Health and medication literacy and the desire to participate in pharmacotherapy decision making – comparison of two countries

Exploring medicine classification and accessibility: a qualitative study

Background

Brunei Darussalam's medicine control governance landscape is complex, driven by legislative directives and directed by the Brunei Darussalam Medicines Control Authority (BDMCA). While the medicine dispensing system in Brunei Darussalam, across both governmental and private sectors, is a critical component of the nation's healthcare, it remains under-researched, leaving gaps in understanding its distinctions, challenges, and opportunities. This study aimed to explore deep into the perspectives of pharmacists regarding the medicine dispensing systems in Brunei Darussalam, medicine accessibility, the classification and regulation of medicines, and the growing role of pharmacists.

Methods

Using a narrative qualitative approach, we conducted in-depth one-on-one interviews with six pharmacists, delving into their personal experiences with topics such as medicine classification and the broader systems for medication provision. The collected narratives were analysed through a rigorous thematic analysis, following the framework established by Braun & Clarke.

Results

Five themes emerged from the data: nuances of Brunei Darussalam's medicine dispensing landscape across both public and private sectors; accessibility and regulatory framework of medicines both in Brunei Darussalam and abroad; prospective implementations to enhance the current system; and the evolving role and expectations of pharmacists in the current healthcare environment. Notably, a significant contribution of this study was the illumination of the differential perspectives between pharmacists operating in governmental versus private contexts.

Conclusion

This study sheds light on the previously under-explored domain of Brunei Darussalam's medicine control governance and medicine dispensing system. By drawing from the first-hand experiences of practicing pharmacists, it offers actionable insights that could guide future policy developments, optimise medicine dispensation and regulation, and shape the evolving role of pharmacists in Brunei Darussalam.

Doctors taking bribes from pharmaceutical companies is common and not substantially reduced by an educational intervention: a pragmatic randomised controlled trial in Pakistan

INTRODUCTION

Incentive-linked prescribing, which is when healthcare providers accept incentives from pharmaceutical companies for prescribing promoted medicines, is a form of bribery that harms patients and health systems globally. We developed a novel method using data collectors posing as pharmaceutical company sales representatives to evaluate private doctors' engagement in incentive-linked prescribing and the impact of a multifaceted educational intervention on reducing this practice in Karachi, Pakistan.

METHODS

We made a sampling frame of all doctors running for-profit, primary-care clinics and randomly allocated participants to control and intervention groups (1:1). The intervention group received a multifaceted seminar on ethical prescribing and reinforcement messages over 6 weeks. The control group attended a seminar without mention of ethical prescribing. The primary outcome was the proportion of participants agreeing to accept incentives in exchange for prescribing promoted medicines from data collectors posing as pharmaceutical company representatives, 3 months after the seminars.

RESULTS

We enrolled 419 of 440 eligible participants. Of 210 participants randomly allocated to the intervention group, 135 (64%) attended the intervention seminar and of 209 participants allocated to the control group, 132 (63%) attended the placebo seminar. The primary outcome was assessed in 130 (96%) and 124 (94%) of intervention and control participants, respectively. No participants detected the covert data collectors. 52 control group doctors (41.9%) agreed to accept incentives as compared with 42 intervention group doctors (32.3%). After adjusting for doctors' age, sex and clinic district, there was no evidence of the intervention's impact on the primary outcome (OR 0.70 [95% CI 0.40 to 1.20], p=0.192).

CONCLUSIONS

This first study to covertly assess deal-making between doctors and pharmaceutical company representatives demonstrated that the practice is strikingly widespread in the study setting and suggested that substantial reductions are unlikely to be achieved by educational interventions alone. Our novel method provides an opportunity to generate evidence on deal-making between doctors and pharmaceutical companies elsewhere.

Development and Testing of a Multi-Component Intervention to Improve Medication Literacy in Glaucoma Patients

Objective

To develop a medication literacy intervention program for glaucoma and test its effects on medication literacy, medication self-efficacy and medication adherence.

