Skills For Success

May/June 2001

Hitting the Target with “Easy-to-Read” Patient Education

Stephanie Mazzeo-Caputo, MSW, MS, RD
Vice President, Health Education,
Doctors+Designers

Are we educating patients effectively? All too often, the answer is: not well enough.

As an industry, we are tireless in discovering, developing and producing medicines that can change lives. Yet the economic and therapeutic success of a drug may hinge on whether patients actually take the medicine, take it appropriately and keep taking it.

  • One study reported that patients who were prescribed potentially lifesaving drugs to lower cholesterol neglected to fill their prescriptions for about 40% of the study year. After five years, half the patients had stopped using cholesterol-lowering therapy altogether.1
  • Another study found that nearly 70% of hypertensive patients do not have their blood pressure under control, primarily because of noncompliance.2
  • Researchers have found that the majority of patients understand less than a third of commonly used health education materials.3

Noncompliance is costly for everyone. Americans spend an estimated $60-$100 billion a year to treat problems caused by noncompliance.4 The cost of noncompliance to the pharmaceutical companies alone totals an estimated $15–$20 billion each year, according to the National Pharmaceutical Council.5

CREATING EASY-TO-READ MATERIALS According to a study in Public Health Reports, half the adult population in the US needs easy-to-read materials, while the other half wants them, regardless of need.6 In keeping with this finding, materials must be written simply and clearly, with visuals that help tell the story and a layout that enhances readability and is tested with the intended patient and physician audience.

Our challenge is to 1) help patients and caregivers understand and comply with their treatment regimen, 2) help providers explain treatments in ways that engage patients and enable them to understand and follow instructions, and 3) use this opportunity to make a positive connection between the pharmaceutical company and their customers—providers and patients.

One way to meet this challenge is to be sure that the interchange between patient and provider is informative and positive. Making patient education and counseling materials understandable and engaging can be a key factor in the success of a new medicine.

Strategy That Achieves Your Goals

Developing easy-to-read patient education materials requires strategic planning. Many writers focus only on what they want to tell the reader, but the most effective way to help patients learn about a condition or manage a treatment is to focus on what the reader wants and needs to know, taking into account the psychosocial health beliefs, educational and cultural factors that affect understanding and motivation.

At Doctors+Designers, our Health Educators ask these kinds of questions in the planning stage:

  • Who is the target audience?
  • What is the goal of the materials?
  • What are the key issues of the target audience?
  • What are the barriers and/or facilitators of treatment adherence?
  • What are the key educational messages?
  • What literacy level is most appropriate?
  • What is the best vehicle to deliver the educational messages?

Writing That Boosts Compliance

Some basic principles of easy-to-read patient education:

  • Use the active voice versus the passive voice.
    Example: “Take your medication” instead of “medication may be taken”
  • Use simple words instead of multisyllable words.
    Example: “Use” instead of “utilize”
  • Use common terms instead of jargon or technical terms.
    Example: “Medicine that lowers swelling” instead of “anti-inflammatory”
  • Use friendly, conversational tone versus formal tone.
    Example: “If you follow your treatment plan, you will feel better” instead of “Compliance with the therapeutic regimen will yield improved outcomes.”
  • Make word “pictures” by using examples and analogies rather than just listing facts.
    Example: “Your body uses up medication just like it uses up food. You know that if you eat a sandwich for lunch, you feel hungry again by dinner time. In the same way, if you take your twice-a-day anti-seizure medication at 8 a.m., your body ‘digests’ it and is ‘hungry’ for more medicine by 8 p.m.”

Writing That Gets the Message Across

Health Educators generally agree that a 6th grade readability level or lower is about right for the majority of patients.7 There are many scales available to help you gauge the reading level of your material, such as the SMOG Formula.

Visuals That Support the Message

One great picture is easily worth a thousand of our carefully crafted words. The visuals you select must reinforce the message. If you’re telling people “don’t drink alcohol while you’re taking this medicine,” indicate what beverages are acceptable. Illustrate the message with these items, not a bottle and shot glass.

It is also important to evaluate materials for cultural and gender-related sensitivities. You can avoid many cross-cultural and translation misunderstandings by keeping metaphors and colloquial expressions out of your materials.

A Layout That Guides the Reader

Good design and layout make comprehension quicker, easier and more efficient. Evaluating the effectiveness of layout and design means learning to view material analytically. Some basic principles to keep in mind:

  • Use headers and subheads that highlight and categorize important information. Patients should be able to look at your material and know what it’s about at a glance. These visual cues are called “road signs” because they give the reader a quick overview of what’s ahead.
  • “Chunk” information into smaller categories so that readers are asked to absorb no more than 4 or 5 items at a time.
  • Use “question” words and phrases to point the reader to important answers: “What should I do if I miss a dose?” “Can I take other medicines at the same time?”
  • Make good use of design devices like boxes, large type, colorful charts, white space and color highlights to make information clear and readable, particularly for older patients.

Testing That Tells You If It Works

The best way to know if your material achieves your goals is to test it. At Doctors+Designers, we develop advisory boards of healthcare providers and patients to review all materials we develop for content and comprehension.

These are some of the questions we ask patients during the testing stage:

  • What does this material tell you about (the disease or condition)?
  • When are you supposed to take this medicine?
  • When should you NOT take this medicine?
  • What does this picture tell you?
  • What benefits do you think you would get from this treatment?

Effective patient education is a winwin for everyone. Well-planned, well-executed materials help brand managers cultivate relationships and enhance positive connections between company and provider. Patients come away with a better understanding of their medical condition and how to manage it. The end result is greater confidence in the care they are receiving, better compliance and persistence in taking their medication and appreciation of the provider and pharmaceutical company for the personal support.

Winning acceptance of a new medication is a key factor in a drug’s success in the marketplace. Pharmaceutical companies that understand the power of patient education to foster compliance will have a definite edge in achieving success. In that critical few moments when healthcare providers talk with patients, effective education and counseling materials can make a crucial difference.

Stephanie Mazzeo-Caputo, MSW, MS, RD, is Vice President, Health Education, at Doctors+Designers, a relationship marketing company devoted to patient-centered health education and medical professional education. The web address is www.doctorsdesigners.com. Stephanie can be reached at (908) 654-4440, ext. 117, or stephanie@doctorsdesigners.com.

References

1. Avorn J, et al. “Persistence of use of lipid-lowering medications: A cross-national study,” JAMA 1998;279:1458–1462.
2. Burnier M. “Long-term compliance with antihypertensive therapy,” Blood Pressure Monitoring 2000;5 Suppl I:S31–34.
3. Cited in University of Utah Hospitals and Clinics, Office of Patient Education, “Patient Education for U: Guidelines for Patient Education Written Materials: Literacy Facts,” 1997.
4. McCarthy R. “The price you pay for the drug not taken,” Business & Health, October 1998.
5. National Pharmaceutical Council, cited in Mazzeo-Caputo S. “In the know: Goals & guidelines for improving patient education,” Pharmaceutical Executive, July 1998.
6. Public Health Reports, 1994, cited in Mazzeo-Caputo.
7. Lorig, Kate, and Associates. Patient Education: A Practical Approach, 2nd Ed. Thousand Oaks, Calif.: SAGE Publications, 1996.