literacy by comparing its convergent and predictive validity to the three most commonly used health literacy assessments and education. SUBJECTS: 827 older adults recruited from an academic general internal medicine ambulatory care clinic or one of five federally qualified health centers in Chicago, IL. Non-English speakers and those with severe cognitive impairment were excluded. MEASURES: Pearson correlations were completed to test the convergent validity of the MMSE with assessments of health literacy and education. Receiver Operating Characteristic (ROC) curves and the d statistic were calculated to determine the optimal cut point on the MMSE for classifying participants with limited health literacy. Multivariate logistic regression models were completed to measure the predictive validity of the new MMSE cut point. KEY RESULTS: The MMSE was found to have moderate to high convergent validity with the existing health literacy measures. The ROC and d statistic analyses suggested an optimal cut point of ≤ 27 on the MMSE. The new threshold score was found to predict health outcomes at least as well as, or better than, existing health literacy measures or education alone. CONCLUSIONS: The MMSE has considerable face validity as a health literacy measure that could be easily administered in the healthcare setting. Further research should aim to validate this cut point and examine the constructs being measured by the MMSE and other literacy assessments.

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Literacy and Misunderstanding Prescription Drug Labels

Abstract: Lower literacy and a greater number of prescription medications were independently associated with misunderstanding the instructions on prescription medication labels.

Cited by 551 publications

References 30 publications

Literacy, Cognitive Function, and Health: Results of the LitCog Study

Literacy, Cognitive Function, and Health: Results of the LitCog Study

Risk of Unintentional Overdose with Non-Prescription Acetaminophen Products

The Mini Mental Status Exam as a Surrogate Measure of Health Literacy

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