Skip to main content
SpringerLink
Log in

The Effectiveness and Value of Written Medicine Information Across Asia and Africa: Systematic Review

  • Systematic Review
  • Published:
Drug Safety Aims and scope Submit manuscript

Abstract

Reviews on the role, value, effectiveness and desirable content of written medicine information (WMI) mostly include studies from high-income countries. We reviewed studies from Africa and Asia published between January 2004 and December 2019 to determine (1) the effect of WMI on knowledge and behaviour and (2) whether patients value WMI and their preferences for WMI. We included 16 intervention studies involving almost 3500 participants and 27 surveys of patients/public totalling over 11,000 people. Both the quality of the intervention studies and the reporting quality varied. Surveys were mostly localised, many with inadequate sampling strategies, and hence, were poorly representative of wider populations. However, most included a high proportion of participants with low educational levels. Most of the intervention studies reported significant improvements in knowledge and/or adherence after provision of WMI. Many utilised specially developed WMI in local languages, enhanced by pictograms. Provision of verbal information in addition to WMI showed variable impact. The proportion of people who read WMI, used as an indicator of its value, was reported in 15 surveys, with an overall figure of 74%. The most desirable aspects of WMI reported in 12 studies were indication, side effects, dose/instructions for use, contraindications, precautions and interactions. Nine studies reported local language was desirable. The studies suggest that WMI can improve both knowledge and adherence and is highly valued by people in many countries across Africa and Asia. Mechanisms should be considered by regulatory authorities and manufacturers to facilitate the provision of leaflets in local languages using simple terminology, perhaps enhanced by pictograms.

This study is registered with PROSPERO, registration number: CRD42019127001.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Raynor DK, Blenkinsopp A, Knapp P, Grime J, Nicolson DJ, Pollock K, Dorer G, Gilbody S, Dickinson D, Maule AJ, Spoor P. A systematic review of quantitative and qualitative research on the role and effectiveness of written information available to patients about individual medicines. Health Technol Assess. 2007;11(5):1–98.

    Google Scholar 

  2. Mullen RJ, Duhig J, Russell A, Scarazzini L, Lievano F, Wolf MS. Best-practices for the design and development of prescription medication information: a systematic review. Patient Educ Counsel. 2018;101(8):1351–67.

    Google Scholar 

  3. Young A, Tordoff J. ‘What do patients want?’ Tailoring medicines information to patients’ needs. Res Soc Admin Pharm. 2017;13:1186–90.

    Google Scholar 

  4. Nualdaisri P, Corlett SA, Krska J. Provision and need for written medicine information in Asia and Africa: a scoping review of the literature. Drug Saf. 2021. https://doi.org/10.1007/s40264-020-01038-8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Critical Appraisal Skills Programme. CASP checklist: randomised controlled trial [Internet]. 2014. Available from: https://casp-uk.net/wp-content/uploads/2018/01/CASP-Randomised-Controlled-Trial-Checklist-2018.pdf. Last accessed 20 Apr 2020.

  6. Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, et al. Evaluating non-randomised intervention studies. Health Technol Assess 2003;7(27)iii-173.

  7. Downes MJ, Brennan ML, Williams HC, Dean RS. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open. 2016;6(12):1–7.

    Google Scholar 

  8. Gebreyohannes EA, Bhagavathula AS, Abegaz TM, Abebe TB, Belachew SA, Tegegn HG, Mansoor SM. The effectiveness of pictogram intervention in the identification and reporting of adverse drug reactions in naïve HIV patients in Ethiopia: a cross-sectional study. HIV/AIDS Res Palliat Care. 2019;11:9–16.

    Google Scholar 

  9. Dowse R, Ehlers M. Medicine labels incorporating pictograms: do they influence understanding and adherence? Patient Educ Couns. 2005;58(1):63–70.

    PubMed  Google Scholar 

  10. Mansoor LE, Dowse R. Medicines information and adherence in HIV/AIDS patients. J Clin Pharm Ther. 2006;31:7–15.

    CAS  PubMed  Google Scholar 

  11. Mansoor L, Dowse R. Written medicines information for South African HIV/AIDS patients: does it enhance understanding of co-trimoxazole therapy? Health Educ Res. 2007;22:37–48.

