Nearly half of adults in England don’t understand health information material, study indicatesBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e8364 (Published 07 December 2012) Cite this as: BMJ 2012;345:e8364
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The article by Susan Mayor raises an interesting issue, which seems to have been overshadowed by public health, in favor of public risk communication and the effects of various methods chosen to illustrate it. Research into the ‘communication of health risks to the public’ has conclusively found that pictorial and representations of information are more universally understood and accepted than blocks of text or graphs, and, that icons convey risk with a better understanding than numbers do .
This realisation has thus paved the way for the increase in user-friendly and simple posters and leaflets that now adorn the walls and patient waiting areas in many hospitals and GP practices. This fact alone leaves me wondering why pharmaceutical packs and inserts are so densely packed with blocks of tiny text? Indeed, I struggle to read the font size clearly and I have to admit I find the style of writing more comparable to an appliance manual than a user-friendly patient poster.
It seems that the problem is, at the least, two-fold. Firstly there is the issue of poor techniques utilised by pharmaceutical companies to display their information. Secondly, it is fundamental to make the information appropriate to its intended audience. Interestingly, in 2003, it was shown that the literacy and numeracy rates equivalent to a good pass at GCSE amongst working adults in the UK reached rates of 56% and 75% respectively , yet pharmaceutical inserts are often too complex for most healthcare professionals to interpret – in a study conducted in 2004, over 30% of surveyed UK doctors were found to have confusion over ratios and percentages when given some examples of drug labels .
With regards to the former, a recent research article  highlighted some of the strategies that could be employed to improve comprehension in this important area, including carton design and the use of new trade names versus Existing trade names. Further supportive research by EU agencies has assessed the communication value of the patient information leaflet and hence revised the template and guidelines. However, no analysis has been carried out to assess this area of pharmaceutical communication and the evidence base for which methods work most effectively for any given patient group remains scarce. It is clear from this conclusion that further empirical research in the field of pharmaceutical communication is absolutely paramount to improvements in this field.
Perhaps the most imperative function of patient information on pharmaceuticals is that of risk communication. Barring the path to clear patient information is the fact that “the information that companies can communicate about benefits and risks is strongly influenced by the obligations of companies to the market and investors .” A recommendation from the abovementioned research article suggests that pharmaceutical companies have a dedicated communications group, who “assess effectiveness of the communications, monitor audience reaction and adjust the communication strategy accordingly.”
With regards to the issue of adult literacy and numeracy rates, I think there is some scope within the methodology of the study  that may actually account for some of the low rates and figures reported. As far as I am aware, the reported literacy rates encompass people whose first language may not be English and may have been educated outside of the UK. I would be interested to see a breakdown of the results by geographic location, first language, socio-economic background and ethnicity as I think this could potentially aid the allocation of research and specific techniques in providing safe, clear and effective pharmaceutical communications for medicine and procedures provided by the NHS.
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2.Skills for life: progress in improving adult literacy and numeracy. National Audit Office Online, published June 2008. Last updated 2012. Available from: http://www.nao.org.uk/publications/0708/skills_for_life_progress_in_i.aspx
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Competing interests: No competing interests
To the Editor,
The inability of 43% of the British population to understand basic health information is of grave concern. One may surmise that ineffective communication between the patient and health professional is the single most important area we need to focus on in healthcare. In fact, we argue that basic literacy and numeracy skills are as critical to health of the nation in the 21st century as sanitation and clean water was in the 19th century [1, 2]. Improvement in basic educational attainment is a hugely powerful public health intervention due to its potency in empowering individuals to develop healthy behaviours.
As healthcare professionals, we must examine our own role in this problem. Frequently, communication between healthcare professionals and patients is suboptimal. Too often health professionals do not take time to explore patient understanding, and explain to the patient in a jargon-free digestible format, in order to enable the informed decision-making process. As medical professionals, we must not lose perspective of the fact that what is obvious to us, may not necessarily be the case for our patients. Case-in-point, work conducted by Weinman and colleagues at Kings College London revealed that even rudimentary anatomy knowledge is lacking in the general public [3, 4]. In the study of 722 participants only 46.5% could correctly locate the heart to the centre of the chest when given four diagrams to choose from (the other options located the heart in the upper chest, the abdomen and the back). This is somewhat worrying, especially when one considers cardiovascular disease is the leading cause of death globally and the charitable expenditure of the British Heart Foundation 2011-12 was £124.2 million .
All patients, irrespective of educational background, deserve the same high quality of healthcare. Identifying methods of overcoming this communication gap, where it exists, is critical to reducing the health inequality gap. One method is to use visual aids to complement our explanations. For example, we have found when consenting for an operation, taking 20 seconds to draw a simple diagram on the back of the patient’s copy of the consent form is a very effective method of enhancing their understanding of the operation e.g. laparoscopic cholecystectomy [Figure].
In summary, if we are make to inroads on the results from Professor Rowlands and colleagues work, perhaps we need to revisit the other information we give patients: from our verbal communication in consultations to the written words in discharge summary letters.
1. Mara D, Lane J, Scott B, Trouba D. Sanitation and Health. PLoS Med.2010;7:e1000363
2. Ferriman A. BMJ readers choose the “sanitary revolution” as greatest medical advance since 1840. BMJ.2007;334:334:111.2
3. Weinman J, Yusuf G, Berks R, Rayner S, Petrie KJ. How accurate is patients' anatomical knowledge: a cross-sectional, questionnaire study of six patient groups and a general public sample. BMC Family Practice.2009;10:10.1186/1471-2296-10-43
4. BBC. Basic anatomy 'baffles Britons'. http://news.bbc.co.uk/1/hi/health/8092930.stm (accessed 8 December 2012).
5. British Heart Foundation. Annual Report and Accounts 2012. http://www.bhf.org.uk/pdf/BHF%20Report%20and%20Accounts%202012_Final.pdf (accessed 8 December 2012).
Competing interests: No competing interests