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Lian S, Liu Y, Xu L, Wang F, Zhang M, Salunke S, Walsh J, Zhao M. Survey-based investigation into the current use of paediatric medicines and administration devices in China. Eur J Pharm Biopharm 2023; 191:290-302. [PMID: 37689320 DOI: 10.1016/j.ejpb.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/06/2023] [Indexed: 09/11/2023]
Abstract
The accurate, rapid and convenient administration of medicines to children is not possible without the use of appropriate administration devices. However, due to the unique nature of this patient population, inappropriate paediatric medication administration has been widely observed worldwide. According to previous surveys carried out in other countries including the UK and Japan, there has been a wide variation in the handling of paediatric devices among children. To date, little is known about the current situation in China where the variety of available paediatric administration devices is more limited than in Europe and the UK. The aim of this study was therefore to conduct a China-wide survey to gain a better understanding of the perspectives of children and their caregivers on paediatric medicines and devices. This study was conducted throughout China with 215 children as well as 749 caregivers of paediatric year groups from 1 to less than 18 years old. The majority of participants (83%) took oral dosage forms where granules, syrup and tablets were ranked as the Top 3 commonly used oral dosage forms. The most commonly used devices, i.e., measuring cups (47.3%) and household spoons (41.1%) were both well accepted by the vast majority of children. More instruction and demonstration by the healthcare professionals were provided to inhalation devices users with the nebuliser and facemask being the most commonly used. In particular, the role of pharmacists in China is expected to be better defined, which may in turn help with the education provided to paediatric users in operating medical devices. The data collected varied considerably with the age of children but not statistically significantly with the region in which the survey was conducted.
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Affiliation(s)
- Shangjie Lian
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Yixiao Liu
- China Medical University-Queen's University Belfast Joint College (CQC), China Medical University, Shenyang, China
| | - Luomeng Xu
- China Medical University-Queen's University Belfast Joint College (CQC), China Medical University, Shenyang, China
| | - Fengjing Wang
- China Medical University-Queen's University Belfast Joint College (CQC), China Medical University, Shenyang, China
| | - Meng Zhang
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Smita Salunke
- University College London School of Pharmacy, London, UK
| | | | - Min Zhao
- School of Pharmacy, Queen's University Belfast, Belfast, UK; China Medical University-Queen's University Belfast Joint College (CQC), China Medical University, Shenyang, China.
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Abidi S, Talegaonkar S, Notani S, Pradhan V, Pokharkar V, Popli H, Walsh J, Salunke S. Stepping into small shoes: Gaining user perspective on appropriate administration devices for paediatric medication in India. Eur J Pharm Biopharm 2023; 191:247-258. [PMID: 37689319 DOI: 10.1016/j.ejpb.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/11/2023]
Abstract
A cross sectional pan-India study about use of administration devices for paediatric oral and inhalation medicines was conducted with a diverse pool of participants of various age groups. Via 634 respondents from more than 15 states in India, this study has identified the administration devices commonly used by parents/caregivers for children 0 to 18 years and by children over 10 years. It has provided insights on device ease of use, challenges faced and recommendations to facilitate the correct use of administration devices for paediatric oral and inhalation medicines. Ethics approval (DPSRU-BREC/2020/A/008)) was obtained from the Biomedical Research Ethics Committee of Delhi Pharmaceutical Sciences and Research University. The survey was completed by parents only (n = 514) and jointly by both parents and children (n = 120). The mean age of the child was 7.2 ± 4.96 years. 72% of the respondents reported that an oral medicine had been taken recently, 6.3% reported that an inhaled medicine had been taken and the remaining 21.9% reported that both an oral and inhaled medicine had been taken. The use of measuring cup was most prevalent followed by household spoons. The mean of the score for ease of use was found to be highest 4.6 ± 0.50 for oral syringe and lowest (3.8 ± 0.76) for measuring cups. The majority of them found the oral device easy to use. Difficulties were reported mostly for measuring cups and household spoons and were related to a lack of user instructions and measuring difficulties. The respondents who found the device easy to use had mostly received clear instructions from healthcare professionals. Compared to oral devices, there were very limited responses for inhalation devices (n = 175/634). Nebulisers with facemasks were most frequently used followed by manually actuated Metered dose inhalers with and without spacer. The mean of the ease-of-use score for dry powder inhalers was found to be highest (4.2 ± 0.37) followed by mist inhalers (4.0 ± 0) and manually actuated pressurised metered dose inhalers (4.0 ± 0.71). The nebulisers with facemask were reported to be difficult to use by most of the respondents despite receiving clear instructions from healthcare professionals. The study findings add evidence to the understudied area of user experiences and perspectives on administration devices for oral and inhalation medicines in India. It highlights a need for initiatives to improve the usability, availability, and affordability of administration devices for children in India. Awareness on the importance of proper use of devices needs to be raised and sustained about the existence of affordable administration devices.
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Affiliation(s)
- Saba Abidi
- School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University (DPSRU), MB Road, New Delhi 110017, India
| | - Sushama Talegaonkar
- School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University (DPSRU), MB Road, New Delhi 110017, India; Society for Paediatric Medicines and Healthcare Initiative (PMHI), Institute of Chemical Technology, Nathalal Parekh Marg, Matunga East, Mumbai 400019, India
| | - Soniya Notani
- European Paediatric Formulation Initiative (EuPFI), University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, United Kingdom
| | - Varsha Pradhan
- Society for Paediatric Medicines and Healthcare Initiative (PMHI), Institute of Chemical Technology, Nathalal Parekh Marg, Matunga East, Mumbai 400019, India
| | - Varsha Pokharkar
- Society for Paediatric Medicines and Healthcare Initiative (PMHI), Institute of Chemical Technology, Nathalal Parekh Marg, Matunga East, Mumbai 400019, India; Department of Pharmaceutics, Bharati Vidyapeeth Deemed University Poona College of Pharmacy, Pune, India
| | - Harvinder Popli
- School of Pharmaceutical Sciences, Delhi Pharmaceutical Sciences and Research University (DPSRU), MB Road, New Delhi 110017, India; Society for Paediatric Medicines and Healthcare Initiative (PMHI), Institute of Chemical Technology, Nathalal Parekh Marg, Matunga East, Mumbai 400019, India
| | - Jennifer Walsh
- European Paediatric Formulation Initiative (EuPFI), University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, United Kingdom; Jenny Walsh Consulting Ltd., BioCity Nottingham, Pennyfoot Street, Nottingham NG11GF, United Kingdom
| | - Smita Salunke
- European Paediatric Formulation Initiative (EuPFI), University College London School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, United Kingdom.
