title: A systematic review of interventions to improve medication information for low health literate populations.
abstract: Health literacy is a barrier to accurately understanding medication information. Current medication information is too difficult to understand for low health literate populations, which imposes a higher risk of misinterpreting prescription label instructions, dosage, duration, frequency, warning labels, written information and verbal pharmacist counseling.
  
  
  
  The primary objective of this paper was to systematically review the evidence on interventions for improving medication knowledge and adherence for low health literate populations.
  
  
  
  A database search of PubMed, Embase, International Pharmaceutical Abstracts, Web of Science, Cochrane Library, CINAHL, PsycINFO, and Scopus databases from the start of each database to studies published prior to March 30, 2015. Studies were included if they explicitly stated they included low health literate populations, included outcome measures for knowledge and/or adherence, focused on medication information, were written in English and were available in full text. Full text papers were excluded if there was no clear mention of an intervention being studied, if the intervention had no focus on any of the domains of health literacy, and if the authors did not specify the inclusion of patients with low health literacy.
  
  
  
  The review identified 1553 titles, 1009 abstracts, and 168 full text articles and included 47 articles in the final review. Of the 47 included studies, 70.2% (33/47) were published in the United States and 87.2 (41/47) were published between 2005 and 2014. Studies were grouped into six different types of interventions 1) written information 2) visual information 3) verbal information 4) label/medication bottle 5) reminder systems and 6) educational programs and services. Results demonstrate significant improvement of knowledge in 27 of 37 interventions and a significant improvement of adherence in 19 of 26 interventions.
  
  
  
  Interventions designed to support low health literate populations can improve patients' medication knowledge and adherence. The most effective interventions include additional aids that enforce written information, information that is personalized, information that is easy to navigate and tools that can be accessed when needed.
authors.affiliation: School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 4G3, Canada.
authors.forename: Huda
authors.initials: H
authors.lastname: Wali
authors.affiliation: School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 4G3, Canada.
authors.forename: Zain
authors.initials: Z
authors.lastname: Hudani
authors.affiliation: School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 4G3, Canada.
authors.forename: Sahr
authors.initials: S
authors.lastname: Wali
authors.affiliation: School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 4G3, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Mercer
authors.affiliation: School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 4G3, Canada. Electronic address: Kelly.grindrod@uwaterloo.ca.
authors.forename: Kelly
authors.initials: K
authors.lastname: Grindrod
mesh_terms: D004348:Drug Labeling; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D055118:Medication Adherence; D010353:Patient Education as Topic / Q000379:methods; D010593:Pharmaceutical Services / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration; D055553:Prescription Drugs / Q000008:administration & dosage; D024382:Professional Role; D017010:Reminder Systems
chemical_list: D055553:Prescription Drugs
keywords: Health literacy; Medication adherence; Medication information; Medication knowledge; Pharmacy