Methods

The intervention was constructed according to the Information-Motivation-Behavioral skills Model and the Health Belief Model. Preliminary protocols were revised through expert group meetings and pre-experiments to form a formal intervention plan. Subsequently, 66 patients with glaucoma were enrolled and randomly assigned to the control and intervention groups. The control group was received with routine follow-up and education for glaucoma patients, while the intervention group was given an 8-weeks medication literacy intervention for glaucoma patients. Before the implementation of the intervention and at the end of the 8th week of the intervention, the Chinese Version of the Medication Literacy Scale, the Short Version of the Glaucoma Medication Self-Efficacy Questionnaire and the Chinese version of the Morisky Medication Adherence Scale-8 were used to evaluate the medication literacy level, medication self-efficacy and medication adherence of glaucoma patients in the intervention group and the control group.

Results

We developed an 8-weeks multi-component medication literacy intervention for glaucoma. Before the start of the intervention, there were no statistically significant differences in the scores of medication literacy, medication self-efficacy and medication adherence between the control group and the intervention group. After the intervention, the medication literacy, medication self-efficacy, and medication adherence of the intervention patients were significantly better than those of the control group (P<0.05).

Conclusion

The 8-weeks multi-component intervention for glaucoma patients can improve their medication literacy, medication self-efficacy, and medication adherence.

Medication literacy and its social contextuality

This article aims to contribute to the discussion about medication literacy, by focussing on the social contextuality of the information mobilised in the use of medicines. We aim to explore the social construction processes of medication literacy, as an essential dimension for a more layperson-centred approach in the promotion of literacy in this field. This approach is justified by the growing social and cultural dissemination of medication use, the diversification of its uses beyond health and illness, and the increasing degree of lay autonomy in managing its use. The article is organised in two main sections. In the first section, we review the social history of medication literacy, including a discussion of the social contextuality of literacy phenomena. In the second section, the analysis of social contextuality is operationalised with a focus on information, covering: (i) ways of relating to institutional information and sources of information about medication; (ii) contexts of sociability in which information is shared and validated. This analysis is empirically supported by selected results from two research projects, conducted in Portugal, on the consumption of medicines and dietary supplements for performance purposes - that is, for the management and/or improvement of cognitive, bodily or relational performance.

Construction and practice of a novel pharmaceutical health literacy intervention model in psychiatric hospital

OBJECTIVE

Pharmaceutical health literacy intervention (PHLI) plays a crucial role in influencing patients' medical decision-making, particularly concerning medication use. However, PHLI has not been widely implemented in China. This study aims to develop a novel PHLI model within a psychiatric hospital setting and evaluate its effectiveness.

METHODS

A PHLI model encompassing four modes-covering inpatients, outpatients, Internet+ and community-was established at The Affiliated Mental Health Center of Jiangnan University. The model's operation was detailed, and its performance data from 2022 and 2023 were evaluated.

RESULTS

In 2022 and 2023, a total of 636 PHLI cases were reported. Of these, 386 cases (60.69%) were identified through the inpatient mode. The proportion of PHLI delivered via inpatient and Internet information subscription modes gradually increased, while interventions through other methods decreased. The age group of 18-30 accounted for 21.97% of cases, with 116 instances reported. Various types of PHLI were provided, including adverse reactions (18.87%), dosage and administration (11.64%), and therapeutic drug monitoring (9.43%). In addition, intervention strategies primarily focused on adverse reaction identification (10.22%), interpretation of pharmaceutical reports (7.23%), and routine examination reminders (6.45%).

CONCLUSION

The PHLI model developed at our hospital offers an effective approach to health literacy intervention and represents an innovation advancement in pharmaceutical health literacy management. It can also serve as a reference framework for other hospitals.

Specific Medication Literacy in Older Adults with Asthma

Purpose

To explore specific medication literacy (SML) of older adults and associations of SML strength.

Methods

This was an observational study. Participants were at least 60 years old, with an asthma diagnosis and in good health. Data were collected by a registered nurse researcher. The SML data collection instrument gathered information about each medication a participant used: name, purpose, how taken, special instructions, adverse effects, and drug-drug or drug-disease interactions. An SML scoring rubric was developed.

Results

All could provide name, and most provided purpose, how taken. The lowest SML domains were side effects and interactions. Age at time of asthma diagnosis correlated with stronger SML scores and living in a disadvantaged neighborhood correlated with lower SML scores.

