1. Cognitive Accessibility of OTC Drug Information Ruth S. Day / Duke University FDA Nonprescription Drugs Advisory Committee (9/25/06) Drug Facts Active ingred Purpose Uses Warnings Directions Inactive ingredients

2. 1) Basic Approach 2) Cognitive Principles 3) Non-OTC Examples Cognitive Accessibility of OTC Drug Information

3. 1) Basic Approach 2) Cognitive Principles 3) Non-OTC Examples 4) OTC Examples 5) Generality 6) Conclusions Cognitive Accessibility of OTC Drug Information

4. QUESTION: How do people understand drug information? Ruth Day

5. QUESTION: How do people understand drug information? ANSWER : With difficulty! Ruth Day

6. QUESTION: How do people understand drug information? ANSWER : With difficulty! WHY: --Heavy information load --Complex/technical information --etc. Ruth Day

7. QUESTION: How do people understand drug information? ANSWER : With difficulty! WHY: --Heavy information load --Complex/technical information --etc. -- Cognitive Accessibility Ruth Day

8. The ease with which Cognitive Accessibility Ruth Day

9. The ease with which people can drug information find understand remember use Cognitive Accessibility Ruth Day

10. The ease with which people can drug information find understand remember use in a safe and effective manner. Cognitive Accessibility Ruth Day

11. The ease with which people can drug information find understand remember use in a safe and effective manner. Cognitive Accessibility Ruth Day * Day, 2000; 2006 *

12. The ease with which people can drug information find understand remember use in a safe and effective manner. Cognitive IN-Accessibility Ruth Day * Day, 2000; 2006

13. INFORMATION SOURCES TV Ads Internet Hardcopy    Ruth Day

14. INFORMATION SOURCES TV Ads Internet Hardcopy    Professional Label Patient Package Inserts Medication Guides Pharmacy Leaflets Print Ads OTC Ruth Day Rx Ads OTC Product Websites

15. INFORMATION SOURCES TV Ads Internet Hardcopy    Professional Label Patient Package Inserts Medication Guides Pharmacy Leaflets Print Ads OTC Ruth Day Product Websites Rx Ads OTC

16. Cognitive Enhanced Cognitive Analyses Displays Experiments Ruth Day BASIC APPROACH

17. Cognitive Enhanced Cognitive Analyses Displays Experiments --Obtain quantitative measures --Calculate “cognitive accessibility” --Compare benefits vs. risks Ruth Day BASIC APPROACH  

18. Cognitive Enhanced Cognitive Analyses Displays Experiments BASIC APPROACH   --Same info --Based on cognitive principles Ruth Day --Obtain quantitative measures --Calculate “cognitive accessibility” --Compare benefits vs. risks

19. Cognitive Enhanced Cognitive Analyses Displays Experiments BASIC APPROACH   Test effects on: --Attention --Comprehension --Memory --Problem Solving --Decision Making --Behavior --Same info --Based on cognitive principles Ruth Day --Obtain quantitative measures --Calculate “cognitive accessibility” --Compare benefits vs. risks

20. Cognitive Enhanced Cognitive Analyses Displays Experiments BASIC APPROACH   Test effects on: --Attention --Comprehension --Memory --Problem Solving --Decision Making --Behavior Health Outcomes --Same info --Based on cognitive principles Ruth Day --Obtain quantitative measures --Calculate “cognitive accessibility” --Compare benefits vs. risks

21. COGNITIVE PRINCIPLES Information Load Chunking Coding Representation Location Speed Readability Comprehension Prior Knowledge Attention Cognitive Task Metacognition Ruth Day

22. COGNITIVE PRINCIPLES Information Load Chunking Coding Representation Location Speed Readability Comprehension Prior Knowledge Attention Cognitive Task Metacognition Ruth Day Day, R.S. (2006) Comprehension of prescription drug information: Overview of a research program. Proceedings of the American Association for Artificial Intelligence, Argumentation for Consumer Healthcare. http://www.aaai.org