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Dowse R, Okeyo S, Sikhondze S, Khumalo N. Methodology of an approach for modifying pictograms showing medication side effects or indication. J Commun Healthc 2023; 16:147-157. [PMID: 37401879 DOI: 10.1080/17538068.2022.2056292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Pictograms may improve user-friendliness and comprehension of written or verbal health information. This paper describes a method to modify pictograms to improve their visual clarity, appeal and overall interpretive complexity in order to reduce the cognitive load on the viewer during comprehension. METHODOLOGY Nine pictograms previously tested for comprehension were selected for modification. In phase 1, two participatory design workshops were conducted with (a) three limited literacy, first-language isiXhosa-speaking participants and (b) four university students. Opinions and ideas for improving interpretation were discussed. In phase 2, revised visuals were generated by the graphic artist and subsequently modified in an intensive, multistage, iterative process. RESULTS As no guidelines for pictogram modification exist, a modification schema was developed based on the process described in this study. Adopting a participatory approach combined with a systematic, intensive modification process enabled the opinions and preferences of the end-users to be heard, ensuring cultural relevance and contextual familiarity of the final product. Careful scrutiny of all individual visual elements of each pictogram, considerations of space, and thickness of lines all contributed to improving the legibility of visuals. CONCLUSIONS The methodology for designing and modifying existing pictograms using a participatory process resulted in nine final pictograms that were approved by all design team members and considered good candidates for subsequent comprehension testing. The methodological schema presented in this paper provides guidance to researchers intending to design or modify pictograms.
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Affiliation(s)
- Ros Dowse
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
| | - Sam Okeyo
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
| | - Simise Sikhondze
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
| | - Nosihle Khumalo
- Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
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Abdu-Aguye SN, Sadiq AM, Shehu A, Mohammed EN. Guessability of standard pharmaceutical pictograms in members of the Nigerian public. Exploratory Research in Clinical and Social Pharmacy 2023; 9:100240. [PMID: 36994355 PMCID: PMC10040885 DOI: 10.1016/j.rcsop.2023.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/22/2023] [Accepted: 02/24/2023] [Indexed: 03/12/2023] Open
Abstract
Background Pharmaceutical pictograms are standardized images used to visually convey medication instructions. Very little is known about the ability of Africans to interpret these images. Objectives Thus, the aim of this study was to assess the guessability (ability to correctly guess meaning) of selected International Pharmaceutical Federation (FIP) and United States Pharmacopoeia (USP) pictograms in members of the Nigerian public. Methods A cross-sectional survey was carried out between May and August 2021 on 400 randomly sampled members of Nigerian public. Selected pictograms (24 FIP and 22 USP pictograms) were grouped and printed on A3 sheets of paper which were used to interview members of the public who fulfilled the study's' eligibility criteria. Respondents were asked to guess the meanings of either the FIP or USP pictograms, and their answers written down verbatim. Descriptive and inferential statistics were used to report the data collected. Results Four hundred respondents were interviewed, with 200 respondents each assessing the guessability of the FIP and USP pictograms. The guessability of assessed FIP pictograms ranged between 3.5 and 95%, while that for the USP pictograms was 27.5-97%. Eleven FIP and Thirteen USP pictograms respectively achieved the International Organization for Standardization (ISO) comprehensibility cutoff point of 67%. Guessing performance (the total number of pictograms correctly guessed by an individual) of respondents that assessed the FIP pictograms was significantly associated with their age (p = 0.044) and highest level of education completed (p = 0.003). For the USP pictograms, guessing performance was only significantly associated with the highest educational level completed (p < 0.001). Conclusions Guessability of both pictogram types varied widely, but the guessability of the USP pictograms was generally better than that for the FIP pictograms. Many of the tested pictograms may however need to be redesigned before they can be correctly interpreted by members of the Nigerian public.
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Alessandrini E, Walsh J, Salunke S. Usability of administration devices for oral and respiratory medicines: views from a UK primary school. Eur J Pharm Biopharm 2022; 178:150-158. [PMID: 35987466 DOI: 10.1016/j.ejpb.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022]
Abstract
The correct use of medicine administration devices is pivotal for optimal drug therapy in children. Little is known about end users' perspectives on administration device use. Thus, the aim of this study was to conduct a survey to gain information and opinions from caregivers and children regarding the usability of paediatric medicine administration devices. A survey was conducted at a primary school in the United Kingdom in children aged 10-12 years and their caregivers. It focused on oral and respiratory devices and comprised two identical parts: 1) for the caregivers, 2) for the children with parental consent. Ethics approval (REC4612-016) was obtained. A total of 57 caregiver-child pairs accessed the survey and it was completed by parents only (n=4), children only (n=31) or jointly (n=22). Most participants (65%) had taken liquid dosage forms (e.g., syrups/suspensions) compared to solid dosage forms (34%). Oral devices most frequently used were oral syringes (42%), measuring spoons (22%), and household spoons (18%), with parents most frequently demonstrating device use to their children. Respiratory devices were used less frequently, and pressurised metered-dose inhalers with/without spacer (pMDIs) were the most commonly used devices (11/13). Instructions on use were provided by healthcare professionals to both caregivers and children. Generally, oral and respiratory devices were considered easy to use and instructions were clear. However, for both oral and respiratory devices, some suggestions for device improvement were provided by participants. Education/training by healthcare professionals and clear supplier instructions (e.g., pictograms) may be especially effective in ensuring that caregivers and children are able to use administration devices appropriately and receive sufficient information on their correct use.
