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Why patient information leaflets need improvement

Health literacy must be considered during patient information leaflet development, as it can make a difference and improve patient lives.

Let’s begin with a question. When it comes to assembling flat-pack furniture, are you an ‘instruction follower’, or do you prefer to work it out for yourself?   

If you’re the latter, it’s most probably because you find instructions impossible to understand. What’s the worst that can happen if you get it wrong, anyway? You either have to start again, or make do with a less-than-perfect chest of draws.  

Sadly, however, failure to follow patient information leaflets (PILs) can carry a much higher price. These may sound like strong words, but consider all the people who haven’t the time or capacity to read PILs properly. Failure to understand how and when to take medication, or how important it is, can have results which are far more disastrous than a wobbly chair. At best, the therapies won’t ease or cure symptoms, and at worst they can aggravate illnesses, produce harmful side-effects and even fatalities.   

Current PIL problems
 
Patient information leaflet improvement can only occur if some of the problems of health literacy are understood first. These include:

COMPLEX LANGUAGE: Often, PIL writers are experts who forget that many will not be familiar with the terms they frequently use. Such language can deter patients from reading.
SALIENT INFO NOT EMPHASISED: Eyes naturally skim long text for ‘highlights’ such as ‘DO NOT TAKE WHILE PREGNANT’. Often, salient points don’t stand out enough.
UNCLEAR INSTRUCTIONS: ‘Avoid alcohol’ could either mean either the substance is harmful when taken with the drug, or that it simply stops the drug from working. Unclear instructions are often ignored completely, rather than queried.
POOR LAYOUT AND FONT SIZE/STYLE: Again, the brain will be put off by what the eye finds hard to look at. 

Solutions
There are current industry guidelines on font, line-spacing and layout, but they are perhaps too uniform and need to be adapted to suit different products and patients. The ‘one size fits all’ approach cannot work in patient information leaflet development.   

Obviously, fonts will usually be smaller when there is more text. But line-spacing should compensate in these cases to give weary eyes a rest, and different fonts colours used for section headings. Italics and underlining have a two-fold effect: they not only highlight the most important information, but also make the complete text more attractive to the eye – and therefore more readable and easy to understand. Also, black font should always have a white background; anything else isn’t visible enough.   

Page layout is a vital ingredient in PILs, but that is certainly not to disregard the content itself. Despite its factual, emotionless matter, the content’s flow and sentence structure determines how easy it is to read (and therefore understand). Therefore complex language should be avoided, and bullet points used when possible (but not too frequently). The ‘active voice’ should always be used.   

The aforementioned problems of complex language, salient info and unclear instructions all come under the ‘content’ umbrella, so PILs need to be free of jargon and complicated terms, focused on stressing the most important points (or actions that need to be taken), and unambiguous. The earlier ‘do not take with alcohol’ example could apply to any instruction: patients need to know what will happen if they fail to follow the advice, not just that they simply need to do as told.   

Besides words, of course, symbols and pictograms can always be a help to readers. They are a back-up, however, and words should therefore always accompany them. The greatest tool in patient information leaflet development, however, is patients themselves. Their feedback is vital, so leaflets should be tested first – and then amended and re-amended until they are satisfactory to all levels of health literacy. Patients, like most people, are more than willing to give their opinions when asked about something they care about.   

Although this is time-consuming, the rewards will be worth it – especially when you remember that these rewards are greater adherence to courses of treatment, better health, and happier patients. 

This blog was originally published here: http://www.wearecouch.com/blog/health-literacy-pil


15th May 2017

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