Practice Short cuts

Poor Americans often misinterpret labels on drug bottles

BMJ 2006; 333 doi: (Published 14 December 2006) Cite this as: BMJ 2006;333:1265

Americans from poor neighbourhoods often struggle to understand labels on drug bottles. When researchers tested 395 men and women from poor urban neighbourhoods across the US, nearly half (46.3%) misunderstood at least one of the five labels tested. People with poor literacy skills did worse than others, although misunderstandings were common even among those who could read well (37.7%). The size of each dose and the number of doses a day were the most common mistakes.

The drugs in the test—two antibiotics, an expectorant, two cardiovascular drugs, and a diuretic—were typical drugs used in primary care practice, and the labels were written in simple English. Even so, “take one tablet by mouth twice daily for seven days” was understood correctly by only 67% of participants. Worse, only a third of those who understood the directions “take two tablets by mouth twice daily” could show the researcher how many pills they should take each day.

Poor literacy, defined as the reading skills expected of someone educated no further than the sixth grade, was independently associated with misunderstanding the labels (adjusted relative risk 2.32, 95% CI 1.26 to 4.28) and with being unable to show a researcher the correct number of pills to take each day (3.02, 1.70 to 4.89).


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