Prescription Drug Warning Pictograms: What are They Really Saying?
AAPA ePoster library. Jackson D. 05/17/17; 180504; 117
David Jackson
David Jackson
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Abstract
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Abstract Objective. Medication adherence is problematically low, with the World Health Organization reporting rates near 50%. One of the many suggested causes is inadequate drug labeling. Additionally, complex instructions may hinder patients from taking prescriptions correctly. Previous research suggests that the pictograms associated with prescription drug warning labels may, in fact, harm rather than enhance, patient understanding of proper medication use. Therefore, despite common use, the role of pictograms is questionable. This research evaluated a prospective patient's ability to identify the intended meaning of pictograms on pharmaceutical warning labels. Methods and Participants. The US Pharmacopeia (USP) has a database of 81 pictograms, which include instructional text. A representative sample of 20 pictograms, without text, was used to evaluate 94 participants' comprehension of pictogram meanings. Individuals, who were at least 21, with English language proficiency of at least a 9th grade level, were recruited. The Rapid Estimate of Adult Literacy in Medicine was used to determine reading level. The pictograms were displayed in two sizes, large and small. Four groups were utilized to control for the bias of which size was viewed first, large or small. Group 1 started with small pictograms 1-10 and then progressed to the large pictograms 11-20. Group 2 started with large pictograms 1-10 and then progressed to the small pictograms 11-20. Group 3 reversed the order of Group 1 and Group 4 reversed the order of Group 2. The data was analyzed using a linear mixed effect model to predict the dependent variable, SCORE (the average grade), using the two fixed effects, SIZE (large and small) and ITEM (pictogram), and their associated interaction. Calculations were completed using R (version 3.3.2 and packages lme4 version 1.1.12, lmerTest version 2.0.32, and lsmeans version 2.25). The output of the linear mixed effect model was subjected to a type 3 ANOVA. Results. Analysis of the 94 participants' data demonstrated statistically significant main effects of SIZE (F(1,96)=74.28, p< .001) and ITEM, (F(19,991)=31.36, p< .001), which were superseded by their interaction (F(19,1218)=5.55, p< .001). The predicted marginal means for each item and size were calculated, and the 95% confidence intervals were further calculated around these marginal means. Four large pictograms were found to have a confidence interval that contained the score of at least four....
Abstract Objective. Medication adherence is problematically low, with the World Health Organization reporting rates near 50%. One of the many suggested causes is inadequate drug labeling. Additionally, complex instructions may hinder patients from taking prescriptions correctly. Previous research suggests that the pictograms associated with prescription drug warning labels may, in fact, harm rather than enhance, patient understanding of proper medication use. Therefore, despite common use, the role of pictograms is questionable. This research evaluated a prospective patient's ability to identify the intended meaning of pictograms on pharmaceutical warning labels. Methods and Participants. The US Pharmacopeia (USP) has a database of 81 pictograms, which include instructional text. A representative sample of 20 pictograms, without text, was used to evaluate 94 participants' comprehension of pictogram meanings. Individuals, who were at least 21, with English language proficiency of at least a 9th grade level, were recruited. The Rapid Estimate of Adult Literacy in Medicine was used to determine reading level. The pictograms were displayed in two sizes, large and small. Four groups were utilized to control for the bias of which size was viewed first, large or small. Group 1 started with small pictograms 1-10 and then progressed to the large pictograms 11-20. Group 2 started with large pictograms 1-10 and then progressed to the small pictograms 11-20. Group 3 reversed the order of Group 1 and Group 4 reversed the order of Group 2. The data was analyzed using a linear mixed effect model to predict the dependent variable, SCORE (the average grade), using the two fixed effects, SIZE (large and small) and ITEM (pictogram), and their associated interaction. Calculations were completed using R (version 3.3.2 and packages lme4 version 1.1.12, lmerTest version 2.0.32, and lsmeans version 2.25). The output of the linear mixed effect model was subjected to a type 3 ANOVA. Results. Analysis of the 94 participants' data demonstrated statistically significant main effects of SIZE (F(1,96)=74.28, p< .001) and ITEM, (F(19,991)=31.36, p< .001), which were superseded by their interaction (F(19,1218)=5.55, p< .001). The predicted marginal means for each item and size were calculated, and the 95% confidence intervals were further calculated around these marginal means. Four large pictograms were found to have a confidence interval that contained the score of at least four....
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