Strategies to optimize comprehension of numerical medication instructions: A systematic review and concept map.
Marianne Sharko, Mohit M Sharma, Natalie C Benda and 6 others
PMID 35123834WHAT IT FOUND
Time words such as morning, noon, evening or bedtime helped patients understand medication instructions better than times per day.
For liquid doses, icons showing the fill line helped, but pictures without explanatory text sometimes reduced comprehension.
Key findings
01Five studies found that time periods such as morning, noon, evening and bedtime improved comprehension, accuracy, regimen consolidation and adherence compared with times per day.
02All five liquid dosing visualization studies, four with caregivers of pediatric patients and one with adults, found improved accuracy, comprehension, preference or recall compared with text-only instructions.
03Two studies found that visualizations without explanatory text reduced comprehension, and participants found an unfamiliar 12-hour clock timeline particularly confusing.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a subset of a larger broad search, so relevant studies may have been missed. It reviewed only written numerical medication instructions, excluding oral counseling, teach-back and other non-numerical communication strategies. The 21 studies used different outcome measures, so the reviewers could not combine point estimates or confidence intervals in a meta-analysis. Many studies had small samples and limited generalizability. Nearly 40% of included studies had design, data collection or analysis limitations that could weaken confidence. Visualizations varied widely in icons, concreteness and explanatory text, so some findings may not apply to a specific label design. Some studies dated back to the 1990s, so their methods and images may be less relevant now.
Declared interests
The authors declared no competing interests and no conflicts of interest. The article metadata lists U.S. government and NIH extramural research support.
The easy way to misread this
Do not assume that adding any picture to a medication label will improve understanding. Some visualizations without explanatory text reduced comprehension, and timelines or tables did not consistently help.