Discussion

Gaps in medication literacy may create less ability to self-monitor. Patients want medication literacy but struggle with appropriate, individualized, information.

Conclusion

The study provides insights on gaps and opportunities for SML.

Analysis of Japanese consumers' attitudes toward the digital transformation of OTC medicine purchase behavior and eHealth literacy: an online survey for digital experience design

Introduction

Since the enactment of the revised Pharmaceutical Affairs Act in Japan in 2009, self-medication practices have increased in the country. However, studies report that consumers pay little attention to the medication facts and risks indicated on the packages of over-the-counter (OTC) medicines, which could be a potential risk. Since the COVID-19 pandemic, the digital transformation of purchasing OTC medicines has progressed. As an appropriate design for the digital transformation is likely to improve consumers' literacy and them obtaining medical information, this study systematically examines Japanese consumers' attitudes toward the digital transformation of OTC medicine purchase behavior and its correlation to eHealth literacy, exploring an appropriate digital experience design in purchasing OTC medicine.

Methods

Participants from the Greater Tokyo Area of Japan participated in an online survey. Consumers' current behavior and preferences in accessing OTC medicine, receiving medication guidance, and obtaining medical information were examined. eHealth literacy was assessed using the J-eHEALS. Descriptive statistics, text mining, and thematic analysis were conducted to answer research questions.

Results

Over 89% of the respondents who had experience in purchasing OTC medicines preferred local pharmacies or stores rather than online purchasing, p < 0.001. Obtaining medicine guidance in pharmacies or stores was the main preference over other approaches, p < 0.001. Furthermore, most of the participants accepted selecting medicine on shelves and digital screens in-store. However, they were accustomed to using smartphones to obtain additional information at the pharmacy or drug store, p < 0.001; this behavior was positively correlated with eHealth literacy, p < 0.001.

Conclusions

Japanese consumers are seeking a combination of conventional and digital behaviors for purchasing OTC medicine rather than opting for a particular method. Most consumers prefer purchasing and receiving instructions in-store while searching for additional decision-making information online. eHealth literacy is positively associated with digital behaviors of OTC medicine information acquisition but less associated with medicine purchases and selections. The hybrid digital experience design may enhance the OTC medicine purchase experience and reduce potential risks by providing appropriate information.

Treatment Decision-Making Preferences of Older Depressed Minority Primary Care Patients

Little research examined the decision-making preferences of older, racially and ethnically diverse minority patients with untreated depression. The study's aims were to identify decision-making preferences and the characteristics associated with a more active preference in the decision-making process for general medical and depression treatment decisions. We assessed the preferred involvement in making general medical and depression treatment decisions of 201 older primary care patients with untreated depression. Linear regressions examined the association of sociodemographic and clinical characteristics with decision-making preference for both decision types. Majority of patients preferred shared decision-making for general medical and depression treatments. Female gender was associated with a preference for active decision-making for depression treatment. For this sample older depressed patients preferred sharing the decision-making responsibilities with physicians. To improve communication and the initiation and adherence to mental health care, physicians must consider older, minority patients' preferences for involvement in the decision-making process.

[Why is it increasingly difficult to "do the right thing" and to "stop doing the wrong thing"? Strategies for reversing low-value practices]

This manuscript describes the factors that have led to the spread of low-value practices (LVP) and the main initiatives to reverse them. The paper highlights the strategies that have proven to be most useful over the years, from the alignment of clinical practice with "do not do" recommendations, to quaternary prevention and the risks associated with interventionism. Reversing LVP requires a planned process with a multifactorial approach engaging the different actors involved. It considers the barriers to de-implementation of low-value interventions and incorporates tools that facilitate adherence to "do not do" recommendations. Family doctor has an especially relevant role in LVP prevention, detection and de-implementation, due to their coordinating and integrating nature in the patients' healthcare, and because most of the citizens' healthcare demands are managed and resolved at the first level of care.

Status and influencing factors of medication literacy among Chinese caregivers of discharged children with Kawasaki disease

Background

The information on medication literacy among Chinese caregivers of discharged children with Kawasaki disease (KD) is unknown. We aimed to investigate the status of medication literacy among caregivers of discharged children with KD and evaluate the influencing factors of medication literacy.

