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Health Literacy Considerations in ResearchA Case Study to Drive Increased Medication Adherence

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Special thanks to our contributors.

• Scott von Lutcken • Heather Collins

• Bill Stone • Tom Donnelly

• Lynn Ricker

Research+

• Karen J. Tibbals

• John Ewing

• Daniel Ryan

3

Background: Compliance & Health Literacy Overview

– What is it?

– Why is it important?

HCP/RPh Survey

– Perception of Compliance

– Communication, Comprehension & Compliance

Patient Survey

– Health Literacy Using Newest Vital Signs (NVS) Scale

– Demographic Profile of the Sample

– Drug Label Test: Health Literate vs. Traditional

– Developing a Simpler Tool

Next Steps?

Agenda

Medication Labels

Health Literate Label Traditional Label

4

Label A

Label B

• More than half of those prescriptions, however, are taken incorrectly or not at all.2

• In a survey of 1,000 patients, nearly 75% admitted to not always taking their medications as directed.3

• A study of over 75,000 commercially-insured patients found that 30% failed to fill a new prescription, and new prescriptions for chronic conditions such as high blood pressure, diabetes, and high cholesterol were not filled 20%-22% of the time.4

• It is estimated that poor compliance costs the US healthcare system $290 billion each year.5

3.8 billion prescriptions are written every year.1

In the US, some

References in notes section.

5

6

Noncompliance so Prevalent?

Why is

Factors governing adherence differ from patient to patient and, even among the same patient, from context to context. Typically, though, there are some “usual suspects” that are responsible to some degree.

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• Forgetfulness

• Lack of knowledge about the medicationand its use

• Cultural, health, and/or religious beliefs about the medication

• Denial or ambivalence regarding the state of their health

• Financial challenges

• Lack of social support

• Lack of health literacy1

An exhaustive literature review that identified seven patient-related barriers to compliance was carried out in 2009 by Kaiser Permanente


7

Noncompliance


8

Among patients with chronic conditions, such as

High Blood Pressure and High Cholesterolnoncompliance tends to be highest if symptoms aren’t experienced.1

Several distinct studies have revealed this trend, with patients not filling prescriptions or stopping medications after some time.


9

1,2,3

NoncomplianceNoncompliance is plentiful, though, even among

patients who exhibit symptoms for life-threatening conditions.

The high cost of medications is often referenced as one reason for poor adherence, but compliance rates improve only marginally when the cost barrier is removed.

This suggests that there are other things going on. Our assumption is that health literacy may be one factor among many that plays a role.

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Poor Adherence

12%HEALTH

LITERATE1

11

88%LOW HEALTH

LITERATE

12

Health Literacy: The Basics

• Definition: “The degree to which

individuals have the capacity to

obtain, process, understand, [and

act upon] basic health information

and services needed to make

appropriate health decisions.”1

1. US Dept Health & Human Services. Healthy People 2010. Washington, DC: US Govt Printing Office. 2000. 2. Parker R et al. Library outreach: overcoming health literacy challenges. J Med Libr Assoc. 2005 October; 93(4 Suppl): S81‐S85.

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• Poor health literacy is “a stronger predictor of a person’s health than age, income, employment status, education level & race.”2

literacy ≠ health literacy

Understanding the Terminology1,2

Ability to use written or printed information

Interpret and compute

Function in society

Develop knowledgeand potential

Integrated reading, listening, and

analytical skills

Ability to obtain, process, and understand basic

health information

Ability to make appropriate healthcare decisions

14

Low Health Literacy: Who’s at Risk?

Health literacy can affect people of all ages,

races, incomes, and education levels1

Some population groups are particularly vulnerable to health literacy challenges:2

1. U.S. Department of Health and Human Services (HHS). Office of Disease Prevention and Health Promotion. National Action Plan to Improve Health Literacy. Washington, DC: Author. 2010.2. Weiss BD. Health Literacy and Patient Safety: Help People Understand. American Medical Association Foundation and American Medical Association. May 2007.

Nearly 9 out of 10 American Adults have a problem related to health literacy

Health literacy depends on the context.Even people with advanced education and reading skills can face health literacy challenges

Recent immigrants who

do not speak EnglishMinorities Low income

The Elderly

(65+)

15

Multiple studies suggest a link between low health literacy and low comprehension.