23. LOAD How much is too much? Ruth Day

24. LOAD Information Load How much is too much? Ruth Day

25. LOAD Information Cognitive Load Load How much is too much? Ruth Day

27. Medication Schedules Ruth Day

28. Polypharmacy Medication Schedules Ruth Day

30. List Ruth Day

31. List Matrix

32. Ruth Day

35. StudyCognitive Tasks Procedure time Memory Comprehension Problem Solving Ruth Day

36. Memory Comprehension (Display Absent) (Display Present) Ruth Day

37. Memory Comprehension (Display Absent) (Display Present) Ruth Day

38. Memory Comprehension (Display Absent) (Display Present) Ruth Day

39. Memory Comprehension (Display Absent) (Display Present) Ruth Day

40. Types of Questions Factual Inferential --“What are the names of the drugs? --“How many total pills per day?” --etc. Ruth Day

41. Types of Questions Factual Inferential --“What are the names of the drugs? --“How many total pills per day?” --etc. Scenarios Go beyond the information given Ruth Day

42. Types of Questions Factual Inferential --“What are the names of the drugs? --“How many total pills per day?” --etc. Scenarios Go beyond the information given Ruth Day

43. Scenario Question: “If you leave home in the afternoon and will not be back until breakfast time the next day, how many Inderal should you take along?” Ruth Day

44. Memory Comprehension Scenario Question: “If you leave home in the afternoon and will not be back until breakfast time the next day, how many Inderal should you take along?” Ruth Day

45. Memory Comprehension Scenario Question: “If you leave home in the afternoon and will not be back until breakfast time the next day, how many Inderal should you take along?” Ruth Day

46. Memory Comprehension Scenario Question: “If you leave home in the afternoon and will not be back until breakfast time the next day, how many Inderal should you take along?” Ruth Day

47. Memory Comprehension Scenario Question: “If you leave home in the afternoon and will not be back until breakfast time the next day, how many Inderal should you take along?” Ruth Day

48. Medication Schedules --Alternative Representations --Multiple Cognitive Tasks Ruth Day

49. CHUNKING

50. Ruth Day CHUNKING Basic idea ….

51. Ruth Day CHUNKING Basic idea ….

52. Ruth Day CHUNKING

53. “Brief Summary” Ruth Day

57. CODING

58. Ruth Day Basic idea …. CODING

59. Ruth Day Basic idea …. CODING Name A Name B

60. Ruth Day CHUNKING & CODING

61. EXAMPLE (Original) Tell your doctor, nurse, and pharmacist if you … are allergic to any medicine, either prescription or nonprescription (OTC); are pregnant or intend to become pregnant while using this medicine are breast-feeding; are using any other prescription or nonprescription (OTC) medicine, especially diuretics (water pills) or potassium-containing medicines or supplements; have any other medical problems, especially heart or blood vessel disease or kidney disease; are on a strict low-sodium diet or dialysis, or use low-salt milk or salt substitutes; have had a kidney transplant Source: Day, R. S. (1999) Optimizing patient comprehension through medicine information leaflets: Cognition experiments. In A.G. Hartzema, S.Tolleson-Rinehart, B.L. Sleath, and R.S. Day, Optimizing Patien Comprehension through Medicine Leaflets. Rockville, MD: U.S. Pharmacopeia. Pp. 60-176. Ruth Day

63. EXAMPLE (Original) Tell your doctor, nurse, and pharmacist if you … are allergic to any medicine, either prescription or nonprescription (OTC); are pregnant or intend to become pregnant while using this medicine are breast-feeding; are using any other prescription or nonprescription (OTC) medicine, especially diuretics (water pills) or potassium-containing medicines or supplements; have any other medical problems, especially heart or blood vessel disease or kidney disease; are on a strict low-sodium diet or dialysis, or use low-salt milk or salt substitutes; have had a kidney transplant Source: Day, R. S. (1999) Optimizing patient comprehension through medicine information leaflets: Cognition experiments. In A.G. Hartzema, S. Tolleson-Rinehart, B.L. Sleath, and R.S. Day, Optimizing Patien Comprehension through Medicine Leaflets. Rockville, MD: U.S. Pharmacopeia. Pp. 60-176. ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~ ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~ Ruth Day