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Affiliation(s)
| | - Jennifer Walsh
- Jenny Walsh Consulting Ltd., BioCity Nottingham, Nottingham, UK
| | - Smita Salunke
- University College London School of Pharmacy, London, UK
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Sedeh FB, Arvid Simon Henning M, Mortensen OS, Jemec GBE, Ibler KS. Communicating with patients through pictograms and pictures - a scoping review. J DERMATOL TREAT 2022; 33:2730-2737. [PMID: 35440279 DOI: 10.1080/09546634.2022.2068790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BackgroundCommunication between patients and Health Care Workers (HCW) may on occasion be challenged by disparities in cultural background, age and educational level. Written educational material is commonly used to reduce the risk of miscommunication. However, literacy among patients may also differ and it is therefore speculated that the use of pictograms may improve patients' understanding and adherence.ObjectiveTo evaluate the scientific literature and investigate the effect and practical utility of pictograms in medical settings with focus on dermatological patients.Materials and methodsPubmed, EMBASE, and Cochrane Library were searched July 2021 for studies regarding use of pictograms in medical settings and dermatology.ResultsThe use of pictograms in dermatology is not well characterized, but studies in other fields of medicine report a positive effect of using pictograms in communication. Pictograms have a significant positive effect when presented alongside verbal or written explanations.ConclusionThe quality of the development process is important to ensure the utility of any pictogram. Involving the target population in the design and validation of the pictograms may be critical. In the validation process, testing of transparency and translucency may benefit from international recommendations.
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Affiliation(s)
| | | | - Ole Steen Mortensen
- Department of Occupational and Social Medicine, Holbaek University Hospital, Holbaek, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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Algabbani AM, Alzahrani KA, Sayed SK, Alrasheed M, Sorani D, Almohammed OA, Alqahtani AS. The impact of using pictorial aids in caregivers’ understanding of patient information leaflets of pediatric pain medications: A quasi-experimental study. Saudi Pharm J 2022; 30:544-554. [PMID: 35693437 PMCID: PMC9177450 DOI: 10.1016/j.jsps.2022.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/27/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Patient information leaflets (PILs) are one of the main sources of information for over-the-counter medications (OTCs). This study aimed to assess caregivers' understanding of instructions in PILs provided with paracetamol medications and the impact of pictograms use. Methods A quasi-experimental study was conducted among caregivers of children aged < 13 years recruited in pediatric outpatient clinics at University Medical City in Riyadh. The calculated sample size was 128; at least 64 participants were needed in each group (the text-only group and the text-plus pictograms group). Caregivers' health literacy was assessed using a validated Arabic version of the Newest Vital Sign scale. Participants’ understanding of PILs instructions was assessed using eight questions on the route of administration, minimal hours between doses, max daily dose, shake medication before use, storage, and reporting adverse events; and was rated based on the number of questions correctly understood. Characteristics of participants were compared by Pearson X2 and t-test was used to assess the significance of mean score differences between groups. Results A total of 130 caregivers participated in the study; almost half of them were mothers (47%, [n = 61]) and 43% (n = 56) have “a possibility of limited health literacy”. The mean number of correct answers to questions assessing the understanding of PILs instructions was significantly higher among the text-plus pictograms group compared to the text-only group (5.25 ± 1.85 vs. 4.38 ± 1.27; p < 0.001). When results were controlled for age and gender, better health literacy was found to be associated with a better understanding of instructions (B = 0.39, 95 %CI 0.23–0.54). Conclusion Limited comprehension of medications instructions was observed; adding pictorial aids to PILs might enhance the comprehension. Differences in health literacy levels of caregivers should be considered when designing PILs.
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Affiliation(s)
- Aljoharah M. Algabbani
- Saudi Food and Drug Authority, Riyadh, Saudi Arabia
- Corresponding authors at: Pharmaceutical and Medical Devices Research Division, Executive Department of Research & Studies, Saudi Food and Drug Authority (SFDA), Northern Ring Branch Road, Hittin, Riyadh 13513, Saudi Arabia.
| | - Khalid A. Alzahrani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Sarah K. Sayed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Deema Sorani
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Omar A. Almohammed
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Co-corresponding author at: King Saud University, Riyadh, Saudi Arabia
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Merks P, Cameron J, Bilmin K, Świeczkowski D, Chmielewska-Ignatowicz T, Harężlak T, Białoszewska K, Sola KF, Jaguszewski MJ, Vaillancourt R. Medication Adherence and the Role of Pictograms in Medication Counselling of Chronic Patients: a Review. Front Pharmacol 2021; 12:582200. [PMID: 34489688 PMCID: PMC8417421 DOI: 10.3389/fphar.2021.582200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Pharmaceutical care requires a patient-centered approach, focusing on the ability of patients to understand drug-related information and follow the instructions delivered by pharmacists as well as other health-care providers included in the circle of care. With the goal of ensuring the prescribed use of medications, called medication adherence, health-care providers have to consider many risk factors such as geography (culture), social economic status, age, and low literacy that may predispose patients to non-adherence, and considerations have to be made for chronic patients living with life-long disease states. The aim of this review is to provide a balanced and comprehensive review outlining a number of different medication counselling and education approaches that have been used to try to improve medication adherence and health outcomes with the use of clear and concise graphic illustrations—called pictograms. By highlighting the current landscape of the general use and efficacy of pharmaceutical pictograms to aid in the knowledge and recall of drug-related information, as well as outlining specific medication adherence outcomes with pharmaceutical pictograms in chronic patients, the current review describes the need for health-care providers to move beyond the traditional didactic methods of oral and verbal communication with patients regarding medication-taking behavior.
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Affiliation(s)
- Piotr Merks
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland.,Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | - Jameason Cameron
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
| | - Krzysztof Bilmin
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, Warsaw, Poland
| | - Damian Świeczkowski
- First Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | | | - Tomasz Harężlak
- Department of Pharmaceutical Technology, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland
| | | | | | | | - Regis Vaillancourt
- Department of Pharmacy, Children's Hospital of Eastern Ontario, Centre Hospitalier pour Enfants de L'est de L'Ontario, Ottawa, ON, Canada
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Lawrence PR, Feinberg I, Spratling R. The Relationship of Parental Health Literacy to Health Outcomes of Children with Medical Complexity. J Pediatr Nurs 2021; 60:65-70. [PMID: 33621896 DOI: 10.1016/j.pedn.2021.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
THEORETICAL PRINCIPLES Children with medical complexity experience negative health outcomes despite the high costs associated with their care. There is growing evidence that low parental health literacy is associated with a number of poor child health outcomes, including medication errors. However, less is known about the relationship between parental health literacy and the health outcomes of children with medical complexity, whose care is known to be more complex and demanding of parents. PHENOMENA ADDRESSED The challenges faced by parents of children with medical complexity are presented, including those related to communication, care coordination, and medication administration. The historical and theoretical perspectives of health literacy are discussed, and the relationship of parental health literacy to pediatric health outcomes for children with medical complexity is explored. RESEARCH LINKAGES Remaining knowledge gaps about parental health literacy and its influence on the health of children with medical complexity are outlined. Future research and clinical practice implications of health literacy and its importance to family-centered care are discussed.