    PubMed  Google Scholar 

  12. Dowse R, Barford K, Browne SH. Simple, illustrated medicines information improves ARV knowledge and patient self-efficacy in limited literacy South African HIV patients. AIDS Care. 2014;26:1400–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Browne SH, Barford K, Ramela T, Dowse R. The impact of illustrated side effect information on understanding and sustained retention of antiretroviral side effect knowledge. Res Soc Admin Pharm. 2019;15(4):467–73.

    Google Scholar 

  14. Al-Saffar N, Deshmuck AA, Carter P, Adib SM. Effect of information leaflets and counselling on antidepressant adherence: open randomised controlled trial in a psychiatric hospital in Kuwait. Int J Pharm Pract. 2005;13:123–31.

    Google Scholar 

  15. Al-Saffar N, Abdulkareem A, Abdulhakeem A, Salah AQ, Heba M. Depressed patients’ preferences for education about medications by pharmacists in Kuwait. Patient Educ Couns. 2008;72(1):94–101.

    PubMed  Google Scholar 

  16. Munsour EE, Awaisu A, Hassali MAA, Dabbous Z, Zahran N, Abdoun E. Impact of customized-consumer medication information on health-related quality of life among patients with type 2 diabetes mellitus. Res Soc Admin Pharm. 2020;16(6):793–9.

    Google Scholar 

  17. Demiralay R. The effects of asthma education on knowledge, behavior and morbidity in asthmatic patients. Turk J Med Sci. 2004;34:319–26.

    Google Scholar 

  18. Taibanguay N, Chaiamnuay S, Asavatanabodee P, Narongroeknawin P. Effect of patient education on medication adherence of patients with rheumatoid arthritis: a randomized controlled trial. Patient Prefer Adher. 2019;13:119–29.

    Google Scholar 

  19. Wrench W, van Dyk L, Srinivas S, Dowse R. Outcome of illustrated information leaflet on correct usage of asthma-metered dose inhaler. Afr J Prim Health Care Fam Med. 2019;11(1):a2079.

    Google Scholar 

  20. Gupta U, Sharma S, Sheth PD, Jha J, Chaudhury RR. Improving medicine usage through patient information leaflets in India. Trop Dr. 2005;35(3):164–6.

    Google Scholar 

  21. Arul Kumaran KSG, Yohannan JK, John J, Palanisamy S, Jacob S. Development and implementation of patient information leaflet on hypertension and to assess its effectiveness. Int J Pharm Res. 2009;1(3):712–9.

    Google Scholar 

  22. Arul Kumaran KSG, Palanisamy S, Rajasekaran A. Development and implementation of patient information leaflets in diabetes mellitus. J Pharm Health Serv Res. 2010;1(2):85–9.

    Google Scholar 

  23. Karuniawati H, Putra ON, Wikantyasning ER. Impact of pharmacist counseling and leaflet on the adherence of pulmonary tuberculosis patients in lungs hospital in Indonesia. Ind J Tubercul. 2019;66:364–9.

    Google Scholar 

  24. Jarernsiripornkul N, Chaipichit N, Chumworathayib P, Krska J. Management for improving patients’ knowledge and understanding about drug allergy. Pharm Pract. 2015;13(1):513.

    Google Scholar 

  25. Jarernsiripornkul N, Phueanpinit P, Pongwecharak J, Krska J. Development and evaluation of user-tested Thai patient information leaflets for non-steroidal anti-inflammatory drugs: Effect on patients’ knowledge. PLoS ONE. 2019;14(1):e0210395.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Kunutsor S, Walley J, Muchuro S, Katabira E, Balidawa H, Namagala E, Ikoona E. Improving adherence to antiretroviral therapy in sub-Saharan African HIV-positive populations: an enhanced adherence package. AIDS Care. 2012;24:1308–15.

    CAS  PubMed  Google Scholar 

  27. Thawani VR, Gharpure KJ, Sontakke SD. Impact of medicine-related information on medicine purchase and use by literate consumers. Ind J Pharmacol. 2014;46(4):420–4.

    Google Scholar 

  28. Ankrah DNA, Ofei CN. The effect of advice to read the medicine/patient information leaflet among patients in Ghana: a cross-sectional study. J Pharm Health Serv Res. 2010;1:91–6.

    Google Scholar 

  29. Kyei S, Ocansey S, Asumeng Koffuor G, Abokyi S, Adu FK. Patients’ information leaflets: its’ influence on ophthalmic patient education and medication compliance. Br J Med Med Res. 2014;4:1217–30.

