Consumer Medicines Information - Improving access for people with low literacy or visual impairment Professor DK Theo Raynor Pharmacy Practice and Medicines Management University of Leeds,

Why is consumer medicines information important? n Medicines are most common form of healthcare intervention n People expected to be more involved in their health care n To be more involved and to maximise benefits of medicines, people need to know: –What their medicines are for –How to use them correctly –Benefits and adverse effects n Verbal information important but limited impact

What about people with low literacy or sight loss? n Written information is needed to complement verbal n However, written information cannot be accessed by 2 large groups of people People with low literacy skills People who are blind or partially sighted

Origin of the work n FIP Barcelona 1999 –Working group to focus on pictograms and special population information needs n Members who contributed to report on which this presentation is based: –Ros Dowse –Marielle Nieuwhof –Francoise Pradel –Evelyn Schaafsma

Aim To determine the special population medicines information needs, notably people with: n low literacy n sight lossPrincipal All people have an equal right to information about their medicines

Over-view n Low literacy –the facts –accessing medicines information n Sight loss –the facts –accessing medicines information n Helping people with low literacy –Maximising readability –Pictograms n Helping people with sight loss –Audiotapes & telephone –Computers & Internet

Low literacy and accessing medicines information Consumer Medicines Information - Improving access for people with low literacy or visual impairment

Low literacy - the facts n Global problem –affects 20% of population n A problem for developing and developed countries –20% of adults read at lowest skill level n Poor reading skills linked with poor health n People reluctant to admit low literacy n Special problems for people from minority ethnic groups - including cultural issues

Readability of medicines information The writing of much health & medicines information requires high level reading skills Poor design and layout add to difficulty n Both are also problems for people with good reading skills

Sight loss & accessing medicine information Consumer Medicines Information - Improving access for people with low literacy or visual impairment

Sight loss - the facts n Sight loss is one of most common causes of disability worldwide –Estimated 180 million n Affects many different backgrounds and of all ages –over 50% more than 60 years of age n Developed countries –age related conditions n Developing countries –malnutrition and disease

Sight loss & accessing medicine information n Medicine labels & leaflets generally use small type face n Many people affected can read large print n Package inserts on thin paper, small type and multiply folded –problems even for normal sighted people

Helping people with low literacy Consumer Medicines Information - Improving access for people with low literacy or visual impairment

Maximising readability n Following guidelines on good writing and design benefits all users: –people with reading difficulties –people with good reading skills n People at all literacy levels better able to understand simple materials written in everyday language n Design & layout as important as content

Content: Key Points n Simple language n Translate jargon n Use short sentences –One message per sentence n Be conversational –Say ‘you’ and ‘your’ n Give practical and specific advice

Design & Layout n Use mainly lower case letters n Bold for emphasis n Familiar type style n Use headings & logical sequence n Lots of white space n Bullet points n Make look easy to read

Pictograms n Can help people with low literacy skills n USP-DI pictograms accessible on web n Also developed and evaluated elsewhere, notably in South Africa n Need evaluating in target population n Always use with verbal information

Helping people with sight loss Consumer Medicines Information - Improving access for people with low literacy or visual impairment

Maximise readability for partially sighted people n At least 14 point type n Ensure strong contrast between background & type n Do not set text over images n Do not use thin paper n When folding paper, do not crease over text

Spoken Word n Helpful for people with sight loss and people with low literacy n Audiotape – indexing systems available n Telephone: – lifeline for many people with sight loss n Can combine the two n All written information should have a phone number in large type

Computer technology & Internet n People with sight loss can access computer-based information through: –Enlarged print size –Speech synthesis software –Braille display technology n Careful web design is essential –Many websites are ‘unreadable’ –Web Accessibility Initiative

Tactile Systems n Braille –raised dots read with a finger n Moon –embossed curves and lines n Very limited number of users –less than 5% in UK

Summary Consumer Medicines Information - Improving access for people with low literacy or visual impairment

Summary I n When someone gets a medicine, the accompanying material may be crucial. Much written material is not accessible to people from these groups n High prevalence means pharmacists will meet many such consumers each day Professionals should be alert for warning signals identifying people at risk n Professional and public awareness needs increasing Include awareness training in basic training and continuing education

Summary II n Pharmacists & consumers need access to the range of options described n Package insert leaflets pose problems for both sighted people and those with sight loss or low literacy n Large print is small intervention with a big impact in people with sight loss n Potential for pharmacies to produce large print versions needs to be realised

Summary III n Good writing & design benefits both literate people & people with low literacy n Pictograms evaluated in the target audience can be useful n Involve people with low literacy and sight loss in testing of methods n Further research needed to identify people’s needs and how to meet them