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Affiliation(s)
- Patricia R Lawrence
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, GA, USA.
| | - Iris Feinberg
- College of Education and Human Development, Georgia State University, GA, USA.
| | - Regena Spratling
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, GA, USA.
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Catania JA, Huun C, Dolcini MM, Urban AJ, Fleury N, Ndyetabula C, Singh R, Young AW, Conserve DF, Lace J, Msigwa JS. Overcoming cultural barriers to implementing oral HIV self-testing with high fidelity among Tanzanian youth. Transl Behav Med 2021; 11:87-95. [PMID: 31785201 DOI: 10.1093/tbm/ibz157] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tanzanian youth have high levels of HIV risk and poor access to HIV-testing. Oral self-implemented testing (Oral-SIT) provides an alternative that reduces barriers to HIV-testing. We examined adaptations to Oral-SIT training components in a randomized experiment to evaluate a "train-the-trainer" strategy for improving comprehension of graphic training materials. Participants (N = 257, age = 14-19 years) were randomly assigned to one of two self-training conditions: graphic instruction book (GIB) or Video-GIB. Outcomes included behavioral performance fidelity, self-reported comprehension, and intentions to seek treatment. Video-GIB participants, relative to GIB-only participants, had higher performance fidelity scores, made fewer performance errors, had better instruction comprehension, and were more likely to intend to seek treatment. Oral-SIT timing errors were significantly more common among GIB-only participants. Graphic training materials in conjunction with a "train-the-trainer" video has significant potential for increasing Oral-SIT's reach by overcoming technological and literacy barriers.
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Affiliation(s)
- Joseph A Catania
- Hallie E. Ford Center, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Cassidy Huun
- Oregon Health Sciences University, Portland, OR, USA
| | - M Margaret Dolcini
- Hallie E. Ford Center, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Angelmary Joel Urban
- Hallie E. Ford Center, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Nick Fleury
- Hallie E. Ford Center, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | | | - Ryan Singh
- Hallie E. Ford Center, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Amy W Young
- Hallie E. Ford Center, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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Patidar P, Mathur A, Pathak A. Can use of pictograms reduce liquid medication administration errors by mothers? An interventional study. BMC Psychol 2021; 9:99. [PMID: 34172090 PMCID: PMC8228905 DOI: 10.1186/s40359-021-00584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 05/10/2021] [Indexed: 11/26/2022] Open
Abstract
Background Liquid medication dosing errors (LMDE) made by caregivers affect treatment in children, but this is not a well-studied topic in many low-and middle-income countries including in India. Methods An intervention study was conducted among mothers attending a pediatric outpatient clinic of a tertiary care setting in Ujjain, India. The mothers randomly measured 12 volumes of a paracetamol liquid preparation by using a dropper (0.5 and 1 mL), measuring cup (2.5 and 5 mL), and calibrated spoon (2.5 and 5 mL) each with two instructions—oral-only measurement session (OMS) and oral plus pictogram measurement session (OPMS, the intervention). The main outcome was dosing error prevalence. The effectiveness of the intervention was assessed by measuring effect size. Risk factors for maximum LMDE were explored using backward multivariate logistic regression models. A P value of < 0.05 was considered statistically significant. Results In total, 310 mothers [mean (± SD) age, 30.2 (± 4.18) years] were included. LMDE prevalence in the OMS versus OPMS for dropper 0.5 mL was 60% versus 48%; for l mL dropper was 63% versus 54%; for 2.5 mL cup 62% versus 54%; for 2.5 calibrated spoon 66% versus 59%; 5 mL cup 69% versus 57%; and 5 mL calibrated spoon 68% versus 55%. Comparing OMS with OPMS, underdosing was minimum with the calibrated spoon for 2.5 mL (OR 4.39) and maximum with the dropper for 1 mL (OR 9.40), and overdosing was minimum with the dropper for 0.5 mL (OR 7.12) and maximum with the calibrated spoon for 2.5 mL (OR 13.24). The effect size (dCohen) of the intervention OPMS was 1.86–6.4. Risk factors for the most prevalent dosing error, that is, with the calibrated spoon for 2.5 mL, were increasing age of the mother (aOR 1.08; P = 0.026) and nuclear family (aOR 2.83; P = 0.002). The risk of dosing errors decreased with higher education of the mothers. Conclusions Pictograms can effectively minimize LMDE even in less educated mothers. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00584-9.
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Affiliation(s)
- Pawan Patidar
- Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456010, India
| | - Aditya Mathur
- Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456010, India
| | - Ashish Pathak
- Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, Madhya Pradesh, 456010, India. .,Department of Women and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden. .,Department of Global Public Health, Health Systems and Policy: Medicines Focusing Antibiotics, Karolinska Institutet, Stockholm, Sweden.