    Google Scholar 

  30. Opare-Addo MN, Buabeng KO, Marfo AF, et al. Source of medicines and medicine information by self-reported persons living with hypertension and diabetes in rural and urban Ghana. Pharm Pract. 2018;16(3):1151.

    Google Scholar 

  31. Afolabi MO, Akinwale VO, Akinyemi OA, Irinoye AI. Patient use and perception of medicine information leaflets. Pharmacoepidemiol Drug Saf. 2012;21:111.

    Google Scholar 

  32. Sevikyan A, Kazaryan I, Amirkhanyan A, Melikyan M. Patients’ expectations on receiving medicines information from community pharmacies. Res Soc Admin Pharm. 2017;13:e10–1.

    Google Scholar 

  33. Amin MEK, Chewning BA, Wahdan AMH. Sources of drug information for patients with chronic conditions in Alexandria, Egypt. Int J Pharm Pract. 2010;19:13–20.

    PubMed  Google Scholar 

  34. Bansal V, Dhamija P, Medhi B, Pandhi P. Package inserts-do they have any role? JK Pract. 2006;13(3):152–4.

    Google Scholar 

  35. Kaikade SB, Jha RK. Assessment of awareness and attitude towards package inserts amongst rural population. Res J Pharm Biol Chem Sci. 2011;2(4):982–5.

    Google Scholar 

  36. Singh KR, Munshi R, Arora D. Assessment of the degree of awareness among physicians and patients about drug package inserts. Int J Pharm Sci Res. 2016;7(3):1258–62.

    Google Scholar 

  37. Dawoodi I, Bhosale UA. Evaluation of knowledge and awareness of patients about prescribed drugs and their package inserts: a cross-sectional study. Asian J Pharm. 2016;10(2):S96–9.

    CAS  Google Scholar 

  38. Nader F, Mousavizadeh K, Ghafourifar P. Patient sources for drug information in Iran: a questionnaire-based survey. Pharm World Sci. 2008;30:764–7.

    PubMed  Google Scholar 

  39. Ahmadi P, Badri S, Zargarzadeh A. An investigation on patient attitudes toward package inserts and their accessibility in Iran. J Res Med Sci. 2018;23:100.

    PubMed  PubMed Central  Google Scholar 

  40. Vinker S, Eliyahu V, Yaphe J. The effect of drug information leaflets on patient behavior. Isr Med Assoc J. 2007;9:383–6.

    PubMed  Google Scholar 

  41. Dawood OT, Hassali M, Saleem F, Ibrahim IR. Assessment of self-reporting reading of medicine’s labels and the resources of information about medicines in general public in Malaysia. Pharmacol Res Perspect. 2018;6(2):e00387.

    PubMed  PubMed Central  Google Scholar 

  42. Saleem H, Ghoto MA, Memon N, Dayo A, Suheryani I, Shafique S, Khan M, Arain MI. Assessment of patients’ awareness towards pharmacotherapy and their sources of drug information in different areas of Hyderabad, Pakistan. Int Res J Biol Sci. 2015;4(8):56–9.

    Google Scholar 

  43. Rahim N, Rafiq K, Iffat W, Nesar S, Shakeel S. Patients comprehension of pharmaceutical package inserts information in Karachi. Pakistan. Trop J Pharm Res. 2015;14(12):2307–11.

    Google Scholar 

  44. Al-Ramahi R, Zaid AN, Kettana N, Sweileh W, Al-Jabi D. Attitudes of consumers and healthcare professionals towards the patient package inserts—a study in Palestine. Pharm Pract. 2012;10(1):57–63.

    Google Scholar 

  45. Sweileh WM, Zeid AA, Jaradat NA. Drug information value of patient package insert (PPI): a sample study in Palestine. J Islam Univ Gaza. 2004;2(2):59–68.

    Google Scholar 

  46. Bawazir SA, Abou-Auda HS, Gubara OA, Al-Khamis KI, Al-Jamani MJMS. Public attitude toward drug technical package inserts in Saudi Arabia. J Pharm Technol. 2003;19:209–18.

    Google Scholar 

  47. Abanmy NO, Al-Quait N, Alami AH, Al-Juhani M, Al-Aqeel S. The utilization of Arabic online drug information among adults in Saudi Arabia. Saudi Pharm J. 2012;20(4):317–21.

    PubMed  PubMed Central  Google Scholar 

  48. Ho CH, Ko Y, Tan M-L. Patient needs and sources of drug information in singapore: is the internet replacing former sources? Ann Pharmacother. 2009;43:732–9.