64. Tell your doctor, nurse, and pharmacist if you have: Allergic to Medicines --prescription medicine --nonprescription medicine (OTC) Pregnancy --are pregnant --intend to become pregnant --are breast-feeding Other Medicines --prescription medicine --nonprescription medicine (OTC) --especially: --diuretics (water pills) --potassium-containing medicines --potassium-containing supplements Medical Conditions --any other medical problems --especially: --heart disease --blood vessel disease --kidney disease --kidney transplant --on dialysis Diet --on a strict low-sodium diet --use low-salt milk --use salt substitutes Chunked & Coded Ruth Day

65. CHUNKING & CODING

66. CONTRAINDICATIONS AND WARNINGS PREGNANCY MUST BE EXCLUDED BEFORE THE START OF TREATMENT WITH DRUG-X. DRUG-X IS CONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT. Ruth Day

67. RARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE. CONTRAINDICATIONS AND WARNINGS PREGNANCY MUST BE EXCLUDED BEFORE THE START OF TREATMENT WITH DRUG-X. DRUG-X IS CONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT. Ruth Day

68. RARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE. CONTRAINDICATIONS AND WARNINGS PREGNANCY MUST BE EXCLUDED BEFORE THE START OF TREATMENT WITH DRUG-X. DRUG-X IS CONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT. Ruth Day

69. CONTRAINDICATIONS AND WARNINGS PREGNANCY MUST BE EXCLUDED BEFORE THE START OF TREATMENT WITH DRUG-X. DRUG-X IS CONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT. RARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE. Ruth Day

70. CONTRAINDICATIONS AND WARNINGS PREGNANCY MUST BE EXCLUDED BEFORE THE START OF TREATMENT WITH DRUG-X. DRUG-X IS CONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT. RARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE. Ruth Day

71. CONTRAINDICATIONS AND WARNINGS PREGNANCY MUST BE EXCLUDED BEFORE THE START OF TREATMENT WITH DRUG-X. DRUG-X IS CONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT. RARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE. Chunked Ruth Day

72. CONTRAINDICATIONS AND WARNINGS PREGNANCY PREGNANCY MUST BE EXCLUDED BEFORE THE START OF TREATMENT WITH DRUG-X. DRUG-X IS CONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT. LIVER TOXICITY RARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE. CHUNKING & CODING Chunked & Coded Ruth Day

73. CONTRAINDICATIONS AND WARNINGS PREGNANCY Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. (See “Contraindications and Warnings.”) Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment. LIVER TOXICITY Rare but life-threatening liver toxicity has been reported, including acute liver failure. Visual Contrast Ruth Day

74. StudyTest time Ruth Day CHUNKING & CODING

75. StudyTest time Ruth Day --Chunked > UnChunked --Coded > UnCoded CHUNKING & CODING

76. Ruth Day READABILITY

77. # Words = 48 # Sentences = 3 Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. (See “Contraindications and Warnings.”) Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment. Ruth Day

78. READABILITY # Words = 48 # Sentences = 3 Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. (See “Contraindications and Warnings.”) Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment. Grade level = 12 Passives = 66% Ruth Day

79. LINGUISTIC STRUCTURE Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment. Ruth Day

80. LINGUISTIC STRUCTURE Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment. Ruth Day

81. LARD FACTOR Ruth Day

82. LARD FACTOR Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment. Original High LF Ruth Day

83. LARD FACTOR Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment. Exclude pregnancy before starting Drug-X treatment. Drug-X is contraindicated in pregnant women or women of childbearing potential who are not using reliable contraception. Avoid pregnancy during Drug-X treatment and after treatment (until completing the drug elimination procedure). Original High LF Revised Lower LF Ruth Day

84. Readability

85. Ruth Day Grade Level

86. Readability Ruth Day Grade Level

87. Readability Grade Level % Passives Ruth Day

88. Readability % Passives Comprehension Memory Behavior Grade Level Ruth Day

89. LOCATION of INFORMATION

90. COGNITIVE PRINCIPLE Ruth Day

91. Task: --see/hear list of items --report them COGNITIVE PRINCIPLE: Serial Position Effect Ruth Day

92. Task: --see/hear list of items --report them Typical Results: % CORRECT LOCATION COGNITIVE PRINCIPLE: Serial Position Effect Ruth Day