Methods

From March 2020 to February 2021, 106 caregivers with a KD child were recruited for the present study. We collected the sociodemographic characteristics of the KD caregivers using structured interviews. The medication literacy of the KD caregivers was assessed by the Chinese version of Medication Literacy Assessment. KD patients' demographic and clinical data were obtained from the medical records. The multiple logistic regression was performed to identify factors associated with medication literacy.

Results

(1) The average medication literacy score was 4.91 ± 1.51. (2) Most of the Chinese KD caregivers had insufficient medication literacy (≤ 5 scores), and only 39.2% of the caregivers had adequate medication literacy (>5 scores). (3) The multiple logistic regression shows that education level, monthly income, and duration of hospitalization are the independent influencing factors on the medication literacy of KD caregivers.

Conclusion

There is preliminary evidence that medication literacy among KD caregivers is low and needs improvement. A higher level of education, higher income, and longer duration of hospitalization were influencing factors of adequate medication literacy.

The relationship between medication literacy and skin adverse reactions in non-small-cell lung cancer patients undergoing targeted EGFR-TKI therapy

BACKGROUND

High medication literacy is the basis of rational medication application and is essential for the management of severe adverse drug reactions. The objective of the present study was to assess the level of medication literacy and determine the association between medication literacy and skin adverse drug reactions in non-small-cell lung cancer (NSCLC) patients undergoing targeted epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy.

METHODS

This is a cross-sectional study conducted from May to September 2020. In total, 296 NSCLC patients undergoing targeted EGFR-TKI therapy were recruited from hospitals in Henan, China. Structured questionnaires were used to evaluate skin adverse drug reactions and medication literacy. Pearson correlation analysis and binary logistic regression analysis were carried out to identify the correlations between medication literacy and the severity of skin adverse drug reactions in the recruited patients.

RESULTS

The research sample consisted of 296 patients with a response rate of 92.5%. The mean score of skin adverse drug reactions and the mean score of medication literacy were 1.83 ± 0.91 and 6.54 ± 2.78, respectively. In total, 188 patients (63.5%) were considered to have moderate medication literacy. According to the binary logistic regression analysis, the following factors were associated with severe skin adverse drug reactions: age (B =  - 3.929, P = 0.000), sex (B = -4.062, P = 0.000), educational level (B = 2.712, P = 0.002), comorbidity (B = 3.297, P = 0.001), eczema history (B = 2.996, P = 0.001), nutritional status (B = -4.891, P = 0.000), blood interleukin-6 level (B = -2.143, P = 0.013), blood high-sensitivity C-reactive protein level (B = -4.015, P = 0.000), combination of drugs (B = -3.183, P = 0.048) and medication literacy (B =  - 1.503, P = 0.000). Subgroup analysis showed that in addition to medication literacy, some other factors including education level, comorbidity, nutritional status, blood interleukin-6 level and combined drug application were common factors that contributed to various adverse skin drug reactions in NSCLC patients under targeted EGFR-TKI therapy.

CONCLUSION

The low medication literacy of the investigated NSCLC patients undergoing targeted EGFR-TKI therapy was correlated with a high proportion of severe skin adverse drug reactions. In addition, factors other than medication literacy including education level, comorbidity, nutritional status, blood interleukin-6 level and the combinatorial application of drugs were also related to the severity of various adverse skin drug reactions. A comprehensive and targeted intervention may be beneficial to improve medication literacy and control severe skin adverse drug reactions in NSCLC patients.

Relationship Between Family Functioning and Medication Adherence in Chinese Patients With Mechanical Heart Valve Replacement: A Moderated Mediation Model

Background: Medication adherence is crucial for patients with mechanical heart valve replacement. Although families functioning is positively associated with medication adherence, little is known about the underlying mechanisms. Objective: To test whether family functioning affects medication adherence through illness perceptions and whether this mediating effect was moderated by medication literacy. Methods: 319 patients after mechanical heart valve replacement were included in this cross-sectional study from June 2021 to October 2021. Data regarding family functioning, illness perceptions, medication adherence, and medication literacy were collected through questionnaires. The moderated mediation model was examined by Hayes's PROCESS macro, based on the bootstrapping method. Results: The results revealed illness perceptions partially mediated the association of family functioning on medication adherence [β = 0.08, 95% confidence intervals: (0.04, 0.12)], and this effect was stronger for patients with low medication literacy than those with high literacy [β = -0.36, 95% CI: (-0.50, -0.22)]. Furthermore, the relationship between family functioning and medication adherence was only significant in patients with low medication literacy [β = 0.36, 95% CI: (0.23, 0.50)]. Conclusion: The mediating effect of illness perceptions between family functioning and medication adherence was moderated by medication literacy. Efforts to improve medication adherence by targeting at improving family functioning may be more effective when considering illness perceptions, especially for patients with limited medication literacy.