    PubMed  Google Scholar 

  49. Liu LST, Goh BQ, Tang WP, Lo FL, Khoo RSY, Lim CJF. Drug information needs and concerns of primary care patients with newly prescribed chronic medications. Proc Singap Healthc. 2018;27(4):294–8.

    CAS  Google Scholar 

  50. Perera T, Ranasinghe P, Perera U, Perera S, Adikari M, Jayasinghe S, Constantine GR. Knowledge of prescribed medication information among patients with limited English proficiency in Sri Lanka. BMC Res Notes. 2012;5:658.

    PubMed  PubMed Central  Google Scholar 

  51. Song S, Lee S-M, Jang S, Lee YJ, Kim N-H, Sohn H-R, Suh D-C. Mediation effects of medication information processing and adherence on association between health literacy and quality of life. BMC Health Serv Res. 2017;17(1):11.

    Google Scholar 

  52. Jarernsiripornkul N, Phueanpinit P, Pongwecharak J, Krska J. Experiences of and attitudes towards receiving information about non-steroidal antiinflammatory drugs: a cross-sectional survey of patients in Thailand. Expert Opin Drug Saf. 2016;15(4):417–26.

    PubMed  Google Scholar 

  53. Pongpunna S, Pratipanawatr T, Jarernsiripornkul N. Survey of outpatients’ use and needs of patient medicine information leaflets in Thailand. Int J Clin Pharm. 2019;41(1):141–50.

    PubMed  Google Scholar 

  54. Division of Innovative Health Products and Services, Food and Drug Administration. Guideline for leaflet development for drug research and innovation [Internet]. 2019. Available from: www.fda.moph.go.th/sites/oss/Shared%20Documents/SmPC-PIL_HPEP%20guideline_updated%20May2019.pdf.

  55. Raynor DK, Knapp P, Moody A, Young R. Patient information leaflets—impact of European regulations on safe and effective use of medicines. Pharm J. 2005;275:609–11.

    Google Scholar 

  56. Raynor DK, Silcock J, Knapp P, Edmondson H. How do patients use medicine information leaflets in the UK? Int J Pharm Pract. 2007;15:209–18.

    Google Scholar 

  57. Krska J, Morecroft CW. Patients’ use of information about medicine side effects in relation to experiences of suspected adverse drug reactions: a cross-sectional survey in medical in-patients. Drug Saf. 2013;36(8):673–80.

    PubMed  Google Scholar 

  58. Patel SP, Dowse R. Understanding the medicines information-seeking behaviour and information needs of South African long-term patients with limited literacy skills. Health Expect. 2013;18:1494–507.

    PubMed  PubMed Central  Google Scholar 

  59. Wongtaweepkij K, Corlett SA, Krska J, Pongwecharak J, Jarernsiripornkul N. Patients’ experiences and perspectives of receiving written medicine information about medicines: a qualitative study. Patient Prefer Adher. 2021;15:569–80.

    Google Scholar 

  60. Council for International Organizations of Medical Sciences Working Group XI: Patient involvement in development and safe use of medicines. Available at: https://cioms.ch/working-groups/working-group-xi-patient-involvement/ Accessed 19 July 2021.

Download references

Author information

Authors and Affiliations

  1. Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Thailand

    Pitchaya Nualdaisri

  2. Medway School of Pharmacy, Universities of Kent and Greenwich, Chatham Maritime, Kent, UK

    Pitchaya Nualdaisri, Sarah A. Corlett & Janet Krska

Authors
  1. Pitchaya Nualdaisri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah A. Corlett
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janet Krska
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Janet Krska.

Ethics declarations

Funding

This work was supported by a Royal Thai Government Scholarship for PN.

Conflict of interest

The authors have no conflicts of interest to declare.

Ethics approval

Ethics approval was not required for this study

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and material

Not applicable.

Code availability

Not applicable.

Author contributions

PN conducted searches, screened titles, extracted data and commented on the article; SC reviewed studies, extracted data and contributed to drafting the article; JK screened titles, extracted data and drafted the article. All authors have read and approved the final version of the manuscript.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 202 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nualdaisri, P., Corlett, S.A. & Krska, J. The Effectiveness and Value of Written Medicine Information Across Asia and Africa: Systematic Review. Drug Saf 44, 1283–1295 (2021). https://doi.org/10.1007/s40264-021-01114-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40264-021-01114-7

Search

Navigation