This article reviews effective ways to deliver health information to patients. It discusses the significance of health literacy and identifies formats that increase patient comprehension of labels, such as using a bubble layout with large sans-serif fonts and avoiding visual clutter. The content should include the drug name, indication, benefits, side effects and directions in a positive and simple manner. New technologies may help distribute medication information through mobile devices.

1. Article Review:
Effective Ways to Deliver Health
Information to Patients
HyungMin Lee
University of Pittsburgh
FDA Rotation
October 26th, 2015

2. Objectives
 Discuss significance of Health Literacy
 Identify what composes patient preferred patient label
 Discuss why certain formats increase patient label
comprehension
 Demonstrate the lessons I’ve learned from the project

3. A Looming Epidemics
2030 Health Literacy Prediction (Parker et al. )
Blue: National Adults Literacy Survey in 1992
Red: Literacy projection for 2030
• 54% of people will have most basic literacy skill in 2030, compared to 43% in 1992

4. Declining Literacy
• Failures in Education System
– Stagnant H.S. grad rates
• Shifting Demographics
– New, larger immigrant population
• Changing Economy
– Growth in knowledge-intensive jobs

5. Inadequate Health Literacy
and Mortality
Age-adjusted survival rate with adequate, marginal and
inadequate health literacy. N=3260 (Baker et al. 2007)

6. Patient Communication
• Consumer Rx materials written
10-11th grade level (Wolf et al.,
2012)
• Less than one third routinely
review (Wolf et al., 2006)
• Physicians, pharmacists missing
opportunities to counsel patients
(Metlay et al., 2005)

7. Patient Information

8. Layouts
• Patients preferred Bubble format( 2-column, segmented
design) 3,4

9. Layout
• Avoid visual clutter2
Employ list formats2
Maximize white space2,4
Chunk information into manageable pieces 2
• Use horizontal text only5
• Most common improvement suggestions for
prescription auxiliary labels8
– Do not prefer white background (99.2%)
– Larger label size needed (85%)
– Prefer a picture (58.3%)
– Prefer a red, yellow, or green background (31.7%)

10. Layouts
• Comprehension was
significantly greater for
all three prototypes 1
• Health literacy form
(simple table format)
had the most improved
patient
comprehension1

11. Typography
• Use clear and simple font2
• Use larger, Sans Serif font5
– Sans (French) = without
– Serif (German) = line
• Preferred Arialfont to Times New Roman3
– Arial font is “bigger and bolder” than Times New Roman font

12. Content
• Patient preferred information 6
– Indication for use5,6
– Expected benefits
– Duration of therapy
– Potential adverse effects
– Information identifies the drug’s name
– Directions for use
– Warnings
Topamax 200 mg
round, peach, imprinted with TOPAMAX, 200
© Cerner Multum

13. Content
• Misleading and confusing information3
– Death related sentences
• “some people have died from these infections”
• One third of respondents indicated such warning discourage
them from taking drug.
– Separation between
“Call Your Doctor” and “Common Side Effects”
• Call Your Doctor: ‘pain, chest discomfort, bleeding, swelling…
all these things are scary’
• Common Side Effects: Not informative

14. Content
• Examples of poor interpretation of auxiliary labels 8
Avoid
Sunlight
(23.3%)
Keep medication away
from sun
Do not chew
or crush
(14%)
Don’t chew but crush
Take at bedtime Crush medication before
taking
Don’t take medication
when it’s hot outside
Don’t swallow medication
whole
There are strong drugs;
stay away from
Sometimes can crush or
bite
Don’t leave in sun or
throw in sun
Dissolve medication in
liquid
Avoid exercise Take medication right
away to get in blood
stream
Be out in sun

15. Preference of Content Order3
– For patients with
immune disorders and
chronic disease, and
respondents 50 to 69
years of age,
– For general population,
and respondents
younger than 50 years
and those 70 years of
age or older
Content Order
Directions for Use
Important Warning

16. Language - Encouraged
• Use concrete2,explicit, active4 , simple 4,8 , and concise8
language
• Stick to positive wording 2,4.
– Negation in statement can hinder memorization
– Older readers are more likely to misremember negatively worded
health guidelines
• Use numeric 5
– Drug dose, concentration, and frequency
• Six-grade reading level 8
• Avoid medical jargon5

17. Medication Information Distribution
Pathways
• In pharmacy in paper and electronic formats
• Online via email or other electronic method (QR code)
• Sent to patient in electronic health record
Pearsall, Bryon. “Patient Medication Information.” Exploring the Promise of Patient Medication Information.
The Brooking Institute. Washington, DC. July 1st, 2014. Presentation

18. Near Field Communication (NFC)
• “NFC-Enabled Cellphones Shipments to Soar
Fourfold in Next Five Years” – IHS 2014
• https://www.youtube.com/watch?v=EdyIP7yqWJY
– 18.2% in 2013  64.0% in 2015
lisinopril

19. Thank You

20. References
1. Wolf et al. Comparative Effectiveness of Patient-centered Strategies to
Improve FDA Medication Guides. Medical Care; 2014; 52:781-789
2. Wilson et al. Working memory and the design of health materials: A cognitive
factors perspective. Patient Education and Counseling 74 (2009) 318–322
3. Kish-Doto et al. Preferences for Patient Medication Information: What Do
Patients Want? Journal of health communication, 19(sup2), 77-88.
4. Boudewyns et al. Influence of patient medication information format on
comprehension and application of medication information: A randomized,
controlled experiment. Patient Education and Counseling (2015)
5. Bailey et al. Advancing best practice for prescription drug labeling: an updated
literature review. Annals of Pharmacotherapy 1-15, 2015
6. Bosworth et al., Medication Adherence: A call for action; review article. Am
Heart J 2011; 162:412-24.
7. Lindquist et al. Unnecessary complexity of home medication regimens among
seniors. Patient Education and Counseling 96 (2014) 93-97
8. Locke et al. Improving prescription auxillary labels to increase patient
understanding. J Am Pharm Assoc. 2014; 54:267–274.
9. Yin et al. Unit of Measurement Used and Parent Medication Dosing Errors.
Pediatrics Vol 134, No. 2: e354-361; Aug 2014.
10. Smith et al. Reducing drug self-injection errors: A randomized trial comparing
a "standard" versus "plain language" version of Patient Instructions for Use.
Research in Social and Administrative Pharmacy. 9, 621-625.