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Chew CC, Chan HK, Chang CT, Hss AS, Hassali MA. Medication-related knowledge, administration practice and adherence among caregivers of chronically ill children in Malaysia. BMC Pediatr 2021; 21:216. [PMID: 33941117 PMCID: PMC8091478 DOI: 10.1186/s12887-021-02691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022] Open
Abstract
Background Caregivers’ knowledge, practice and adherence in medication administration who care for children with chronic illness requiring long-term pharmacological treatments are factors associating with children medication safety at home. This study aimed to determine the medication-related knowledge, administration practice and adherence among caregivers of chronically ill children in Malaysia. This cross-sectional study was conducted at the paediatric outpatient clinic of a tertiary public hospital. Caregivers of chronically ill children, who engaged in medication administration at home for at least 3 months, were conveniently recruited. Their medication-related knowledge and administration practice were evaluated based on a checklist, while their adherence to medication administration was assessed using a validated 5-point scale. The associated factors were also explored. Results Of the 141 participants, most were mothers (90.8%) and had a full-time job (55.3%). Most of them had adequate medication-related knowledge (71.6%) and an appropriate administration practice (83.0%). The majority of them (83.0%) also rated themselves as adherent to medication administration. The participants with a child above 5 years of age (91.2%) were found to have a better practice than those with younger children (75.3%) in medication administration (p = 0.012). However, those with a child taking two (adjusted OR: 12.53) or three (adjusted OR: 8.29) medications, getting their refills from private health institutions apart from this hospital (adjusted OR = 7.06) and having multiple illnesses (adjusted OR = 21.25) were more likely to be not adherent to medication administration. Conclusion Caregivers of chronically ill children in Malaysia generally have sufficient knowledge and an appropriate practice of medication administration at home. Yet, strategies to improve the adherence to medication administration, particularly in those who care for children with complicated health conditions, are warranted.
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Affiliation(s)
- Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia. .,Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia.
| | - Huan-Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health, 05460 Alor Setar, Kedah, Malaysia
| | - Chee-Tao Chang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
| | - Amar-Singh Hss
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, Level 4, Ambulatory Care Centre (ACC), Jalan Raja Ashman Shah, 30450, Ipoh, Perak, Malaysia
| | - Mohamed Azmi Hassali
- Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
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Koeck JA, Young NJ, Kontny U, Orlikowsky T, Bassler D, Eisert A. Interventions to Reduce Pediatric Prescribing Errors in Professional Healthcare Settings: A Systematic Review of the Last Decade. Paediatr Drugs 2021; 23:223-40. [PMID: 33959936 DOI: 10.1007/s40272-021-00450-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pediatric medication therapy is prone to errors due to the need for pharmacokinetic and pharmacodynamic individualization and the diverse settings in which pediatric patients are treated. Prescribing errors have been reported as the most common medication error. OBJECTIVES The aim of this review was to systematically identify interventions to reduce prescribing errors and corresponding patient harm in pediatric healthcare settings and to evaluate their impact. METHODS Four databases were systematically screened (time range November 2011 to December 2019), and experimental studies were included. Interventions to reduce prescribing errors were extracted and classified according to a 'hierarchy of controls' model. RESULTS Forty-five studies were included, and 70 individual interventions were identified. A bundle of interventions was more likely to reduce prescribing errors than a single intervention. Interventions classified as 'substitution or engineering controls' were more likely to reduce errors in comparison with 'administrative controls', as is expected from the hierarchy of controls model. Fourteen interventions were classified as substitution or engineering controls, including computerized physician order entry (CPOE) and clinical decision support (CDS) systems. Administrative controls, including education, expert consultations, and guidelines, were more commonly identified than higher level controls, although they may be less likely to reduce errors. Of the administrative controls, expert consultations were most likely to reduce errors. CONCLUSIONS Interventions to reduce pediatric prescribing errors are more likely to be successful when implemented as part of a bundle of interventions. Interventions including CPOE and CDS that substitute risks or provide engineering controls should be prioritized and implemented with appropriate administrative controls including expert consultation.
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Koeck JA, Young NJ, Kontny U, Orlikowsky T, Bassler D, Eisert A. Interventions to Reduce Medication Dispensing, Administration, and Monitoring Errors in Pediatric Professional Healthcare Settings: A Systematic Review. Front Pediatr 2021; 9:633064. [PMID: 34123962 PMCID: PMC8187621 DOI: 10.3389/fped.2021.633064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Pediatric patients cared for in professional healthcare settings are at high risk of medication errors. Interventions to improve patient safety often focus on prescribing; however, the subsequent stages in the medication use process (dispensing, drug administration, and monitoring) are also error-prone. This systematic review aims to identify and analyze interventions to reduce dispensing, drug administration, and monitoring errors in professional pediatric healthcare settings. Methods: Four databases were searched for experimental studies with separate control and intervention groups, published in English between 2011 and 2019. Interventions were classified for the first time in pediatric medication safety according to the "hierarchy of controls" model, which predicts that interventions at higher levels are more likely to bring about change. Higher-level interventions aim to reduce risks through elimination, substitution, or engineering controls. Examples of these include the introduction of smart pumps instead of standard pumps (a substitution control) and the introduction of mandatory barcode scanning for drug administration (an engineering control). Administrative controls such as guidelines, warning signs, and educational approaches are lower on the hierarchy and therefore predicted by this model to be less likely to be successful. Results: Twenty studies met the inclusion criteria, including 1 study of dispensing errors, 7 studies of drug administration errors, and 12 studies targeting multiple steps of the medication use process. A total of 44 interventions were identified. Eleven of these were considered higher-level controls (four substitution and seven engineering controls). The majority of interventions (n = 33) were considered "administrative controls" indicating a potential reliance on these measures. Studies that implemented higher-level controls were observed to be more likely to reduce errors, confirming that the hierarchy of controls model may be useful in this setting. Heterogeneous study methods, definitions, and outcome measures meant that a meta-analysis was not appropriate. Conclusions: When designing interventions to reduce pediatric dispensing, drug administration, and monitoring errors, the hierarchy of controls model should be considered, with a focus placed on the introduction of higher-level controls, which may be more likely to reduce errors than the administrative controls often seen in practice. Trial Registration Prospero Identifier: CRD42016047127.
