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BANNER

READING ANDUNDERSTANDING AMEDICINE LEAFLET BYADOLESCENTCONSUMERS AND ITSDETERMINANTS

Burapadaja S, Jamreondararasame B,Sanguansermsri JFaculty of PharmacyChiang Mai UniversityThailand

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Reading and Understanding a Medicine Leaflet by Adolescent Consumers and Its

Determinants Burapadaja S, Jamreondararasame B, Sanguansermsri J

Abstract: Problem Statement: In Thailand, there is an increase of medications and there are

still problems of inappropriate medication use. One problem is that consumers have little

information on medications. Reading and understanding a medicine leaflet is one way to

obtain such information that could result in appropriate medication use. But there is little

knowledge on how to promote this behavior. Objectives: To determine if consumers read

and understand leaflets about medicines, and the factors affecting a consumer's reading and

understanding of a leaflet. Design: A cross-sectional design was used to examine the leaflet

content of Dangerous medicine compared with a suggestion for leaflet content by WHO. The

same design, using a questionnaire, was used to investigate reading practices. A two-group

design was used to determine comprehension of the leaflet content. All analyses used the p

value of 0.05. Setting: This national study was done in a university in Chiang Mai by

members of the professional sector. Study Population: The leaflet sample (n=154)

information was collected from community pharmacies by purposive sampling. The subject

sample (n=348) was recruited from the freshmen in 2002 of a university (N about 4000) by

systematic sampling. Intervention: An original leaflet was selected from the leaflet sample.

A new leaflet was developed using the same content as the original one but with a different

design to make the content easily understandable. Each subject was assigned either to Group

1 to read the original leaflet or to Group 2 to read the new one, and understanding was

measured using a 24-item test. Each item had three choices. A correct choice was given a

score for an item. Results: About 90% of leaflets examined had less information for

consumers than that suggested by WHO. Some content could be unfamiliar and difficult for

consumers to understand. About 20% of consumers read a leaflet regularly when buying or

taking a medicine. The main factors affecting low consumer reading were little access to a

leaflet and low ability of consumers to read. Difficult leaflet content would inhibit consumers

from reading them. The average score of Group 1 was 13.81 (57%) from a total of 24, and

that of Group 2 was 18.37 (76%) which was significantly higher. Both percentages were

lower than 80%, the understanding level accepted by several countries. Leaflet content was a

main factor affecting the understanding. Arranging the content to be more easily

understandable could increase the understanding level. Conclusions: Factors affecting a

consumer’s reading and understanding of a leaflet included little access to a leaflet, difficult

content and insufficient information. These shortages should be improved so that consumers

could understand apppropriate use of medication. The governmental sector and other related

sectors should provide more access and guarantee the quality of leaflet for consumers.

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INTRODUCTION

• There is an increase of medication • There are still problems of

inappropriate medication use• A problem is that consumers have little

information on medication• A medicine leaflet is an official written

source that could provide such information

Advantages of reading and

understanding of a leaflet

• Increasing compliance

• Increasing awareness of possible

adverse actions

• Improving medication knowledge

• Preventing drug-related problems

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Therefore, consumers should read,

understand and follow the leaflet when

buying or taking a medicine because

they could perform appropriate

medication by doing that.

But we have little knowledge about

whether consumers get information by

reading and understanding a leaflet, so

this study focused on this issue and had

these questions:

• Do consumers read and understand a

leaflet?

• What are the factors affecting the

consumer’s reading and

understanding of a leaflet ?

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OBJECTIVES

To determine if consumers read and

understand leaflets about medicines,

and the factors affecting a consumer’s

reading and understanding of a leaflet

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METHODS

Phase A Leaflet content

Population: Leaflets of “Dangerous

medicines” commonly

used at drugstores

Sampling: A sample (n=154) was

collected in two

months

Analysis: Content analysis based

on WHO Guidelines

WHO Guidelines for leaflet information

Medicine name PrecautionComposition ContraindicationIndication Adverse effectDosage Specific warningProperty Storage Duration of treatment

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Phase B Consumer’s reading

Population: University freshmen

(N about 4000)

Sampling: A sample (n=348) was

selected basing on

student code

Theory: Social Cognitive

Variables: Attitude, Belief,

Personal influence,

Availability, Access,

Content barrier,

Self-efficacy and

Reading a leaflet

Tool: A questionnaire

reliable and valid

Analysis: Path analysis

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Phase C Consumer’s understandingA set of leaflets was selected from the leaflet sample

basing on these criteria: separating from its label, having one composition and having at least 9 information topics. A leaflet was randomly selected from this set and referred to as an original.

A new leaflet was developed by using the same content as the original but with different arrangement. The arrangement aimed to make the new one easily understandable basing on these criteria: using simple words, emphasizing critical words, separating sentence into items

and putting content in order.

A 24-item test used for the leaflet comprehension of

reader had a total score of 24.

The same sample as Phase B was divided into

Group 1 to read the original leaflet, and

Group 2 to read the new leaflet

Then both groups did the test.

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RESULTS

Phase A Leaflet contentPresence of information topic

Topic % LeafletDosage 99.3Name 97.4Indication 96.7Composition 59.7Specific warning 43.5Precaution 40.2Property 39.6Duration 33.1Contraindication 29.9Adverse effect 25.3Storage condition 20.8

1 Almost all leaflets had less information suggested by WHO

2 There were technical terms that might be difficult for consumers to understand

3 A leaflet separate from its label tended to have more information

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Phase B Consumer’s reading

1 Percentage of reading

% RespondentRegular reading 17.5Irregular reading 82.5

2 Factors affecting the reading

Direct factors Access to a leaflet Self-efficacy to read a leafletIndirect factors (via self-efficacy)

Content difficult to understand Access to a leaflet

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Phase C Consumer’s understanding

The average score of both groups

Group 1 Group 213.81 18.37 p .001(57%) (76%)

This meant that the criteria used todeveloped the new leaflet could increase the understanding score or level.

However, several countries accept that the content is considered asunderstandable when the understandinglevel of reader is 80%.

Compared to the acceptable level, the understanding levels of both groupswere lower and unsatisfactory.

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CONCLUSIONS

Most consumers seldom read a leaflet regularly when purchasing or taking a medicine because of little access to a leaflet and low self-efficacy to read due to difficult content.

The consumer’s understanding of a leaflet was unsatisfactory because of content difficult to understand.

There were shortages of leaflets:Little access to a leafletContent difficult to understandInsufficient information

These shortages should be improved in order that consumers could read and understand a leaflet.

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Reasons to improve the leaflets

• To empower consumers in caring for their medication and health

• To provide more access to information on medication

• To create a supportive leaflet• To guarantee health care provision

SUGGESTIONS

• A leaflet should be separate from its label because it would be more accessible and could have more information.

• A leaflet should be understandable by passing a test of understanding

• Like a label, a leaflet should have a standard information enough and essential for consumers