93. Task: --see/hear list of items --report them Typical Results: % CORRECT LOCATION COGNITIVE PRINCIPLE: Serial Position Effect Ruth Day

94. LOCATION of INFORMATION Ruth Day

95. Study Leaflet Cognitive Tasks Experiments time Ruth Day Example “What are possible side effects?”

96. Ruth Day

98. LEAFLET SECTION Ruth Day

99. Task: --see/hear list of items --report them Typical Results: % CORRECT LOCATION COGNITIVE PRINCIPLE: Serial Position Effect Ruth Day

100. Task: --see/hear list of items --report them Typical Results: % CORRECT LOCATION COGNITIVE PRINCIPLE: Serial Position Effect Ruth Day Risks

101. Produced New TV Ad Hypothetical Drug Flu Aide Ruth Day

102. Structure & content --Like typical ads --Purpose --vary specific factors --observe effects on cognition Flu Aide Produced New TV Ad Hypothetical Drug Ruth Day

103. See ad time Favorable UnFavorable LOCATION of Side Effects Experiment Flu Aide Ruth Day OR

104. See ad time Favorable UnFavorable LOCATION of Side Effects Experiment Same visual Same auditory Differ only in location of side effects Flu Aide Ruth Day OR

105. Flu Aide Favorable UnFavorable LOCATION Ruth Day

106. 0 10 20 30 40 50 EarlyLate % Correct Flu Aide Favorable UnFavorable LOCATION Ruth Day

107. Flu Aide Favorable UnFavorable LOCATION Ruth Day

108. ~ 100% Flu Aide Favorable UnFavorable LOCATION Ruth Day

109. READABILITY Ruth Day

110.  Rx Ruth Day READABILITY

111. Readability = Comprehensibility READABILITY Ruth Day

112. Readability = Comprehensibility However, --easy to measure --has predictive value --therefore = quick “proxy” for comprehensibility READABILITY Ruth Day

113. READABILITY GRADE LEVEL Ruth Day

114. READABILITY GRADE LEVEL Ruth Day

115. READABILITY GRADE LEVEL Ruth Day

116. READABILITY GRADE LEVEL Ruth Day 3

117. See ad Test time Benefits Risks Other (N = 1-3) Ruth Day Experiments Ruth Day

118. Overall ~ 80% ~ 20% Ruth Day

119. Alternative Representations Ruth Day

120. Alternative Representations Ruth Day SAME DIFFERENT Information Displays

121. Alternative Representations Ruth Day

122. Alternative Representations Ruth Day Linear Orderings

123. Alternative Representations High Sev Low Sev High Freq Low Freq Good State Bad State Severity Frequency Health State Ruth Day

124. Alternative Representations High Sev Low Sev High Freq Low Freq Good State Bad State Severity Frequency Health State Ruth Day

125. Alternative Representations High Sev Low Sev High Freq Low Freq Good State Bad State Severity Frequency Health State Ruth Day

126. Alternative Representations Linear Orderings Ruth Day

127. Alternative Representations Linear Orderings Mild Diarrhea Drowsiness Nausea Life-Threatening Chest pain Shortness of breath Slurred speech Ruth Day

128. Alternative Representations Linear Orderings Mild Diarrhea Drowsiness Nausea Life-Threatening Chest pain Shortness of breath Slurred speech Ruth Day

129. Alternative Representations Linear Orderings Mild Diarrhea Drowsiness Nausea Life-Threatening Chest pain Shortness of breath Slurred speech Ruth Day

130. Drug X Chest pain Shortness of breath Slurred speech Diarrhea Drowsiness Nausea Ruth Day

131. Chest pain Shortness of breath Slurred speech Diarrhea Drowsiness Nausea Drug X Ruth Day

132. Alternative Representations Ruth Day SAME DIFFERENT Information Displays

133. PARAGRAPH Plain Possible side effects include chest pain, slurred speech, seizure, anxiety, joint pain, weakness, dry mouth, headache, and nausea. Ruth Day

