The impact of textual elements on the comprehensibility of drug label instructions (DLIs): A systematic review

Abstract

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.

Association between health literacy and medication comprehension; attitudes toward reporting adverse events in adults using over-the-counter medicines

“…Therefore, health education focusing on communicative or critical HL, rather than just providing knowledge, would be effective in improving the understanding of medication package inserts. Furthermore, development of more readable and an improved format could contribute to the understanding of medication package inserts [ 22 ].…”

Patients Misunderstanding of Dosage Instructions among Patients Attending Kenema Pharmacy: Do Pharmacists Ask ‘Tell me so I know you understand?’

“…Poor labeling of prescription drugs and patient nonnoncompliance to prescribed medicines is major reason for outpatient medication errors and adverse events (2-4) (10,11). A systematic review conducted to evaluate the impact of textual elements on the comprehensibility of drug label instructions (DLIs) showed that using clear labels about dosage instructions sing plain language can improve patient understanding of dosage instructions (24).…”

Comprehensibility of a personalized medication overview compared to usual-care prescription drug labels

“…Researchers have long studied how to best provide comprehensive medication information related to medication use and understanding in a simplistic and practical manner. As such, numerous studies related to this topic have been published ( Maghroudi et al, 2021 ). Studies have focused on factors such as, complexity of dosing instructions particularly in relation to patient health literacy ( Beckman et al, 2005 ; Shrank et al, 2007 ; European Commission, 2009 ; Bailey et al, 2012 ; Emmerton et al, 2012 ; Koster et al, 2014 ; Patel et al, 2018 ), requirements concerning content an comprehensibility of the text ( Raynor and Bryant, 2013 ; Pires et al, 2016 ; Yuan et al, 2019 ), precision of writing dosing instructions ( Borgsteede and Heringa, 2019 ), and the use of icons, graphics and pictograms ( Kheir et al, 2014 ; van Beusekom et al, 2017 ).…”

“…Also, studies have focused on communication of medicines information, format and organization of the medicines label, as well as number of medicines dispensed ( Wolf et al, 2007 ; Bailey et al, 2012 ; Emmerton et al, 2012 ; Samaranayake et al, 2018 ). There is attention for improving the PDL texts ( Maghroudi et al, 2018 ; Maghroudi et al, 2021 ), which has improved the labels. However, the ideal approach to bundle these aspects still remains unclear.…”