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A mobile prototype to identify adults 55+ who have difficulty
reading or understanding prescription labels
K Grindrod, A Gates, S Leat, L Dolovich, R Slavcev, R Drimmie, B Aghaei, C Poon, S Khan
Do you know if your patients can read and
understand their prescription labels?
• People need to be able to see, read and understand labels to
safely use medications and avoid errors.
• Half of labels are misunderstood.1
• Poor legibility of labels is partly to blame.2,3
• On a typical label, the store logo is the most clear and legible
and has a mean font size of 13 points.
• By comparison, the medication instructions and medication
names have a mean font size of 9 points .
• Warning labels have a mean font size of 6 points.
• Low literacy, vision and cognition make it even harder.4-9
• Pharmacists can provide additional support for people who
cannot read or understand labels but there is no systematic
strategy in place to identify people at risk.
Research question & objective
Question: Can a mobile screening tool be used to identify people
who cannot read or understand labels?
Objective: To determine the usability and reliability of a mobile
tool to identify adults 55+ who cannot read or understand labels.
ClereMed is an HTML-5
prototype that simulates
It is designed to be a 2min
assessment of 3 things:
1. Patient’s reported ability to
read or understand labels.
2. “Drag and drop” simulation
where the font size
increases if the patient
makes an error (9, 12, 15, 18).
3. Pharmacist assessment of
the patient’s risk factors for
Designing ClereMed How ClereMed performed
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Table. Participant characteristics (N=47)
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Usability. Using the validated 10-item Systems Usability
Scale,10 the usability score was 76/100 meaning it had above
average usability. Further, 84% of participants found ClereMed
“easy to use.”
Reliability. ClereMed was moderately accurate in identifying
functional vision impairment but was not sensitive for mild
Lessons Learned. The essential first step to designing a
mobile health solution is to consult with the target audience and
user experience designers. It will help define who the users are
and who they are not. Apps are expensive to build so it is
important to consider how the mobile tool will fit into the workflow.
A good tool should improve both the quality and efficiency of care.
Thank you. Our project
was partly funded by an
unrestricted grant from the
joint University of
adherence fund. We also
give special thanks to the
retirement homes in the KW
area for all their help during
recruitment. We do not have
any conflicts of interest to
We recruited 47 adults aged ≥55y from pharmacies, retirement
homes and a low vision optometry clinic.
Participants tested ClereMed on an iPad and completed a paper
questionnaire on demographics, computer literacy and usability.
We assessed cognition using the Montreal Cognitive Assessment
(MoCA) and functional reading ability using the MNRead Acuity
Participants completed a real-life simulation with different sized
labels, M&M candies and a pillbox.
1. Davis. J Gen Intern Med. 2009: 24(1):57-62.
2. Shrank. Arch Intern Med 2007;167(16):1760-65.
3. Leat. Can Pharm J 014 147: 179-187.
4. Wolf. Patient Educ Couns. 2007: 7(3):293-300.
5. Bailey. Fam Med. 2009; 41(10):715-21.
6. Latham. Ophthalmic Physiol Opt 2011;31(3):275-82.
7. Crews. Am J Public Health 2004;94(5):823-829.
8. McCann. Br J Gen Pract. 2012;62(601):e530-7.
9. Press. J Gen Intern Med 2011;26:635-42.
10.Brooke. In: Usability Evaluation in Industry. (1996).
ClereMedUniversity of Waterloo, McMaster University, Communitech