134. PARAGRAPH Plain Possible side effects include chest pain, slurred speech, seizure, anxiety, joint pain, weakness, dry mouth, headache, and nausea. Categorized Possible dangerous side effects include chest pain, slurred speech, and seizure. Some are worrisome such as anxiety, joint pain, and weakness. Others are mild such as dry mouth, headache, and nausea. Ruth Day

135. PARAGRAPH Plain Possible side effects include chest pain, slurred speech, seizure, anxiety, joint pain, weakness, dry mouth, headache, and nausea. Categorized Possible dangerous side effects include chest pain, slurred speech, and seizure. Some are worrisome such as anxiety, joint pain, and weakness. Others are mild such as dry mouth, headache, and nausea. Ruth Day

136. LIST Plain --chest pain --slurred speech --seizure --anxiety --joint pain --weakness --dry mouth --headache --nausea Ruth Day

137. LIST Plain Chunked + --chest pain --slurred speech --seizure --anxiety --joint pain --weakness --dry mouth --headache --nausea Dangerous --chest pain --slurred speech --seizure Worrisome --anxiety --joint pain --weakness Mild --dry mouth --headache --nausea Ruth Day

138. LINE dry mouth anxiety chest pain headache joint pain slurred speech nausea weakness seizure Mild Dangerous Ruth Day

139. LINE ARROW dry mouth anxiety chest pain headache joint pain slurred speech nausea weakness seizure Mild Dangerous dry mouth anxiety chest pain headache joint pain slurred speech nausea weakness seizure Ruth Day

140. LINE ARROW ARROW + dry mouth anxiety chest pain headache joint pain slurred speech nausea weakness seizure Mild Dangerous dry mouth anxiety chest pain headache joint pain slurred speech nausea weakness seizure dry mouth anxiety chest pain headache joint pain slurred speech nausea weakness seizure Ruth Day

141. MATRIX More Common Less Common Rare chest pain slurred speech seizure anxiety joint pain weakness dry mouth headache nausea Ruth Day DangerousWorrisomeMild

142. MATRIX More Common Less Common Rare chest pain slurred speech seizure anxiety joint pain weakness dry mouth headache nausea Ruth Day DangerousWorrisomeMild

143. Dangerous Common Rare chest pain slurred speech seizure dry mouth headache nausea Mild dry mouth headache nausea anxiety MATRIX Ruth Day

144. Alternative Representations of Same Information --Text --List --Linear Ordering --Matrix --Lots More (…..) Ruth Day

145. Alternative Representations of Same Information --Text --List --Linear Ordering --Matrix --Lots More (…..) Cognitive Consequences Ruth Day

146. --Text --List --Linear Ordering --Matrix --Lots More (…..) Cognitive Consequences Day, R. S. Alternative representations. In G. H. Bower (Ed.), The Psychology of Learning and Motivation. New York: Academic Press, 1988, 22, 261-305. Effects on --Perception --Attention --Comprehension --Memory --Problem Solving Alternative Representations of Same Information Ruth Day

147. --Text --List --Linear Ordering --Matrix --Lots More (…..) Cognitive Consequences Day, R. S. Alternative representations. In G. H. Bower (Ed.), The Psychology of Learning and Motivation. New York: Academic Press, 1988, 22, 261-305. Effects on --Perception --Attention --Comprehension --Memory --Problem Solving --Behavior & Health Alternative Representations of Same Information Ruth Day