Limited Health Literacy

Less likely to understand: 1, 2

• Terminology

• Risks

• Benefits


16

Comprehension and Behavior


17

• A correlation between comprehension and behavior, however, is not as clear.

• That being said, it is commonly assumed that low health literacy compromises self-care by influencing patients’ ability to understand and learn health-related materials that could otherwise inform attempts at self-care.2

• Higher rates of hospitalization than in individuals with higher health literacy.1,2,3

• Higher mortality rates than in individuals with higher health literacy.4

• Though the link is not definitive, the relationship between health literacy and outcomes likely reflects inadequate self-care behaviors.

Lower health literacy has been linked to poorer overall health outcomes.


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19

Agenda


– What is it?


HCP/RPh Survey



Patient Survey





Next Steps?

• Assess HCPs perceptions of patient adherence

• Determine what information HCPs provide to patients

Research Objectives

Research Objectives and Methodology

• 10 minute online survey by Research+

• Interviews were collected April 1st, 2016.

Methodology

Sample Overview

PCPs 50

CARDs 50

PHARMs 50

Total 150

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Doctors estimate that over 20% of patients aren’t taking their medication as prescribed, and that 12% don’t

understand how to take their medication.

MD & RPh Results

30%

22%

16%

14%

13%

12%

9%

0% 20% 40% 60%

Blood pressure too high

Aren't taking medication

Side effects

Can't afford Rxs

Don't fill

Don't understand

Drug interactions

21

MDs are optimistic that a majority of patients are taking their medication as prescribed. Meanwhile, most of RPhs say

up to 24% hypertensive Rxs are abandoned; up to 24% of initial starts are not refilled; and up to 49% are refilled late.

This suggests a bigger problem than MDs realize.

48%

48%

4%

1%

10%

90%

8%

28%

64%

2%

16%

52%

30%

75-100%

50-74%

25-49%

0 to 24%

RPh filled late

RPh not refilled

RPh abandoned

MDs Take as prescribed

Problems Discovered During Patient Visit

Physicians are more likely to tell the patient about dosing than to ask if they take their medication

60%

26%

14%

5%

36%

59%

3%

14%

83%

0% 50% 100%

Some of the time or less

Most of the time

All the time

MD tell dosing

MD Ask if taking

RPh Ask if taking

MD & RPh Results

22

All

Total n=50

What the drug is for 98%

When the drug should be taken 92%

How the drug should be taken 88%

Potential side effects 96%

Check for drug interactions 78%

None of the above 0%

Pharmacists have a lot of things to tell patients – how and when the

drug should be taken are just part of it.

MDs and RPhs agree that between 15 and 20% of patients have hearing difficulties or difficulties with

understanding or reading English.

RPhs are slightly more likely than MDs to believe that compliance

is related to comprehension

18%

19%

21%

18%

18%

16%

0% 20% 40%

Understand English

Read English

Hearing

RPh

1%4% 6% 8% 10%

17%21%

17%

10%7%

2% 4% 6%

12%

36%

24%

4%

12%

1 2 3 4 5 6 7 8 9 10

Disagree Agree

MD Mean = 6.48

RPh Mean = 7.24

MD

MD & RPh Results

23

Percentage of Patients Having Difficulties

Triggers to ask About Compliance• About 60% of doctors indicated that there are

particular circumstances in which they will ask about drug compliance.

• The most often trigger for a doctor to ask about whether the patient is taking their blood pressure medication is lack of efficacy (26 mentions).

• Also mentioned, but at much lower levels, were if the patient hasn’t called for refills for their Rx (11), if the patient has previously demonstrated lack of compliance (10) , is on multiple meds (9 mentions), or if cost is a concern for the patient (8) .

• Perceived health literacy is not a trigger.

RP

hs

18%Yes

38%Yes

MDs are more surprised about compliance statistics than RPhs

MD

s

MD & RPh Results

24

25

Agenda


– What is it?


HCP/RPh Survey



Patient Survey





Next Steps?

• Assess individuals health literacy.

• Assess comfort with filling out medical forms.

• Determine how an individuals health literacy impact their ability to read a medication label.

Research Objectives


• 11 minute online survey with hypertensive individuals/members of the general population.

• Special recruiting effort to achieve an adequate sample of low income/education individuals.

• Respondents were recruited from MarketVision’s panel (74%) supplemented by Custom Mix (26%).

