TABLE 5-2 Voicing Understanding vs. Taking Correct Action

When Asked to Demonstrate the Instruction

“Take Two Tablets by Mouth Twice Daily”

Reading Level

Voiced Understanding

Demonstrated Correctly










SOURCE: Adapted from Davis et al., 2006.

understanding label information. But even people with good reading skills have poor comprehension when labels include information that is not relevant or does not go together. If too much information is on the label, or if it is too cryptic, people will not be able to perform the actions necessary to take their medications correctly.

There is a difference between people saying they can understand a statement and being able to take the correct action. The gap widens as literacy decreases (Table 5-2). It is important to foster more discussion so that the words we use are actionable by the patients.

Visuals add to people’s comprehension and to their willingness to look at information (Delp and Jones, 1996). But if visuals are not good or if they are not well tested, they may not make a difference.

GlaxoSmithKline has made a concerted effort to foster internal awareness of health literacy principles and facilitated application of those principles to patient- and consumer-directed materials. The company developed standardized health literacy training that is available across the organization including the marketing departments, patient recruitment and product labeling teams, and research and development staff. Medications are complicated and needs vary, but giving staff good tools—review checklists, a style guide, internal and external expert review support—makes implementation easier. The company is seeing a difference.

Depending on the medication, patient information is available in several forms: med guide, patient package insert (PPI), patient information leaflet (PIL) and consumer medicine information (CMI) (Table 5-3).

GlaxoSmithKline has conducted consumer testing to improve consumer medication information, taking such standard information and putting it into a more patient friendly format in a type of drug fact box found on over-the-counter (OTC) labels. As expected, consumers found it easier to correctly find and restate information from simplified formats: adequate print size and print quality, spacing between lines, information presented in tables with gridlines, bolding of important words and phrases, and easy-to-understand language with actionable information. There were also surprises. Participants had clear opinions on what kinds

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