148. Alternative Representations Text List Line Matrix (etc.) Effects Ruth Day

149. Alternative Representations Text List Line Matrix (etc.) Effects Original Enhanced DISPLAY Ruth Day

150. Alternative Representations Text List Line Matrix (etc.) Effects Original Enhanced DISPLAY Ruth Day

151. Alternative Representations Ruth Day

152. Alternative Representations Ruth Day  Possible side effects include:

153. Study Test Side Effects time Ruth Day Experiments Ruth Day Multiple cognitive tasks

154. One Task “What are the possible side effects? Ruth Day

155. One Task “What are the possible side effects? Ruth Day

156. One Task “What are the possible side effects? Ruth Day

157. One Task “What are the possible side effects? Ruth Day

158. One Task “What are the possible side effects? Ruth Day

159. One Task “What are the possible side effects? Ruth Day

160. One Task “What are the possible side effects? Ruth Day

161. Much knowledge Much expertise Ruth Day Physicians & Patients

162. Much knowledge Little knowledge Much expertise Little expertise Ruth Day Physicians & Patients

163. Much knowledge Little knowledge Much expertise Little expertise Ruth Day

164. Much knowledge Little knowledge Much expertise Little expertise Cognitive Processes Ruth Day Attention Comprehension Memory

165. Much knowledge Little knowledge Much expertise Little expertise Cognitive Cognitive Processes Factors. Ruth Day Attention Chunking Comprehension Location Memory Readability

166. OTC Drug Facts Active ingred Purpose Uses Warnings Directions Inactive ingredients Ruth Day

167. OTC Drug Facts Active ingred Purpose Uses Warnings Directions Inactive ingredients Drug Facts Package Insert Package Ruth Day

168. Ibuprofen (2002) Ruth Day

169. Drug Facts Active Ingredient (in each tablet) Purpose Ibuprofen 200 mg Pain reliever/fever reducer Uses temporarily relieves minor aches and pains due to: minor pain of arthritis headache backache menstrual cramps the common cold muscular aches toothache temporarily reduces fever Warnings Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen may cause stomach bleeding. Do not use if you have ever had an allergic reaction to any other pain reliever/fever reducer. Ask a doctor before use if you have p roblems or serious side effects from taking pain relievers or fever reducers s tomach problems that last or come back, such as heartburn, upset stomach, or pain ulcers b leeding problems h igh blood pressure, heart or kidney disease, are taking a diuretic, or are over 65 years of age Ask a doctor or pharmacist before use if you are u nder a doctor’s care for any serious condition t aking any other product that contains ibuprofen, or any other pain reliever/fever reducer t aking a prescription drug for anticoagulation (blood thinning) t aking any other drug When using this product take with food or milk if stomach upset occurs Ruth Day

170. Stop use and ask a doctor if an allergic reaction occurs. Seek medical help right away. pain gets worse or lasts more than 10 days fever gets worse or lasts more than 3 days stomach pain or upset gets worse of lasts redness or swelling is present in the painful area any new symptoms appear If pregnant or breast feeding, ask a health professional before use. It is especially important not to use ibuprofen during the last 3 months of pregnancy unless definitely directed to do so by a doctor because it may cause problems in the unborn child or complications during deliver. Keep out of reach of children. In case of overdoes, get medical help or contact a Poison Control Center right away. Directions do not take more than directed adults and children 12 years and over 1 table every 4 to 6 hours while symptoms persist if pain or fever does not respond to 1 tablet, 3 tablets may be used do not exceed 6 tablets in 24 hours, unless directed by a doctor children under 12 years: ask a doctor Other information each tablet contains: ibuprofen store at 20 -25° C (68-77° F) avoid high humidity and excessive heat aove 40°C (104° F) do not use if seal on bottle has been opened Inactive ingredients acetylated monoglyceride, beeswax and/or carnauba wax, croscarmellose sodium, iron oxides, lecithin, methylparaben, microcrystalline cellulose, pharmaceutical glaze, povidone, propylparaben, silicon dioxide, simethicone, sodium benzoate, sodium lauryl sulfate, starch, stearic acid, sucrose, titanium dioxide Ruth Day

171. Read label Test time Uses Warnings Other Ruth Day Drug Facts Ruth Day

172. Read label Test time Uses Warnings Other Ruth Day Drug Facts Ruth Day Good Poor

173. Warnings Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen may cause stomach bleeding. Original Ruth Day

174. Warnings Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen may cause stomach bleeding. Original Ruth Day

175. Warnings Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen may cause stomach bleeding. Alternative Representations Original Ruth Day