• Interviews were collected between March 18 th, 2016 and March 28th, 2016.

Methodology

Sample Overview (n=805)

Segment Classification

Hypertensive Label A n= 200

Hypertensive Label B n=206

General Population Label A n=201

General Population Label B n=199

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Random assignment of participant to medication label. The labels depicted the same product,

but were written at different levels of education.

Determine Health Literacy Level through answering a series of questions

about an ice cream label

Assess individuals’ ability to correctly answer information

about medication labels

Health Literate Label

LabelA

TraditionalLabel

LabelB

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Medication Labels

Health Literate Label Traditional Label

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Label A

Label B

Health Literacy Using NVS Scale

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Health Literacy Levels

6%

20%

74%

Total (n=805)

Adequate Literacy

Possible Limited Literacy

Limited Literacy

Score of 4-6 almost always indicates adequate literacyScore of 2-3 indicates the possibility of limited literacy Score of 0-1 suggests high likelihood (50% or more) of limited literacy

“If you eat the entire container, how many calories will you eat?”

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Respondents were categorized using the Newest Vital Signs (NVS); 74% had adequate literacy.

Demographic Profile of Sample

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50%

27%

42%

54%

No

50%

73%

58%

46%

Yes

Total Limited Literacy(A)

Possible Limited Literacy(B)

Adequate Literacy(C)

EthnicityTotal

Limited Literacy

(A)

PossibleLimited Literacy

(B)

Adequate Literacy

(C)

Caucasian/White 80% 55% 79%A 82%A

African American/Black 11% 37%BC 17%C 7%

Asian or Pacific Islander 4% 2% 2% 4%

Native American 1% 0% 0% 1%

Other 4% 4% 3% 5%

Demographic Profile | Health Literacy Types High Likelihood of Limited Literacy, Possible Limited Literacy, Adequate Literacy

Gender

Diagnosed with Hypertension

Hispanic Origin(% Answering yes)

12%

Base: Total (n=805); Limited Literacy (n=51); Possible Limited Literacy (n=158); Adequate Literacy (n=596)A/B/C indicates a significant difference between groups at a 95% confidence level.Q.1/Q.3/Q.5/Q.6/Q.7

C

C

43% 57%42% 58% 42% 58% 42% 58%

11% 12% 12%

Average AgeTotal

Limited Literacy

(A)


(B)

Adequate Literacy

(C)

51 56C 54C 50

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Those with hypertension more often have limited or possible limited health literacy.

AB

Demographic Profile | Health Literacy Types High Likelihood of Limited Literacy, Possible Limited Literacy, Adequate Literacy

Income LevelTotal

Limited Literacy(A)


(B)

Adequate Literacy

(C)

24k or less 40% 59%C 53%C 34%

25k- 39,999k 21% 20% 19% 22%

40k-59,999k 12% 12% 12% 12%

60k-74,999k 8% 0% 6% 10%A

75k-99,999k 7% 2% 3% 8%B

100k + 9% 2% 3% 12%AB

CaregiversTotal

Limited Literacy(A)


(B)

Adequate Literacy

(C)

A Child 19% 18% 13% 20%B

An Elderly Parent 7% 16%BC 6% 6%

A Disabled Person 4% 10%C 5% 4%

An Elderly Relative or Friend 3% 6% 2% 3%

I am not a Caretaker 72% 67% 75% 72%Base: Total (n=805); Limited Literacy (n=51); Possible Limited Literacy (n=158); Adequate Literacy (n=596)A/B/C indicates a significant difference between groups at a 95% confidence level.Q.8/Q.9/Q.10

3%

50%

23%

24%

4%

73%BC

16%

8%

8%C

57%C

20%

15%

2%

46%

24%

28%

Less thanhigh school

Completed HighSchool/GED

Some College/Technical School

Graduated College/Technical School or

more

Total Limited Literacy(A)

Possible Limited Literacy(B)

Adequate Literacy(C)

School Completed

AB

$

33

Those who have adequate health literacy tend to have higher income and education, while those with limited or possible limited literacy tend to have lower income and education.

Drug Label Test: Health Literate vs. Traditional Label

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31% 10% 40% 29%

13%

53%

87%

47%

MedicationLabel A(n=79)

MedicationLabel B(n=79)

6%

36%

95%

64%



1%

30%

99%

70%



Correct(To treathigh bloodpressure)

Incorrect36%46%

64%54%

MedicationLabel A(n=25*)

MedicationLabel B(n=26*)

Health Literacy Segments PRODUCT XYZ is a medicine that is prescribed...

