title: Low literacy impairs comprehension of prescription drug warning labels.
abstract: BACKGROUND
  Adverse events resulting from medication error are a serious concern. Patients' literacy and their ability to understand medication information are increasingly seen as a safety issue.
  
  
  OBJECTIVE
  To examine whether adult patients receiving primary care services at a public hospital clinic were able to correctly interpret commonly used prescription medication warning labels.
  
  
  METHODS
  In-person structured interviews with literacy assessment.
  
  
  METHODS
  Public hospital, primary care clinic.
  
  
  METHODS
  A total of 251 adult patients waiting for an appointment at the Louisiana State University Health Sciences Center in Shreveport (LSUHSC-S) Primary Care Clinic.
  
  
  METHODS
  Correct interpretation, as determined by expert panel review of patients' verbatim responses, for each of 8 commonly used prescription medication warning labels.
  
  
  RESULTS
  Approximately one-third of patients (n=74) were reading at or below the 6th-grade level (low literacy). Patient comprehension of warning labels was associated with one's literacy level. Multistep instructions proved difficult for patients across all literacy levels. After controlling for relevant potential confounding variables, patients with low literacy were 3.4 times less likely to interpret prescription medication warning labels correctly (95% confidence interval: 2.3 to 4.9).
  
  
  CONCLUSIONS
  Patients with low literacy had difficulty understanding prescription medication warning labels. Patients of all literacy levels had better understanding of warning labels that contained single-step versus multiple-step instructions. Warning labels should be developed with consumer participation, especially with lower literate populations, to ensure comprehension of short, concise messages created with familiar words and recognizable icons.
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71104, USA. tdavis1@lsuhsc.edu
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Pat F
authors.initials: PF
authors.lastname: Bass
authors.forename: Mark
authors.initials: M
authors.lastname: Middlebrooks
authors.forename: Estela
authors.initials: E
authors.lastname: Kennen
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Ramon
authors.initials: R
authors.lastname: Durazo-Arvizu
authors.forename: Anna
authors.initials: A
authors.lastname: Bocchini
authors.forename: Stephanie
authors.initials: S
authors.lastname: Savory
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Parker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D032882:Comprehension; D004348:Drug Labeling; D064420:Drug-Related Side Effects and Adverse Reactions; D004522:Educational Status; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D004364:Pharmaceutical Preparations; D011932:Reading
chemical_list: D004364:Pharmaceutical Preparations