176. Warnings Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen may cause stomach bleeding. Warnings Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Stomach bleeding: Ibuprofen may cause stomach bleeding. Alternative Representations Original NewLine & Coded Ruth Day

177. Warnings Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen may cause stomach bleeding. Warnings Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Stomach bleeding: Ibuprofen may cause stomach bleeding. WARNINGS Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: --hives --facial swelling --asthma (wheezing) --shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Stomach bleeding: Ibuprofen may cause stomach bleeding. Original NewLine & Coded Chunked & Coded Alternative Representations Ruth Day

178. Warnings Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen may cause stomach bleeding. Warnings Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Stomach bleeding: Ibuprofen may cause stomach bleeding. WARNINGS Allergy alert: Ibuprofen may cause a severe allergic reaction which may include: --hives --facial swelling --asthma (wheezing) --shock Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers. Stomach bleeding: Ibuprofen may cause stomach bleeding. Alternative Representations Original NewLine & Coded Chunked & Coded Ruth Day

179. Ibuprofen (2002) Stomach bleeding Ruth Day

180. Acetaminophen + (2006) Liver damage Ruth Day

181. Acetaminophen PM (2006) #1 Ruth Day

182. Acetaminophen PM (2006) #1 Ruth Day

183. Acetaminophen PM (2006) #1 #2 Ruth Day

184. Acetaminophen PM (2006) #1 #2 Ruth Day

185. Generality of Results Ruth Day

186. Generality of Results People Information Cognitive Source Task Patients NonPatients Physicians Other HCPs Demographics --age --education --literacy --etc. Ruth Day

187. Generality of Results People Information Cognitive Source Task Patients NonPatients Physicians Other HCPs Demographics --age --education --literacy --etc. OTC label OTC package Package insert Professional Label CMI Medication Guides Print Ads TV Ads Ruth Day

188. Generality of Results People Information Cognitive Source Task OTC label OTC package Package insert Professional Label CMI Medication Guides Print Ads TV Ads Attention Search Recall Recognition Definition Comprehension Problem Solving Decision Making Patients NonPatients Physicians Other HCPs Demographics --age --education --literacy --etc. Ruth Day

189. Drug Information Toolkit Ruth Day Cognitive Accessibility Check-List

190. Cognitive Accessibility Check-List Uses Warnings …. Chunking Coding Readability Location Format [etc] Ruth Day

191. Cognitive Accessibility Check-List Uses Warnings …. Chunking Coding Readability Location Format [etc] Ruth Day +

192. FORMAT SELECTION Ruth Day

193. Purposes Uses Warnings Directions …. CONTENT FORMAT SELECTION Ruth Day

194. CONTENT Text List Matrix …. FORMAT FORMAT SELECTION Purposes Uses Warnings Directions …. Ruth Day

195. CONTENT Text List Matrix …. FORMAT Understand Remember Use COGNITIVE TASK FORMAT SELECTION Purposes Uses Warnings Directions …. Ruth Day

196. CONTENT Text List Matrix …. FORMAT Understand Remember Use COGNITIVE TASK FORMAT SELECTION Source: Adapted from Day, R.S. (1988) Alternative representations. In G.H. Bower (Ed.), The Psychology of Learning and Motivation, 22, 261-306. New York: Academic Press. Purposes Uses Warnings Directions ….

197. DRUG INFORMATION Physically present Ruth Day

198. DRUG INFORMATION Physically Functionally present absent Ruth Day

199. Cognitive Accessibility of OTC Drug Information ruthday@duke.edu http://www.duke.edu/~ruthday/medcog.html Drug Facts Active ingred Purpose Uses Warnings Directions Inactive ingredients

200. Day, R.S. (2006) Comprehension of prescription drug information: Overview of a research program. Proceedings of the American Association for Artificial Intelligence, Argumentation for Consumer Healthcare. http://www.aaai.org Day, R. S. (1988) Alternative representations. In G.H. Bower (Ed.), The Psychology of Learning and Motivation. New York: Academic Press, 22, 261-305. Day, R.S. (2000) Brandname.Com’ – Cognitive accessibility of drug information on drug product websites. Drug Information Association.