1. 1 BANNER READING AND UNDERSTANDING A MEDICINE LEAFLET BY ADOLESCENT CONSUMERS AND ITS DETERMINANTS Burapadaja S, Jamreondararasame B, Sanguansermsri J Faculty of Pharmacy Chiang Mai University Thailand

2. 2 Reading and Understanding a Medicine Leaflet by Adolescent Consumers and Its Determinants Burapadaja S, Jamreondararasame B, Sanguansermsri J Abstract: Problem Statement: In Thailand, there is an increase of medications and there are still problems of inappropriate medication use. One problem is that consumers have little information on medications. Reading and understanding a medicine leaflet is one way to obtain such information that could result in appropriate medication use. But there is little knowledge on how to promote this behavior. Objectives: To determine if consumers read and understand leaflets about medicines, and the factors affecting a consumer's reading and understanding of a leaflet. Design: A cross-sectional design was used to examine the leaflet content of Dangerous medicine compared with a suggestion for leaflet content by WHO. The same design, using a questionnaire, was used to investigate reading practices. A two-group design was used to determine comprehension of the leaflet content. All analyses used the p value of 0.05. Setting: This national study was done in a university in Chiang Mai by members of the professional sector. Study Population: The leaflet sample (n=154) information was collected from community pharmacies by purposive sampling. The subject sample (n=348) was recruited from the freshmen in 2002 of a university (N about 4000) by systematic sampling. Intervention: An original leaflet was selected from the leaflet sample. A new leaflet was developed using the same content as the original one but with a different design to make the content easily understandable. Each subject was assigned either to Group 1 to read the original leaflet or to Group 2 to read the new one, and understanding was measured using a 24-item test. Each item had three choices. A correct choice was given a score for an item. Results: About 90% of leaflets examined had less information for consumers than that suggested by WHO. Some content could be unfamiliar and difficult for consumers to understand. About 20% of consumers read a leaflet regularly when buying or taking a medicine. The main factors affecting low consumer reading were little access to a leaflet and low ability of consumers to read. Difficult leaflet content would inhibit consumers from reading them. The average score of Group 1 was 13.81 (57%) from a total of 24, and that of Group 2 was 18.37 (76%) which was significantly higher. Both percentages were lower than 80%, the understanding level accepted by several countries. Leaflet content was a main factor affecting the understanding. Arranging the content to be more easily understandable could increase the understanding level. Conclusions: Factors affecting a consumer’s reading and understanding of a leaflet included little access to a leaflet, difficult content and insufficient information. These shortages should be improved so that consumers could understand apppropriate use of medication. The governmental sector and other related sectors should provide more access and guarantee the quality of leaflet for consumers.

3. 3 INTRODUCTION There is an increase of medication There are still problems of inappropriate medication use A problem is that consumers have little information on medication A medicine leaflet is an official written source that could provide such information Advantages of reading and understanding of a leaflet Increasing compliance Increasing awareness of possible adverse actions Improving medication knowledge Preventing drug-related problems

4. 4 Therefore, consumers should read, understand and follow the leaflet when buying or taking a medicine because they could perform appropriate medication by doing that. But we have little knowledge about whether consumers get information by reading and understanding a leaflet, so this study focused on this issue and had these questions: Do consumers read and understand a leaflet? What are the factors affecting the consumer’s reading and understanding of a leaflet ?

5. 5 OBJECTIVES To determine if consumers read and understand leaflets about medicines, and the factors affecting a consumer’s reading and understanding of a leaflet

6. 6 METHODS Phase ALeaflet content Population:Leaflets of “Dangerous medicines” commonly used at drugstores Sampling:A sample (n=154) was collected in two months Analysis: Content analysis based on WHO Guidelines WHO Guidelines for leaflet information Medicine namePrecaution CompositionContraindication IndicationAdverse effect DosageSpecific warning PropertyStorage Duration of treatment

7. 7 Phase BConsumer’s reading Population:University freshmen (N about 4000) Sampling:A sample (n=348) was selected basing on student code Theory:Social Cognitive Variables:Attitude, Belief, Personal influence, Availability, Access, Content barrier, Self-efficacy and Reading a leaflet Tool:A questionnaire reliable and valid Analysis:Path analysis

8. 8 Phase CConsumer’s understanding A set of leaflets was selected from the leaflet sample basing on these criteria: separating from its label, having one composition and having at least 9 information topics. A leaflet was randomly selected from this set and referred to as an original. A new leaflet was developed by using the same content as the original but with different arrangement. The arrangement aimed to make the new one easily understandable basing on these criteria: using simple words, emphasizing critical words, separating sentence into items and putting content in order. A 24-item test used for the leaflet comprehension of reader had a total score of 24. The same sample as Phase B was divided into Group 1 to read the original leaflet, and Group 2 to read the new leaflet Then both groups did the test.

9. 9 RESULTS Phase ALeaflet content Presence of information topic Topic% Leaflet Dosage99.3 Name97.4 Indication96.7 Composition59.7 Specific warning43.5 Precaution40.2 Property39.6 Duration33.1 Contraindication29.9 Adverse effect25.3 Storage condition20.8 1Almost all leaflets had less information suggested by WHO 2There were technical terms that might be difficult for consumers to understand 3A leaflet separate from its label tended to have more information

10. 10 Phase BConsumer’s reading 1Percentage of reading % Respondent Regular reading17.5 Irregular reading82.5 2Factors affecting the reading Direct factors Access to a leaflet Self-efficacy to read a leaflet Indirect factors (via self-efficacy) Content difficult to understand Access to a leaflet

11. 11 Phase CConsumer’s understanding The average score of both groups Group 1Group 2 13.81 18.37p.001 (57%)(76%) This meant that the criteria used to developed the new leaflet could increase the understanding score or level. However, several countries accept that the content is considered as understandable when the understanding level of reader is 80%. Compared to the acceptable level, the understanding levels of both groups were lower and unsatisfactory.

12. 12 CONCLUSIONS Most consumers seldom read a leaflet regularly when purchasing or taking a medicine because of little access to a leaflet and low self-efficacy to read due to difficult content. The consumer’s understanding of a leaflet was unsatisfactory because of content difficult to understand. There were shortages of leaflets: Little access to a leaflet Content difficult to understand Insufficient information These shortages should be improved in order that consumers could read and understand a leaflet.

13. 13 Reasons to improve the leaflets To empower consumers in caring for their medication and health To provide more access to information on medication To create a supportive leaflet To guarantee health care provision SUGGESTIONS A leaflet should be separate from its label because it would be more accessible and could have more information. A leaflet should be understandable by passing a test of understanding Like a label, a leaflet should have a standard information enough and essential for consumers