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Affiliation(s)
- Joachim A Koeck
- Hospital Pharmacy, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - Nicola J Young
- Hospital Pharmacy, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - Udo Kontny
- Section of Pediatric Hematology, Department of Pediatric and Adolescent Medicine, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - Thorsten Orlikowsky
- Section of Neonatology, Department of Pediatric and Adolescent Medicine, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Albrecht Eisert
- Hospital Pharmacy, Rheinisch-Westfälische Technische Hochschule Aachen University Hospital, Aachen, Germany.,Institute of Clinical Pharmacology, University Hospital of Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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Sletvold H, Sagmo LAB, Torheim EA. Impact of pictograms on medication adherence: A systematic literature review. Patient Educ Couns 2020; 103:1095-1103. [PMID: 31924384 DOI: 10.1016/j.pec.2019.12.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this systematic review was to investigate the potential effect of pictograms on patient adherence to medication therapies. METHOD PubMed, MEDLINE, Embase, CINAHL, and CENTRAL were searched for relevant articles. Experimental studies testing the use of pictograms in patient counselling regarding medication therapy, which quantitatively measured adherence, were included. RESULTS Seventeen studies were identified that fulfilled our inclusion criteria. These were heterogeneous with respect to study setting, population size, and the medication regimen tested. All the studies had methodological quality limitations. The pictogram interventions differed with respect to complexity, intervention length, and the measured adherence outcome. Ten studies (58.8 %) reported a statistically significant effect, of the pictogram intervention in question, on patient adherence to medication therapies. Of these, 80 % involved populations at elevated risk for non-adherence. CONCLUSION AND PRACTICE IMPLICATIONS Pictograms used in combination with written and/or oral information can have a positive impact on patient populations that are highly at risk for non-adherence when counselled on the proper use of medicines.
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Affiliation(s)
- Hege Sletvold
- Faculty of Nursing and Health Sciences, Nord University, Norway.
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Zanobini P, Lorini C, Baldasseroni A, Dellisanti C, Bonaccorsi G. A Scoping Review on How to Make Hospitals health Literate Healthcare Organizations. Int J Environ Res Public Health 2020; 17:ijerph17031036. [PMID: 32041282 PMCID: PMC7037285 DOI: 10.3390/ijerph17031036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 12/13/2022]
Abstract
The concept of health literacy is increasingly being recognised as not just an individual trait, but also as a characteristic related to families, communities, and organisations providing health and social services. The aim of this study is to identify and describe, through a scoping review approach, the characteristics and the interventions that make a hospital a health literate health care organisation (HLHO), in order to develop an integrated conceptual model. We followed Arksey and O’Malley’s five-stage scoping review framework, refined with the Joanna Briggs Institute methodology, to identify the research questions, identify relevant studies, select studies, chart the data, and collate and summarize the data. Of the 1532 titles and abstracts screened, 106 were included. Few studies have explored the effect of environmental support on health professionals, and few outcomes related to staff satisfaction/perception of helpfulness have been reported. The most common types of interventions and outcomes were related to the patients. The logical framework developed can be an effective tool to define and understand priorities and related consequences, thereby helping researchers and policymakers to have a wider vision and a more homogeneous approach to health literacy and its use and promotion in healthcare organizations.
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Affiliation(s)
- Patrizio Zanobini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
- Correspondence: ; Tel.: +39-3663435179
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
| | - Alberto Baldasseroni
- Tuscany Regional Centre for Occupational Injuries and Diseases (CeRIMP), Central Tuscany LHU, Via di San Salvi, 12, 50135 Florence, Italy;
| | - Claudia Dellisanti
- Department of Epidemiology, Regional Health Agency of Tuscany, Via Pietro Dazzi, 1, 50141 Florence, Italy;
| | - Guglielmo Bonaccorsi
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
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Pérez-Jover V, Sala-González M, Guilabert M, Mira JJ. Mobile Apps for Increasing Treatment Adherence: Systematic Review. J Med Internet Res 2019; 21:e12505. [PMID: 31215517 PMCID: PMC6604503 DOI: 10.2196/12505] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/28/2019] [Accepted: 05/11/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND It is estimated that 20% to 50% of patients do not take their medication correctly, and this leads to increased morbidity and inefficacy of therapeutic approaches. Fostering treatment adherence is a priority objective for all health systems. The growth of mobile apps to facilitate therapeutic adherence has significantly increased in recent years. However, the effectiveness of the apps for this purpose has not been evaluated. OBJECTIVE This study aimed to analyze whether mobile apps are perceived as useful for managing medication at home and if they actually contribute to increasing treatment adherence in patients. METHODS We carried out a systematic review of research published using Scopus, Cochrane Library, ProQuest, and MEDLINE databases and analyzed the information about their contribution to increasing therapeutic adherence and the perceived usefulness of mobile apps. This review examined studies published between 2000 and 2017. RESULTS Overall, 11 studies fulfilled the inclusion criteria. The sample sizes of these studies varied between 16 and 99 participants. In addition, 7 studies confirmed that the mobile app increased treatment adherence. In 5 of them, the before and after adherence measures suggested significant statistical improvements, when comparing self-reported adherence and missed dose with a percentage increase ranging between 7% and 40%. The users found mobile apps easy to use and useful for managing their medication. The patients were mostly satisfied with their use, with an average score of 8.1 out of 10. CONCLUSIONS The use of mobile apps helps increase treatment adherence, and they are an appropriate method for managing medication at home.
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Affiliation(s)
| | | | - Mercedes Guilabert
- Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche, Spain
| | - José Joaquín Mira
- Departamento Psicología de la Salud, Universidad Miguel Hernández, Elche, Spain
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Lühnen J, Steckelberg A, Buhse S. Pictures in health information and their pitfalls: Focus group study and systematic review. Z Evid Fortbild Qual Gesundhwes 2018; 137-138:77-89. [PMID: 30217737 DOI: 10.1016/j.zefq.2018.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/16/2018] [Accepted: 08/03/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health information often includes different categories of pictures. This study comprises: A) exploration of the perception of photos presented in a brochure on the prevention of osteoporosis and B) a systematic review on the effects of pictures in health information. METHODS A) We conducted four focus groups. Participants with heterogeneous cultural and educational background were included. The interviews were subjected to qualitative content analysis. B) We searched PubMed, CENTRAL, PSYNDEX, PsycINFO, CINAHL, Campbell Collaboration and DIMDI. Randomized controlled trials (RCTs) on predefined cognitive and affective outcomes were included. Two reviewers independently extracted data and assessed the quality of evidence. Descriptive data synthesis was conducted. RESULTS A) Within the focus groups comprising 37 participants, four generic categories were identified: comprehension, perception, congruence between photos and content, and alternatives. Identification with portrait photos and the connection between photos and text were important to participants. B) In total, 13 RCTs were included. Quality of evidence was moderate. Types of pictures and their intention varied between studies. Cartoons enhanced comprehension, satisfaction and readability. Photos did not improve cognitive or affective outcomes. Effects of anatomical pictures, pictographs, and drawings were ambiguous. CONCLUSION The overall effect of using pictures in health information remains unclear. The type of pictures and readers' characteristics may influence both perception and interpretation. Type, amount, and intention of the pictures should be considered carefully.
