Consumer Medicines Information - Consumer Medicines Information -

Improving access for people with Improving access for people with

low literacy or visual impairmentlow literacy or visual impairment

Professor DK Theo Raynor

Pharmacy Practice and Medicines Management University of Leeds, UK

D.K.Raynor@leeds.ac.ukD.K.Raynor@leeds.ac.uk

Why is consumer medicines Why is consumer medicines information important?information important?

Medicines are most common form of healthcare intervention

People expected to be more involved in their health care

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 Verbal information important but limited impact

What about people with low What about people with low literacy or sight loss?literacy or sight loss?

Written information is needed to complement verbal

However, written information cannot be accessed by 2 large groups of people

People with low literacy skillsPeople with low literacy skills

People who are blind or partially People who are blind or partially sightedsighted

Origin of the workOrigin of the work

FIP Barcelona 1999– Working group to focus on pictograms and special

population information needs

Members who contributed to report on which this presentation is based:– Ros Dowse– Marielle Nieuwhof – Francoise Pradel – Evelyn Schaafsma

AimAimTo determine the special populationmedicines information needs,notably people with: low literacy sight loss

PrincipalPrincipalAll people have an equal right to information about their medicines

Over-viewOver-view Low literacy

– the facts– accessing medicines information

Sight loss – the facts– accessing medicines information

Helping people with low literacy– Maximising readability– Pictograms

Helping people with sight loss– Audiotapes & telephone– Computers & Internet

Low literacy and accessing Low literacy and accessing medicines informationmedicines information

Consumer Medicines Information - Improving access for people with low

literacy or visual impairment

Low literacy - the factsLow literacy - the facts Global problem

– affects 20% of population A problem for developing and developed

countries– 20% of adults read at lowest skill level

Poor reading skills linked with poor health People reluctant to admit low literacy Special problems for people from minority

ethnic groups - including cultural issues

Readability of medicines Readability of medicines informationinformation The writing of much health &

medicines information requires high level reading skills

Poor design and layout add to difficulty

Both are also problems for people with good reading skills

Sight loss & accessing Sight loss & accessing medicine informationmedicine information

Consumer Medicines Information - Improving access for people with low

literacy or visual impairment

Sight loss - the facts Sight loss - the facts Sight loss is one of most common causes

of disability worldwide– Estimated 180 million

Affects many different backgrounds and of all ages– over 50% more than 60 years of age

Developed countries– age related conditions

Developing countries– malnutrition and disease

Sight loss & accessing Sight loss & accessing medicine informationmedicine information

Medicine labels & leaflets generally use small type face

Many people affected can read large print

Package inserts on thin paper, small type and multiply folded– problems even for normal sighted people

Helping people with Helping people with low literacylow literacy

Consumer Medicines Information - Improving access for people with low

literacy or visual impairment

Maximising readabilityMaximising readability Following guidelines on good writing and

design benefits all users:– people with reading difficulties– people with good reading skills

People at all literacy levels better able to understand simple materials written in everyday language

Design & layout as important as content

Content: Key PointsContent: Key Points

Simple language Translate jargon Use short sentences

– One message per sentence Be conversational

– Say ‘you’ and ‘your’ Give practical and specific advice

Design & LayoutDesign & Layout Use mainly lower case letters Bold for emphasis Familiar type style Use headings & logical sequence Lots of white space Bullet points

Make look easy to read

PictogramsPictograms

Can help people with low literacy skills USP-DI pictograms accessible on web Also developed and evaluated

elsewhere, notably in South Africa Need evaluating in target population Always use with verbal information

Helping people with Helping people with sight losssight loss

Consumer Medicines Information - Improving access for people with low

literacy or visual impairment

Maximise readability for Maximise readability for partially sighted peoplepartially sighted people

At least 14 point type Ensure strong contrast between

background & type Do not set text over images Do not use thin paper When folding paper, do not crease over

text

Spoken WordSpoken Word Helpful for people with sight loss and people

with low literacy Audiotape

– indexing systems available Telephone:

– lifeline for many people with sight loss Can combine the two

All written information should have a phone number in large type

Computer technology & Computer technology & InternetInternet

People with sight loss can access computer-based information through:– Enlarged print size– Speech synthesis software– Braille display technology

Careful web design is essential– Many websites are ‘unreadable’– Web Accessibility Initiative

Tactile SystemsTactile Systems

Braille– raised dots read with a finger

Moon– embossed curves and lines

Very limited number of users– less than 5% in UK

SummarySummary

Consumer Medicines Information - Improving access for people with low

literacy or visual impairment

Summary ISummary I When someone gets a medicine, the

accompanying material may be crucial.• Much written material is not accessible to people

from these groups

High prevalence means pharmacists will meet many such consumers each day

• Professionals should be alert for warning signals identifying people at risk

Professional and public awareness needs increasing

• Include awareness training in basic training and continuing education

Summary IISummary II Pharmacists & consumers need access to

the range of options described Package insert leaflets pose problems for

both sighted people and those with sight loss or low literacy

Large print is small intervention with a big impact in people with sight loss

Potential for pharmacies to produce large print versions needs to be realised

Summary IIISummary III Good writing & design benefits both

literate people & people with low literacy Pictograms evaluated in the target

audience can be useful Involve people with low literacy and

sight loss in testing of methods Further research needed to identify

people’s needs and how to meet them