Instruments assessing medication literacy in adult recipients of care: A systematic review of measurement properties

OBJECTIVES

The assessment of medication literacy in patients is an important step in assisting clinicians to plan for education, prescription simplification, assistance and/or medication aids. There have been several attempts to develop a standardised, objective measure of medication literacy. The objectives of this systematic review were to critically appraise, compare and summarise the measurement properties of existing instruments that assess medication literacy in adult recipients of care.

DESIGN

A systematic review was performed.

SEARCH METHODS

Structured searches were conducted in Embase, MEDLINE PubMed, CINAHL, APA PsycINFO and Web of Science Core Collection in March 2020. Additional searches were performed in ProQuest Dissertations and Theses, DART Europe, and Google Scholar, followed by citation tracking of included studies.

REVIEW METHODS

Two researchers independently identified eligible studies. Two researchers then assessed the methodological quality of the studies and quality of measurement properties, using the Consensus-based Standards for selection of health Measurement Instruments (COSMIN) guidelines. A best-evidence synthesis for each instrument was performed.

RESULTS

From the 5035 citations, 17 studies were included that concerned 13 instruments using different administration methods (i.e., performancebased or self-report), medication type (i.e., prescribed or nonprescribed) and context of use (i.e., clinical or community settings). Very low- to moderate-quality evidence supported satisfactory content validity regarding relevance and comprehensibility, while comprehensiveness remained inconsistent. Other measurement properties were less frequently examined and were supported by moderate-quality evidence (i.e., structural validity) to low- or very low-quality evidence (i.e., internal consistency, reliability, construct validity). The bestvalidated instrument is the unidimensional 14-item Medication Literacy in Spanish and English assessment tool (MedLitRxSE), based on direct testing of participant performance regarding four hypothetical scenarios on medication use. Nine instruments have the potential to be recommended but require additional research, while for others, their psychometric soundness is too limited and they require content revisions.

CONCLUSION

This is the first systematic review to identify instruments for medication literacy. None of the identified instruments had all measurement properties properly assessed and none reported measurement invariance, measurement error and responsiveness of the instrument. Further research is necessary for a better theoretical understanding of medication literacy in order to assist health professionals in identifying patient needs for education, regimen simplification, assistance and/or medication aids. Such research will help conceptualise new instruments that not only cover relevant domains dedicated to specific populations (e.g., polymorbid and/or older individuals), but also exhibit satisfactory measurement properties.

Relationship Between Medication Literacy and Medication Adherence in Inpatients With Coronary Heart Disease in Changsha, China

Background: Medication literacy may be associated with medication safety, and medication adherence is critical in treating coronary heart disease. Few studies have explored the association between medication literacy and medication adherence in patients with coronary heart disease. The aim was to investigate the status of medication literacy and medication adherence among Chinese inpatients with coronary heart disease, and explore the association between medication literacy and medication adherence.

Methods: The study was a cross-sectional survey. Four hundred seventy inpatients with coronary heart disease were recruited from hospitals in Changsha, Hunan, China. Participants’ demographic and clinical data were retrieved from hospital charts. Medication adherence was assessed using the four-item Morisky Medication Adherence Scale. Medication literacy was assessed using the Chinese Version of the Medication Literacy Scale. For univariate analysis, potential factors influencing medication adherence were tested by T-tests, analysis of variance, and the Kruskal–Wallis H test. Binary logistic regression model was conducted with medication adherence as the outcome variable in order to analyze the association between medication literacy and medication adherence in inpatients with coronary heart disease.

