Inadequate Font Size As A Cause Of Noncompliance
While young at heart, I am presbyopic of vision. Consequently, I have become aware of the difficulty reading certain types of texts that one routinely encounters on a frequent basis. The day to day category that has proved most troublesome is, by a wide margin, prescription medication labels.
It will surprise no one familiar with my interest in patient compliance that I have been speculating on the likelihood that misunderstanding and frustration engendered by problems reading the instructions jammed onto these labels lead to unintentional noncompliance with medication.
The potential for problems of this sort seems so high, in fact, that I have been surprised how infrequently this issue is listed as a possible cause. Illiteracy and instructions being written in a language other than the patient’s, for example, are much more common in the literature.
This week, I happened onto an exception to this pattern: Barriers to Medication Adherence in Poorly Controlled Diabetes Mellitus by Peggy Soule Odegard, PharmD and Shelly L. Gray, PharmD,1 identifies challenges to adherence behaviors in 77 patients taking diabetic medication. The pertinent results show that “taking more than two doses of DM medication daily and difficulty reading the DM medication prescription label were significantly associated with higher hemoglobin A1c.”2
The Variability and Quality of Medication Container Labels
Shrank and colleagues published The Variability and Quality of Medication Container Labels3, an assessment of “the format, content, and variability of prescription drug container labels dispensed in the community.”
Excerpted from the abstract:
To illustrate the results of materials printed font sizes, I have provided, in the graphic that follows, lines in Arial typeface in those same font sizes, rounded to the nearest whole number (which is given in parentheses).
Dr. Shrank’s findings are damning, and there is more, but that’s the next post.
Small Print and Noncompliance – Part 2: More Evidence, Solutions, and Why This Issue Is Important (and not just to me)
- Peggy Soule Odegard, PharmD and Shelly L. Gray, PharmD, Barriers to Medication Adherence in Poorly Controlled Diabetes Mellitus The Diabetes Educator, Vol. 34, No. 4, 692-697. 2008↩
- Increased A1c is used here as a proxy for poor adherence↩
- William H. Shrank, MSHS, MD; Jessica Agnew-Blais, et al. The Variability and Quality of Medication Container Labels. Arch Intern Med. 2007;167(16):1760-1765.↩