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Affiliation(s)
- Julia Lühnen
- Universität Hamburg, MIN Fakultät, Gesundheitswissenschaften, Hamburg, Deutschland.
| | - Anke Steckelberg
- Martin-Luther-Universität Halle-Wittenberg, Medizinische Fakultät, Institut für Gesundheits- und Pflegewissenschaft, Halle (Saale), Deutschland
| | - Susanne Buhse
- Universität Hamburg, MIN Fakultät, Gesundheitswissenschaften, Hamburg, Deutschland
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Sharma A, Dongre P, Bellala K, Reddy P, Kuppermann BD, Bandello F. Role of retinal image-based counseling in the treatment of peripheral retinal lesions. Eye (Lond) 2019; 33:161-3. [PMID: 30120401 DOI: 10.1038/s41433-018-0196-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 11/09/2022] Open
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Leiner M, Peinado J, Baylon A, Lopez I, Pathak I. Divide and conquer: improving parental understanding of health-related instructions using sequential pictorial instructions. Health Educ Res 2018; 33:104-113. [PMID: 29579193 DOI: 10.1093/her/cyy004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
Patient misunderstandings of healthcare-related instructions result in significant health, social and economic consequences. Pushing the boundaries of traditional academic methods may offer strategies that promote new ways to improve communication and understanding between healthcare providers, caregivers and patients. Comics can be an educational tool, offering an innovative strategy to communicate health-related information. Our study objective was to compare parents' understanding of health-related instructions (i.e. prescription labels, medical instructions and emergency situation scenarios) that were presented using two different formats-sequential pictorial instructions (SPIs) versus written text instructions (WRIs).This was a cross-sectional study to compare parents' understanding of health-related instructions for pediatric patients using structured SPIs versus WRIs. Parents (n = 359, 18-82 years old) of pediatric patients were given a card with instructions that were presented as SPIs (n = 195, 54.3%) or WRIs (n = 164, 45.7%), and then they completed a questionnaire. Total (14 questions) and grouped scores (10 questions) for parental comprehension of prescription and medical emergency instructions were significantly higher among participants viewing the SPIs than those viewing the WRIs in both English and Spanish. The mean understanding of instructions significantly increased from 6% to 12.2% when comparing the WRI versus the SPI.Our initial findings indicate that parents and caregivers of pediatric patients had significantly better understanding and recall of instructions delivered using SPIs than using WRIs.
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Affiliation(s)
- Marie Leiner
- Department of Pediatrics, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Jesus Peinado
- Department of Pediatrics, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Angelica Baylon
- Department of Pediatrics, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
| | - Isis Lopez
- Paul Foster School of Medicine, El Paso, TX 79905, USA
| | - Indu Pathak
- Department of Pediatrics, Texas Tech University Health Sciences Center El Paso, El Paso, TX 79905, USA
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Benjamin L, Frush K, Shaw K, Shook JE, Snow SK, Wright J, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N, Joseph M, Alade K, Amato C, Avarello JT, Baldwin S, Barata IA, Berg K, Brown K, Bullard-Berent J, Dietrich AM, Friesen P, Gerardi M, Heins A, Holtzman DK, Homme J, Horeczko T, Ishimine P, Lam S, Long K, Mayz K, Mehta S, Mellick L, Ojo A, Paul AZ, Pauze DR, Pearson NM, Perina D, Petrack E, Rayburn D, Rose E, Russell WS, Ruttan T, Saidinejad M, Sanders B, Simpson J, Solari P, Stoner M, Valente JH, Wall J, Wallin D, Waseem M, Whiteman PJ, Woolridge D, Young T, Foresman-Capuzzi J, Johnson R, Martin H, Milici J, Brandt C, Nelson N. Pediatric Medication Safety in the Emergency Department. Pediatrics 2018; 141:peds.2017-4066. [PMID: 30352389 DOI: 10.1542/peds.2017-4066] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric patients cared for in emergency departments (EDs) are at high risk of medication errors for a variety of reasons. A multidisciplinary panel was convened by the Emergency Medical Services for Children program and the American Academy of Pediatrics Committee on Pediatric Emergency Medicine to initiate a discussion on medication safety in the ED. Top opportunities identified to improve medication safety include using kilogram-only weight-based dosing, optimizing computerized physician order entry by using clinical decision support, developing a standard formulary for pediatric patients while limiting variability of medication concentrations, using pharmacist support within EDs, enhancing training of medical professionals, systematizing the dispensing and administration of medications within the ED, and addressing challenges for home medication administration before discharge.
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Affiliation(s)
- Lee Benjamin
- Department of Emergency Medicine, St Joseph Mercy Ann Arbor, Ypsilanti, Michigan
| | - Karen Frush
- Department of Pediatrics, School of Medicine, Duke University, Durham, North Carolina
| | - Kathy Shaw
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joan E. Shook
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and
| | - Sally K. Snow
- Retired; Former Trauma Program Director, Cook Children's Medical Center, Fort Worth, Texas
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Merks P, Świeczkowski D, Balcerzak M, Drelich E, Białoszewska K, Cwalina N, Krysinski J, Jaguszewski M, Pouliot A, Vaillancourt R. The evaluation of pharmaceutical pictograms among elderly patients in community pharmacy settings - a multicenter pilot study. Patient Prefer Adherence 2018; 12:257-266. [PMID: 29497281 PMCID: PMC5818874 DOI: 10.2147/ppa.s150113] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The search for new ways to optimize the use of medications by patients has led the pharmaceutical community to promote the idea of introducing pictograms into routine practice. The main intention of pictograms is to ease patient adherence and to reduce potential risks or errors associated with the use of medications. PURPOSE To evaluate a series of pharmaceutical pictograms for patient comprehension. PATIENTS AND METHODS The study was conducted in community pharmacies within a European Union country that belongs to the professional research network. Structured interviews were used to evaluate the pictograms for patient comprehension. This consisted of an assessment of the following: the transparency and translucency of the pictograms, health literacy, and pictogram recall. Participants were also given the opportunity to provide feedback on how to improve the pictograms. The primary endpoint was pictogram comprehension. Secondary outcomes included recall of the pictograms and pictogram translucency. RESULTS The study included 68 patients with whom face-to-face interviews were performed. Low transparency results (≤25%) and extensive patient feedback in initial interviews led to the withdrawal of certain pictograms (n=15) from the evaluation. Among the pictograms included in the final stage of our research, 22 pictograms (62.8%) obtained an acceptable transparency level ≥66%. All pictograms passed the short-term recall test with positive results. CONCLUSION A majority of the designed and modified pictograms reached satisfactory guess-ability scores. Feedback from patients enabled modification of the pictograms and proved that patients have an important voice in the discussion regarding the design of additional pictograms.
