Assessment Of Pictogram Use In Pediatric Oral Liquid Medication Labeling At Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia
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Date
2016-06
Authors
Chan, Huan Keat
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Abstract
Liquids are commonly the preferred form of oral medication delivery for children. Generally, using pictograms to illustrate medication instructions is viewed as a feasible approach to improve communication, but limited information is available on its usefulness in pediatric medicine. This thesis consists of three studies with different designs, eventually leading to the construction of a pictogram-plus-text label for pediatric liquid medications. First, a systematic review was conducted to determine the effectiveness of pictographic interventions introduced to assist children’s caregivers in liquid medication administration. Electronic databases, including MEDLINE, CINAHL, PsycINFO, the Cochrane Library, Scopus and ScienceDirect, were searched for articles published up to February 2015. Five interventional studies with a total of 962 subjects reported positive results for at least one of the targeted endpoints, including dosing accuracy, comprehension and recall of medication instructions, and children’s adherence to treatment. Thereafter, a survey (n=208) was undertaken in the Sultanah Bahiyah Hospital, Alor Setar, to assess health literacy and difficulty in reading the medication labels among caregivers. Their health literacy was measured by using the validated Malay version of the Newest Vital Sign (NVS-M), and results showed that only 5.8% of them had adequate health literacy. Caregivers who had only primary or secondary educational levels (adjusted odds ratio [OR]: 34.44; 95% confidence interval [CI]: 6.2,
214.08; p<0.001) and monthly incomes below the poverty threshold of MYR830 (adjusted OR: 11.12; 95% CI: 1.13, 109.75; p=0.039) were more likely to have limited health literacy. Results of this survey also showed that more than 80% of caregivers reported certain levels of difficulty in reading medication levels, which was associated with the limited health literacy (φ=0.46; p<0.001). Subsequently, a qualitative study involving 18 pharmacists was conducted in the Sultanah Bahiyah Hospital, Alor Setar, to identify weaknesses of the existing labeling of pediatric liquid medications. Focus group discussions, face-to-face interviews, and onsite observation were used for data collection. Four major themes emerged from the content analysis, including format of labels, presentation of medication instructions, insufficiency of information, and the need for external aids and education. Participants made several recommendations, such as to bold and enlarge the font sizes of key information, to illustrate important instructions via pictograms, and to use “four-time periods” to denote administration times. In conclusion, this thesis has highlighted the potential areas for interventions to improve the communication of medication instructions with caregivers. In response to the findings, a pictogram-plus-text label was constructed and is ready to be tested in real health care settings.
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Liquids are commonly the preferred form of oral medication delivery for children , using pictograms to illustrate medication instructions is viewed as a feasible approach