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.C/D/E indicates a significant difference between groups at a 95% confidence level.Q.21 PRODUCT XYZ is a medicine that is prescribed... *Caution: Small base size.

BBD

D

B

% point difference between labels A & B“Correct” answers

A

AEA

E


(D)

LimitedLiteracy

(C)

Adequate Literacy

(E)Total

35

Those with adequate health literacy more often get this correct than those with limited health literacy.

10% 14% 18% 8%

3% 8%6%9%

1%2%

90%80%



20% 27%4%

4%4%

12%

72%58%



8%18%

13%

18%1%

4%

79%61%



1% 4%4%8%

1%

95%87%



No(Correct)

Yes

It doesn't say

I don't know

Health Literacy Segments Frank is allergic to product xyz. Should he take PRODUCT XYZ?

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.C/D/E indicates a significant difference between groups at a 95% confidence level.Q.22 Frank is allergic to product xyz. Should he take PRODUCT XYZ? *Caution: Small base size.


(D)

LimitedLiteracy

(C)

Adequate Literacy

(E)Total

BBD

A

E

E

E

E

E

EB

A

36



15% 2% 10% 17%

20%31%

12%

15%8%

12% 4%8% 8%

40% 42%



19%33%

14%3%1% 3%5% 3%

9%

61%51%



11%23%6%

7%

1%

1%1%

1%

4%

81%64%



*Once a day(Correct)

Twice a day atbreakfast andat dinner

Before each meal

When she feelsstressed out

None of the above

I don't know


(D)

LimitedLiteracy

(C)

Adequate Literacy

(E)Total

13%25%

8%

6%1%

1%2%

2%1%

5%

75%60%



Health Literacy Segments Christine has been prescribed PRODUCT XYZ and should take it...

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.C/D/E indicates a significant difference between groups at a 95% confidence level.Q.23 Christine has been prescribed PRODUCT XYZ .and should take it... *Caution: Small base size.

BE

BD

A

A

A

A

E

E

DB

A

A

37



53% 13% 40% 60%

36%27%

24%

15%

12%

19%

40%27%



8%

31%10%

30%

2%

1%

6%

2%

5%

79%

26%



11%

33%23%

27%

4%

1%

6%

3%

9%62%

22%



5%

31%6%

32%

1%4%

2%

5%

87%

27%



*Chest pain, musclecramps, and dizziness(Correct)

Coughing, shortness ofbreath, and sweating

Watery eyes, bodyrash, and dry mouth

Sneezing, feeling cold,and an itchy throat

None of thecombinations above

I don't know

Health Literacy Segments

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.C/D/E indicates a significant difference between groups at a 95% confidence level.Q.24 Potential side effects of taking Product XYZ include... *Caution: Small base size.


(D)

LimitedLiteracy

(C)

Adequate Literacy

(E)Total

B

BD

A

AA

A

AE

E

EB

AAA

A

A

Potential SEs

38


Those with adequate health literacy more often get this correct for Label A than those with limited health literacy; on Label B both groups do equally well.

33% 13% 18% 39%

11%24%5%

7%

1%

2%

2%

8%

6%

16%

76%

43%



15%28%

11%

13%3%

5%

8%

13%

11%

56%38%



7%23%3%

6%

1%

1%7%

5%

17%

84%

45%



*May cause a problemwith how it works(Correct)

Will not cause aproblem with how itworks

May make it stronger,giving you better bloodpressure control

Will make it safer touse

None of the above

I don't know

36%27%

8%

8%

8%12%

4% 12%4%

15%

40%27%



Health Literacy Segments Taking PRODUCT XYZ with grapefruit juice...

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.C/D/E indicates a significant difference between groups at a 95% confidence level.Q.26 Taking PRODUCT XYZ with grapefruit juice... *Caution: Small base size


(D)

LimitedLiteracy

(C)

Adequate Literacy

(E)Total

B

BD

A

A

AEEE

E

E

B

A

A

A

39



12%27%

16%

4%

20%

31%

24%

15%

12%

19%16%

4%



2% 8%3%

12%8%

19%

12%

28%

19%

26%57%

7%



5%15%9%

20%13%

20%

17%

25%

24%

14%33%

5%



B

AE

AEEE

E

4%11%

6%

18%

9%

29%

18%

30%

67%

8%



5

4

3

2

1

0

Overall Performance on Medication Label

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.C/D/E indicates a significant difference between groups at a 95% confidence level. Label Scores*Caution: Small base size.