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Affiliation(s)
- Piotr Merks
- Department of Pharmaceutical Technology, Collegium Medicum in Bydgoszcz, Nicolaus University in Torun, Bydgoszcz-Torun, Poland
- Piktorex Sp. z.o.o., Warsaw, Poland
| | - Damian Świeczkowski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
- Correspondence: Damian Świeczkowski; Miłosz Jaguszewski, First Department of Cardiology, Medical University of Gdansk, Dębinki 7, 80-952 Gdansk, Poland, Tel +48 73 202 2498, Email ;
| | | | | | | | - Natalia Cwalina
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Jerzy Krysinski
- Department of Pharmaceutical Technology, Collegium Medicum in Bydgoszcz, Nicolaus University in Torun, Bydgoszcz-Torun, Poland
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
- Correspondence: Damian Świeczkowski; Miłosz Jaguszewski, First Department of Cardiology, Medical University of Gdansk, Dębinki 7, 80-952 Gdansk, Poland, Tel +48 73 202 2498, Email ;
| | - Annie Pouliot
- Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
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Abstract
BACKGROUND Previous studies suggest that pictograms may improve patients' understanding of medication schedules. Understanding a medication schedule is a necessary first step for medication adherence. OBJECTIVE This study aimed to determine if pictograms improved patients' ability to correctly fill a pillbox. DESIGN This is a randomized, controlled, crossover pilot study. PARTICIPANTS This study involves 30 patients on the medical wards of an urban, tertiary care center. MAIN MEASURES The PillBox Test required participants to fill a 7-day pillbox with pill-sized colored beads. Participants were randomized to either the control or the experimental condition first. In the control condition, a standard pillbox was used with text instructions on the pill bottles. In the experimental condition, a pictogram pillbox was used with text and pictogram instructions on the pill bottles. KEY RESULTS There was no significant difference in passing on text or pictogram PillBox Test based on the order of group administration. However, 77% of participants reported that pictograms helped them understand medication instructions, 67% of participants preferred pictograms, and 93% felt pictograms should be used on all medication labels. CONCLUSIONS In this pilot study, the use of pictograms did not significantly improve participants' ability to correctly fill a pillbox. However, most participants preferred pictograms to text labels. Further research is needed to determine the efficacy of pictograms in specific populations.
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Chan HK, Aswad E, Ho YE. Influences of pictogram-based instructions in paediatric drug labelling on dosing accuracy among caregivers: a pilot study from Malaysia. J Pharm Health Serv Res 2017. [DOI: 10.1111/jphs.12169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Huan-Keat Chan
- Clinical Research Centre; Sultanah Bahiyah Hospital; Kedah Malaysia
| | - Edi Aswad
- Pharmacy Department; Sultanah Bahiyah Hospital; Kedah Malaysia
| | - Yiing-Ee Ho
- Pharmacy Department; Sultanah Bahiyah Hospital; Kedah Malaysia
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Basch CH, Roberts KJ, Zagnit EA, Martinez A. Marketing Strategies Used to Promote Children’s Medicine Sold on Internet Sites of Pharmaceutical Stores. J Community Health 2016; 41:1212-1216. [DOI: 10.1007/s10900-016-0205-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chan HK, Hassali MA, Lim CJ, Saleem F, Ghani NA. Improving pediatric liquid medication labeling of the hospital information system in Malaysia: qualitative analysis of pharmacists' perceptions. Pharm Pract (Granada) 2016; 14:699. [PMID: 27382422 PMCID: PMC4930856 DOI: 10.18549/pharmpract.2016.02.699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/01/2016] [Indexed: 11/16/2022] Open
Abstract
Background: Inadequacies of drug labeling have been frequently reported among Malaysian healthcare institutes, in which the Hospital Information System (HIS) is used. Objective: To identify potential areas to improve the existing labels used for pediatric liquid medications. Methods: This study was qualitative in nature, whereby focus group discussions (FGDs), face-to-face interviews (FTFIs), and onsite observation were used for data collection. Pharmacists stationed at three units (outpatient, inpatient and clinical pharmacy) of a tertiary hospital were targeted. Both FGDs and FTFIs were facilitated using a semi-structured interview guide, video-recorded and transcribed verbatim. All transcripts were thematically analyzed using content analysis approach. Results: Thirteen pharmacists participated in FGDs, while five were approached for FTFIs. Data analysis resulted in four major themes: format of labels, presentation of medication instructions, insufficiency of information, and the need for external aids and education. Participants unanimously agreed on the need for enlarging font sizes of key information. Suggestions were made to use more specific instructions for administration times and pictograms to illustrate important directions. The absence of information about storage, stability and handling of liquid medications was also highlighted. While discussion mainly focused on improving drug labeling, participants consistently stressed the need for an instruction sheet and pharmacist-based, one-to-one education regarding medication instructions. Conclusion: This study provides important insights into critical shortcomings in current labeling practice, underlying the need for developing a new label that incorporates a new format, additional information and pictograms for pediatric liquid medications.
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Affiliation(s)
- Huan-Keat Chan
- Pharmacy Department, Sultanah Bahiyah Hospital. Kedah ( Malaysia ).
| | - Mohamed A Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia . Penang ( Malaysia ).
| | - Ching-Jou Lim
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia . Penang ( Malaysia ).
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Baluchistan . Quetta ( Pakistan ).
| | - Norazila A Ghani
- Pharmacy Department, Sultanah Bahiyah Hospital. Kedah ( Malaysia ).
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