Results: Among 512 participants, 470 (91.8%) produced valid responses for the survey. Mean (SD) of medication adherence score was 2.26 (13.6); only 13.6% had optimal medication adherence. Mean (SD) of medication literacy score was 7.52 (4.09); participants with adequate medication literacy was 30.2% (142). Binary logistic regression analysis indicated that medication literacy was an independent predictor associated with medication adherence. Participants with adequate medication literacy were more likely to have optimal medication adherence (OR 1.461 [95% CI: 0.114, 0.643]; P = 0.005), and participants with a high level of education (OR 0.613 [95% CI: 0.284, 0.694]; P< 0.001), a fewer number of medicines (OR 1.514 [95% CI: -0.631, -0.198]; P < 0.001), having medical insurance (OR 0.770 [95% CI: -1.769, 0.059]; P = 0.043), and single inpatients were more likely to be adherent (OR 1.655 [95% CI:-0.858, -0.149]; P = 0.005).

Conclusions: The study indicates a significant association between medication literacy and medication adherence in patients with coronary heart disease. These results suggest that medication literacy is an important consideration in the development, implementation, and evaluation of medication adherence interventions.

Association Between Medication Literacy and Medication Adherence Among Patients With Hypertension

Background: Few studies have investigated the association between medication literacy and medication adherence as well as the influence of medication literacy on medication adherence in hypertensive patients. Thus, the goal of the present study was to determine the association between medication literacy and medication adherence in hypertensive patients. Methods: A cross-sectional survey was conducted between August 2016 and December 2016. Self-administered questionnaires were completed, including a self-developed and structured socio-demographic questionnaire; a self-developed, validated, and self-reported Medication Literacy Scale for Hypertensive Patients (C-MLSHP) used for medication literacy measurement; and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8), an eight-item validated, self-report scale for adherence measurement with a total score range of 0-8. A cut-off of 6 was applied to differentiate adherence levels, including patients with an MMAS score <6 (low adherence), MMAS score = 8 (high adherence), and MMAS score ≥6 and <8 (moderate adherence). In this study, hypertensive patients' medication literacy levels and adherence to antihypertensive agents were identified. Pearson correlation analysis was carried out to identify the correlation between medication literacy and adherence. Binary logistic regression analysis was performed with medication adherence as the outcome variable in order to confirm factors associated with medication adherence. Results: A total of 420 hypertensive patients, including 198 women and 222 men with a mean age of 60.6 years (SD = 12.4), were recruited. The mean score of hypertensive patients on the medication literacy scale was 24.03 (SD = 5.13). The mean scores of the four dimensions of knowledge, attitude, skill, and behavior on the medication literacy scale of this study were 6.22 ± 2.22, 5.04 ± 1.16, 4.50 ± 2.21, and 8.27 ± 1.90, respectively. Regarding medication adherence, the mean score of the C-MMAS-8 in this study was 4.82 (SD = 2.11). A total of 63.6% of patients presented with low adherence, 29.5% presented with moderate adherence, and 7.6% presented with high adherence. The Pearson correlation results showed that medication literacy (r = 0.342, P < 0.01) as a whole variable and the three dimensions of knowledge (r = 0.284, P < 0.01), attitude (r = 0.405, P < 0.01), and behavior (r = 0.237, P < 0.01) were significantly associated with medication adherence. Binary logistic regression analysis indicated that annual income [OR 1.199 (95% CI: 1.011-1.421); P = 0.037] and two dimensions of attitude [OR 2.174 (95% CI: 1.748-2.706); P = 0.000] and behavior [OR 1.139 (95% CI: 1.002-1.294); P = 0.046] in medication literacy were found to be independent predictors of medication adherence. Individuals with better attitudes and behavior literacy in medication literacy were more likely to adhere to the use of antihypertensive agents. Those who had higher annual incomes were more likely to adhere to the use of antihypertensive agents. Conclusion: The levels of medication literacy and medication adherence of hypertensive patients are suboptimal and need to be improved in China. The level of medication literacy in patients with hypertension could affect their adherence to antihypertensive drugs. It was suggested that hypertensive patients' medication adherence could be improved and driven by increasing the medication literacy level, especially in the attitude and behavior domains. Pertinent strategies that are specific to several dimensions of medication literacy should be developed and implemented in order to promote full medication literacy among hypertensive patients, thus facilitating optimal adherence and blood pressure control.