Can improving the literacy of patient information help combat antimicrobial resistance?

The work described here was presented at the Pharmacy Together 2019 conference.

Health texts currently exceed public reading skills: over 40 percent of adults aged 16 to 65 in England do not have the skills to read and understand health information. One way to increase understanding and encourage behaviour change is to improve health literacy. Health literacy is defined as “the ability of individuals to gain access to, understand and use information in ways which promote good health”. 

Antimicrobial resistance (AMR) is a worldwide public health crisis, and improving health literacy may help deliver elements of the 5-year antimicrobial resistance strategy as set out by the Department of Health in 2019.

Our objectives were to develop a patient information leaflet (PIL) on antibiotic courses and AMR, incorporating health literacy techniques, and to user test the PIL with patients. In addition, identify whether the PIL is effective in improving patient knowledge on antibiotic use, and whether health literacy techniques make it easier for patients to understand the information provided. 

We also aimed to test the effectiveness of the PIL as a structured counselling tool by practicing community pharmacists by identifying whether they believed it was a useful counselling tool which supported their practice, and whether they believed that their patients benefitted from the written counselling provided compared to the verbal counselling patients are usually given. 

This study required and received ethics approval. Using the revised Royal Pharmaceutical Society Checklist for Community Pharmacy and health literacy techniques (including the Patient Education Materials Assessment Tool), a patient information leaflet and patient questionnaire was developed. 

Data was collected from eight consenting community pharmacies, over a five-week period. The patient information leaflet was used as a counselling tool by pharmacists and handed to patients during the dispensing of short-course antibiotics. Convenience sampling was used to complete face-to-face questionnaires with patients receiving counselling using the patient information leaflet. In addition, pharmacists completed a questionnaire at the end of the study period.

Patient feedback

We received 106 completed patient questionnaires. Almost all patients reported having taken antibiotics previously. Patients were asked about their AMR knowledge before exposure to the new patient information leaflet. Thirteen percent reported that they ‘knew a lot’, just over half ‘knew something’, and about a fifth had heard of AMR but didn’t know anything about it. Nine percent of patients reported that they had never heard of AMR.

Level of education was correlated with AMR knowledge, with 90 percent of university graduates having “some/a lot knowledge” about AMR, compared to only two-thirds of college or sixth form leavers and just over half of school leavers.

Almost all patients agreed that the patient information leaflet had improved their knowledge on appropriate antibiotic use. 81 percent of patients intended to change their behaviour and thought that the PIL had improved their antibiotic knowledge, with just over half of these patients stating that they “always finish a prescribed course of antibiotics”. All patients reported that the PIL was easy to follow. Ninety percent of patients who had previously received antibiotics reported that the counselling received using the PIL was easier to understand than previous counselling.

Pharmacist feedback

All 8 pharmacists completed questionnaires and reported that they thought the PIL supported their practice. Six pharmacists continued to hand out the PIL when investigators were not present. 

On a scale of 1 (not at all) to 5 (improved a lot), pharmacists scored how much they thought the patient information leaflet would improve patients’ knowledge on appropriate antibiotic use. Five out of eight pharmacists reported scores of 4 or 5, indicating that they thought the PIL would improve patient knowledge. Two pharmacists reported a score of 3, and one reported a score of 2. 

Five of the eight pharmacists did not feel that the PIL took longer than their standard counselling, and of the three who that felt it did take longer, two felt that it was worthwhile. 

Key messages

Although a small sample, most patients had taken antibiotics before. Education about AMR is needed at the point of antibiotic dispensing. Simplified information in patient information leaflets developed using health literacy techniques could help raise awareness of AMR and appropriate antibiotic use alongside supporting pharmacists’ practice as a structured counselling tool. Pharmacists believed that, compared to the verbal counselling patients are usually given, written counselling using health literacy techniques had led to improved AMR education at the point of antibiotic dispensing. This pilot suggests that patients’ behaviour can be influenced by structured counselling, drawing on health literacy techniques. Future work could include different formats of the patient information leaflet for different cohorts.

This work was presented as a poster at the Pharmacy Together 2019 conference, organised by UKCPA and Pharmacy Management.

Additional authors: 

Kiyah Beck, Koulla Ioannou, Sidrah Ahmed, Syeda Nadia Zaman, Saima Afzal, Sarah Frank: University of Huddersfield

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement: 

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.


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