(D)

LimitedLiteracy

(C)

Adequate Literacy

(E)Total

BD

AD

A

A

AA

B

A

A

A

A

A

4.1 2.7 2.6 2.1 3.4B 2.2 4.5BD 2.9D

40

Average NumberCorrect

Those with adequate health literacy get more questions correct than those with limited health literacy.

Correlations:

Total# Correct (Q21-Q26) X Health Literacy Score 0.43 0.23

Total# Correct (Q21-Q26) X Comfort Filling out Medical Forms* 0.10 0.15

Total# Correct (Q21-Q26) X Household Income 0.17 0.07

Total# Correct (Q21-Q26) X Age -0.09 0.01

Total# Correct (Q21-Q26) X Last Year of School Completed 0.13 0.08

Newest Vital Signs (NVS) Predicting Accuracy on the Label Test

41

The Newest Vital Signs (NVS) measure does moderately well in predicting accuracy on the test on the Health Literate label, but does less well on the Traditional label.

Label A

Label B

Drug Label Test: by Patient Background

42

4.1B 2.9H

8%1%

12%

7%

19%

8%

27%

20%

28%

63%

6%



3%11%5%

12%9%

20%

15%

26%

20%

24%50%

8%



1% 3%1%13%

8%

18%

9%

30%

18%

30%

64%

6%



5

4

3

2

1

0

3% 7%6%13%9%

21%17%

27%

16%

25%50%

8%



2% 8%3%8%9%

16%13%

31%

21%

31%53%

7%



2%8%3%

17%8%

23%

10%

24%

16%

22%

61%

7%



General Population

(H)

Income 24k or Less

(E)

Income 25k and Beyond

(F)

HS or Less Education

(C)

Some College or More

(D)

Hypertensive(G)

Average NumberCorrect

B

AD

A

A

A

D

BC

A

A

A

A

3.9B 2.6 4.3BC 2.9C

BA

A

A

A

BE

A

A

A

A

3.9B 2.7 4.4BE 2.7

F

F

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.C/D/E/F indicates a significant difference between groups at a 95% confidence level.Label Scores

4.2B 2.6

Overall Performance on Medication Label

B A

A

A

AA

B

B

B

AG

A

43

Those with hypertension get similar scores on the medication label test as those without hypertension.

Developing a Simpler Tool:Comfort with Medical Forms?

44

59%

41%

(n=51)

49%

51%

(n=158)

Health Literacy Segments Compared to Comfort With Medical Forms

.C/D/E indicates a significant difference between groups at a 95% confidence level.Q.18 How comfortable are you filling out medical forms?


(D)

LimitedLiteracy

(C)

Adequate Literacy

(E)

CD

EE

Comfortable Filling Out

Medical Forms

35%

65%

(n=596)

Comfortable(Top 2)

Not Comfortable(Bottom 3)

45

This question about being comfortable with filling out medical forms was thought to be a simpler proxy for determining health literacy. It provides some direction, but another 1-question tool should be considered.

46

Agenda


– What is it?


HCP Survey



Patient Survey





Next Steps?

47

Next Steps?

Appendix

48

Demographic Splits

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.E/F/G/H/I/J indicates a significant difference between groups at a 95% confidence level.Q.21 PRODUCT XYZ is a medicine that is prescribed...

3%13%1%7%

1%

1%1%3%

95%76%



To treat high blood pressure(Correct)

For hyperactivity To treat liver failure For the treatment of kidney disease None of the above I don't know

3%17%2%

13%1%

1%

1%

3%15%

94%

52%



B B

A

AA

AE

A

A

F

E

General Population

(F)

1%15%

1%

11%1%1%

10%

97%

63%



5%14%2%9%1%1%

2%8%

92%

68%



B

A

AA

BI

A

A

A

Income 24k or Less

(G)

Income 25k or More

(H)

4%17%2%

11%

1%1%

1%

10%

93%

61%



2%11%1%9%

1%

1%2%9%

97%

69%



B

A

A

A

B

BB

BB

High Schoolor Less

(I)


(J)

Hypertensive(E)

% Point Difference Between Labels A & B“Correct” answers

19% 42% 32% 28% 24% 34%

A

49

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.E/F/G/H/I/J indicates a significant difference between groups at a 95% confidence level.Q.21 PRODUCT XYZ is a medicine that is prescribed...

