1. Health Literacy, Medicines and Pharmacy: Setting the Scene
School of Healthcare
FACULTY OF MEDICINE AND HEALTH
Health Literacy, Medicines and Pharmacy: Setting the Scene
DK Theo Raynor
Professor of Pharmacy Practice , University of Leeds &
Director, Luto Research Ltd

2. 30 years ago …………. What does this mean?
“One to be taken every 8 hours”
53%: every 8 hours for 2 doses only
“Avoid alcoholic drink”
61%: no alcohol
39%: drink a little

3. Two way street?
“There was limited comprehension and understanding of
medications; thus, functional health literacy of the study
population was poor". 
Only valid if sure that information presented was worded,
designed and delivered appropriately
You can't simply say that their health literacy was poor; rather their health knowledge was poor
Did the information follow best practice? - simple words?
Hence medication & health literacy is two-way street
Need to meet patients half way
by applying good practice in spoken and written information
to make sure what is supplied actually meets patients' needs
Raynor DK. Medication Literacy Is a 2-Way Street. Mayo Clinic Proceedings 2008

4. Over-view Overview of Leeds research
Systematic review
Expressing harm & benefit information
Performance based testing and health literacy
What is “User Testing”?
Applying to the NPSA Lithium booklet
Key messages

5. Leeds Research on Consumer Medicines Information
School of Healthcare
FACULTY OF MEDICINE AND HEALTH
Leeds Research on Consumer Medicines Information
Health Literacy, Medicines and Pharmacy: Setting the Scene

6. Medicines Management Research Group
Consumer medicines information
Impact of EU legislation & User Testing
Expressing risks and benefits to patients
Medicines pictograms
US & Australian patient leaflets
Expert advice to MHRA, EMEA and FDA
World Universities Network (WUN)
Key collaborators Sydney & Wisconsin
Also Universities of Utrecht & North Carolina
University Spin Out:
Patient information testing service for pharma
>15,000 participant interviews

7. Systematic Review - Key Findings
Most people do not value information they receive
Patients do not want written information as substitute for spoken information
Great concern about complex language & poor visual presentation of information
Patients value the idea of information:
set in the context of their particular illness
contains a balance of benefit & harm information
Raynor DK, Blenkinsopp A, Knapp et al. Systematic review of research on role & effectiveness of written information to patients about medicines. Health Technol Assess 2007;11:1-160

8. Information design principles
Short familiar words and short sentences
Short headings that stand out
Type as large as possible
Leave ‘white space’
Use bullets for lists
Be conversational
Use the ‘active voice’
Use non-justified text
Use bold lower case for emphasis
Pictures and graphs don’t necessarily help
Raynor DK, Dickinson D. Key principles to guide development of consumer medicine information--content analysis of information design texts. Ann Pharmacother 2009;43:
Knapp, P; Raynor, DK; Jebar, AH; Price, SJ,  Interpretation of medication pictograms by adults in UK. Ann Pharmacother,  2005;39:

9. Expressing risk Side effect data using verbal descriptors
Such as ‘common’ and ‘rare’
Overall gross overestimation of risk
Percentages confuse many
percentages less than 1?
Natural frequencies work better
Like ‘Affects less than 1 in a 100 patients’
Combining words & frequencies may have advantages
Rare (affects less than 1 in 100 people)
Berry, Raynor, Knapp. Provision of information about drug side effects. Lancet 2002
Knapp, Raynor et al.  Communicating risk of side effects to patients: an evaluation of UK regulatory recommendations. Drug Safety 2009;32:

10. How to present benefit information?

11. Performance Based Testing and Health Literacy
School of Healthcare
FACULTY OF MEDICINE AND HEALTH
Performance Based Testing and Health Literacy
Health Literacy, Medicines and Pharmacy: Setting the Scene

12. Do not exceed the stated dose
Content or Performance based testing?
Content Based Testing: Readability Formulae
Do not take into account:
layout or design of leaflet
size of text or typeface
sequence of words used
Do not exceed the stated dose
Guide a only are they
Performance based testing: User Testing
How does the information perform?
Can people find and understand the information they need?

13. User Testing in brief Select 15 key points
Relevant to safe and effective use
Design & pilot a questionnaire which tests:
Finding each piece of information
Understanding (express in own words)
Recruit 20 people from target group
Interviewed individually
Interview concludes with qualitative questions
What did they like and not like about the leaflet?

14. Try, try and try again User Testing is an iterative process
Test material
Identify problems
the points people struggled with & their general comments
Remedy problems
Using research evidence & good practice in writing & design
Test again
Raynor DK. Testing, Testing: The Benefits of User-testing Package Leaflets Regulatory Affairs Focus 2008

17. User Testing during development of Lithium Booklet
Two rounds of User Testing during development
of Lithium Booklet
Target not reached for many questions including:
The need to carry Lithium Alert Card
Causes of lithium levels going up
Why need to take same brand
When should you take during the day

19. Other User Testing Research

20. Key Messages Health and medication literacy is a two-way street
Patients’ information needs are not necessarily met in the ways we think are best
Presenting harm information is best provided using natural frequencies
Presenting benefit information requires more research
Performance based testing can significantly improve information