The last time Inez had a head cold, she reached for three different remedies—a nasal decongestant, something for her sore throat, and a syrup for her cough. In her quest for relief, she failed to notice that all three contained acetaminophen, and each featured a warning about the dangers of multiple doses of the drug. Inez was fortunate that she had no adverse reaction: for some, acetaminophen poisoning leads to liver damage and failure.
While many patients neglect to read the information on over-the-counter and prescription drug labels, those with low literacy are daunted by unfamiliar terminology and confusing or dense medical instructions. “Many drugs have very specific regimens, and many patients simply cannot follow these detailed instructions,” says Iliana Delgado of EDC’s Adult Media Literacy Alliance (ALMA). “The directions will say to take three times a day with milk and people won’t, or they won’t take the full round of antibiotics. Some people buy over-the-counter medications and take more than the recommended dosage because they think it’s safe.”
ALMA has developed “Health Smarts While You Wait,” a volunteer-based health literacy program throughout New York City that helps patients improve their health literacy and manage their healthcare more effectively. The program features one-to-one education in hospital and clinic waiting rooms and information booklets and video segments.
ALMA’s principal effort has been to develop materials to promote literacy through its TV411 series, an award-winning educational television show. TV411 teaches the elements of reading, writing, and math in the context of practical problems: how to read a pay stub, balance a checkbook, understanding business jargon, time management, and nutrition.
When ALMA staff reformatted its TV411 material several years ago, health clinicians asked them to also repackage and restructure the information so that it could be offered to patients in hospital and clinic waiting areas.
The new health initiative, funded by the Josiah Macy, Jr. Foundation, addresses three critical skill areas involved in medical compliance: reading medical labels correctly and fully, managing multiple medications, and using a medical journal to manage chronic illness and track relevant medical information—symptoms, medications, possible side effects, and important contact information.
Waiting Room Education
The ALMA-trained volunteers provide patients in waiting areas with information, using hands-on equipment to reinforce the information—a pill caddy, pill bottles, commonly used over-the-counter medications, large print labels, and a sample medical journal.
The volunteers engage patients in mini-lessons and distribute a free Spanish/English magazine with a variety of reinforcing activities. The Health Smarts booklet uses everyday language and diagrams to show patients the key information on prescription labels and over-the-counter medication. It also includes exercises designed to help patients figure out a proper dosage schedule and learn medical abbreviations and terminology, for example, word scrambles and mix-and-match abbreviations.
“Many people don’t understand the need to follow specific dosage instructions,” explains Delgado. “One woman used to think, ‘use the big spoon for big kids and a little spoon for little kids.’ Clearly, for many patients and their families, this information will help increase safety.”
The pages devoted to reading over-the-counter and prescription labels, for instance, use enlarged labels with callout boxes to show where on the label to find different information. Below each is a quiz: “If you start feeling better, can you stop taking this medicine?” “What is the active ingredient?” “Is this medicine OK for your four year-old child?”
Partners include the Mount Sinai Hospital, Hospital for Special Surgery, Lutheran Healthcare, New York Methodist Hospital and New York Hospital Queens. Volunteers are undergraduate and graduate students from Hunter College, Columbia University, New York University, Rutgers University, and Brooklyn College.
“You can tell from the look on volunteers’ faces as people responded to learning new information. They simply lit up as if to say, ‘Wow. I’m doing some good here!’ and were thrilled that patients were so open and receptive to the information they had to offer,” says Delgado.
Other benefits of the program are more subtle. Many patients are unaware that generic drugs are the same as the name brand. One patient stated, “I am so appreciative of this information. I’ve been buying generic drugs because they are so much cheaper and I always felt badly because I thought I was cheating my children of the highest quality medicine.”
ALMA is now working with other institutions and expanding to new areas, including Norwalk, Connecticut, and other hospitals in the New York City area including the Lincoln Hospital (the Bronx) and Gouverneur Hospital Center in Chinatown.
Originally published on August 31, 2007