3%16%2%

6%1%

1%

1%

1%10%

93%

66%



3%14%1%

13%1%

9%

96%

63%



2%13%1%

14%1%

1%3%

15%

97%

54%



Demographic Splits



4%15%2%

9%7%

94%

69%



2%14%9%1%

1%

2%

1%

8%

97%

66%



4%15%2%

10%1%

1%10%

94%

64%



B B

A

A

AE

A

B

AH

AHAA

G

B

A

A

A

B

Female(I)

Age 18-44(G)

Age 45+(H)

Caretaker(I)

Not a Caretaker

(J)

Male(E)

% Point Difference Between Labels A & B“Correct” answers

27% 33% 43% 25% 31% 30%

B

AA

A

A

AA

A

50

48% 57% 44% 60%

5%

32%7%

31%

2%5%

2%

6%

85%

25%



*Chest pain, musclecramps, and dizziness

Coughing, shortness ofbreath, and sweating

Watery eyes, bodyrash, and dry mouth

Sneezing, feeling cold,and an itchy throat

None of thecombinations above

I don't know6%

32%7%

27%

2%

1%

6%

3%

6%

84%

27%



11%

31%14%

32%

2%5%

1%

4%74%

26%



Health Literacy Segments Potential side effects of taking Product XYZ include...

11%30%

16%

29%

2%

1%

7%

1%

5%71%

27%




(D)


Income24k or less

(E)

Income25k or more

(F)


(C)

BBC

BBE

AA

A

A

AA

A

A

A

A

A

A

A

AD

D

F

F

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.C/D/E indicates a significant difference between groups at a 95% confidence level.Q.24 Potential side effects of taking Product XYZ include... 51

8%23%8%

7%1%1%

1%

1%

4%

81%65%



*Once a day(Correct)

Twice a day atbreakfast andat dinnerBefore each meal

When she feelsstressed out

None of the above

I don't know16%27%

8%

8%1%3%

1%1%

5%

72%59%



13% 15% 15% 16%

17%29%

9%6%2%

2%4%

3%1%

8%

68%53%



10%23%9%

5%2%

2%1%

2%2%

6%

78%63%




Health Literacy Segments

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.C/D/E/F indicates a significant difference between groups at a 95% confidence level.Q.23 Christine has been prescribed PRODUCT XYZ and should take it...

B BB

BC

F

F

E

A

A

A

A

A

A

A

A

52


(D)

Income24k or less

(E)

Income25k or more

(F)


(C)

10% 9% 7% 12%

5% 12%10%11%2%2%

85%75%



2% 4%3%7%2%

96%87%



6% 9%6%

10%1%1%

87% 80%



8%5%

9%1%

3%

93%81%



No(Correct)

Yes

It doesn't say

I don't know

Health Literacy Segments Frank is allergic to product xyz. Should he take PRODUCT XYZ?

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.C/D/E/F indicates a significant difference between groups at a 95% confidence level.Q.22 Frank is allergic to product xyz. Should he take PRODUCT XYZ?

BBC BE

AD A AD

F

C

53



(D)

Income24k or less

(E)

Income25k or more

(F)


(C)

32% 28% 24% 34%

Health Literacy Segments PRODUCT XYZ is a medicine that is prescribed...

A/B indicates a significant difference between Label A and Label B at a 95% confidence level.C/D/E/F indicates a significant difference between groups at a 95% confidence level.Q.21 PRODUCT XYZ is a medicine that is prescribed...




4%17%2%

11%1%1%

1%

10%

93%

61%



2% 11%1%9%1%

1%2%9%

97%

69%



5% 14%2%9%

1% 1%

2%8%

92%

68%



1%15%1%

11%1%1%

10%

97%

63%



B

A

A

A

B

AA

AA

B

A

A

A

BE

A

A

AF

54


(D)

Income24k or less

(E)

Income25k or more

(F)


(C)

Health Literacy Considerations in Research - Intellus Connect/slides/Mon 415 Health... · Health...

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