Cognitive Accessibility of OTC Drug Information Ruth S. Day / Duke University FDA Nonprescription...
-
Upload
lesley-dickerson -
Category
Documents
-
view
217 -
download
0
Transcript of Cognitive Accessibility of OTC Drug Information Ruth S. Day / Duke University FDA Nonprescription...
Cognitive Accessibilityof OTC Drug Information
Ruth S. Day / Duke UniversityFDA Nonprescription Drugs Advisory Committee
(9/25/06)
Drug FactsActive ingred PurposeUsesWarningsDirectionsInactive ingredients
1) Basic Approach
2) Cognitive Principles
3) Non-OTC Examples
Cognitive Accessibilityof OTC Drug Information
1) Basic Approach
2) Cognitive Principles
3) Non-OTC Examples
4) OTC Examples
5) Generality
6) Conclusions
Cognitive Accessibilityof OTC Drug Information
QUESTION:How do people understand drug information?
ANSWER: With difficulty!
WHY: --Heavy information load
--Complex/technical information
--etc.
Ruth Day
QUESTION:How do people understand drug information?
ANSWER: With difficulty!
WHY: --Heavy information load
--Complex/technical information
--etc.
--Cognitive AccessibilityRuth Day
The ease with which
people can drug information
findunderstandrememberuse
Cognitive Accessibility
Ruth Day
The ease with which
people can drug information
findunderstandrememberuse
in a safe and effective manner.
Cognitive Accessibility
Ruth Day
The ease with which
people can drug information
findunderstandrememberuse
in a safe and effective manner.
Cognitive Accessibility
Ruth Day* Day, 2000; 2006
*
The ease with which
people can drug information
findunderstandrememberuse
in a safe and effective manner.
Cognitive IN-Accessibility
Ruth Day* Day, 2000; 2006
INFORMATION SOURCES
TV Ads Internet Hardcopy
Professional LabelPatient Package InsertsMedication GuidesPharmacy LeafletsPrint AdsOTC
Ruth Day
Rx Ads
OTC
Product Websites
INFORMATION SOURCES
TV Ads Internet Hardcopy
Professional LabelPatient Package InsertsMedication GuidesPharmacy LeafletsPrint AdsOTC
Ruth Day
Product Websites
Rx Ads
OTC
Cognitive Enhanced Cognitive Analyses Displays Experiments
--Obtain quantitative measures
--Calculate “cognitive accessibility”
--Compare benefits vs. risks
Ruth Day
BASIC APPROACH
Cognitive Enhanced Cognitive Analyses Displays Experiments
BASIC APPROACH
--Same info
--Based on cognitive principles
Ruth Day
--Obtain quantitative measures
--Calculate “cognitive accessibility”
--Compare benefits vs. risks
Cognitive Enhanced Cognitive Analyses Displays Experiments
BASIC APPROACH
Test effects on:--Attention--Comprehension--Memory--Problem Solving--Decision Making--Behavior
--Same info
--Based on cognitive principles
Ruth Day
--Obtain quantitative measures
--Calculate “cognitive accessibility”
--Compare benefits vs. risks
Cognitive Enhanced Cognitive Analyses Displays Experiments
BASIC APPROACH
Test effects on:--Attention--Comprehension--Memory--Problem Solving--Decision Making--Behavior
Health Outcomes
--Same info
--Based on cognitive principles
Ruth Day
--Obtain quantitative measures
--Calculate “cognitive accessibility”
--Compare benefits vs. risks
COGNITIVE PRINCIPLES
Information Load
Chunking
Coding
Representation
Location
Speed
Readability
Comprehension
Prior Knowledge
Attention
Cognitive Task
Metacognition
Ruth Day
COGNITIVE PRINCIPLES
Information Load
Chunking
Coding
Representation
Location
Speed
Readability
Comprehension
Prior Knowledge
Attention
Cognitive Task
Metacognition
Ruth Day
Day, R.S. (2006) Comprehension of prescription drug information: Overview of a research program. Proceedings of the American Association for Artificial Intelligence, Argumentation for Consumer Healthcare. http://www.aaai.org
0
20
40
60
80
100
List Matrix List Matrix
% C
OR
RE
CT
Memory Comprehension(Display Absent) (Display Present)
Ruth Day
0
20
40
60
80
100
List Matrix List Matrix
% C
OR
RE
CT
Memory Comprehension(Display Absent) (Display Present)
Ruth Day
0
20
40
60
80
100
List Matrix List Matrix
% C
OR
RE
CT
Memory Comprehension(Display Absent) (Display Present)
Ruth Day
0
20
40
60
80
100
List Matrix List Matrix
% C
OR
RE
CT
Memory Comprehension(Display Absent) (Display Present)
Ruth Day
Types of Questions
Factual Inferential
--“What are the names of the drugs?
--“How many total pills per day?”
--etc.
Ruth Day
Types of Questions
Factual Inferential
--“What are the names of the drugs?
--“How many total pills per day?”
--etc.
Scenarios
Go beyond theinformation given
Ruth Day
Types of Questions
Factual Inferential
--“What are the names of the drugs?
--“How many total pills per day?”
--etc.
Scenarios
Go beyond theinformation given
Ruth Day
Scenario Question:“If you leave home in the afternoon and will not be back until breakfast time the next day, how many Inderal should you take along?”
Ruth Day
0
20
40
60
80
100
List Matrix List Matrix
% C
OR
RE
CT
Memory Comprehension
Scenario Question:“If you leave home in the afternoon and will not be back until breakfast time the next day, how many Inderal should you take along?”
Ruth Day
0
20
40
60
80
100
List Matrix List Matrix
% C
OR
RE
CT
Memory Comprehension
Scenario Question:“If you leave home in the afternoon and will not be back until breakfast time the next day, how many Inderal should you take along?”
Ruth Day
0
20
40
60
80
100
List Matrix List Matrix
% C
OR
RE
CT
Memory Comprehension
Scenario Question:“If you leave home in the afternoon and will not be back until breakfast time the next day, how many Inderal should you take along?”
Ruth Day
0
20
40
60
80
100
List Matrix List Matrix
% C
OR
RE
CT
Memory Comprehension
Scenario Question:“If you leave home in the afternoon and will not be back until breakfast time the next day, how many Inderal should you take along?”
Ruth Day
EXAMPLE (Original)
Tell your doctor, nurse, and pharmacist if you …• are allergic to any medicine, either prescription or nonprescription (OTC);• are pregnant or intend to become pregnant while using this medicine• are breast-feeding;• are using any other prescription or nonprescription (OTC) medicine, especially diuretics (water pills) or potassium-containing medicines or supplements;• have any other medical problems, especially heart or blood vessel disease or kidney disease;• are on a strict low-sodium diet or dialysis, or use low-salt milk or salt substitutes;• have had a kidney transplant
Source: Day, R. S. (1999) Optimizing patient comprehension through medicine information leaflets: Cognition experiments. In A.G. Hartzema, S.Tolleson-Rinehart, B.L. Sleath, and R.S. Day, Optimizing Patien Comprehension through Medicine Leaflets. Rockville, MD: U.S. Pharmacopeia. Pp. 60-176.
Ruth Day
EXAMPLE (Original)
Tell your doctor, nurse, and pharmacist if you …• are allergic to any medicine, either prescription or nonprescription (OTC);• are pregnant or intend to become pregnant while using this medicine• are breast-feeding;• are using any other prescription or nonprescription (OTC) medicine, especially diuretics (water pills) or potassium-containing medicines or supplements;• have any other medical problems, especially heart or blood vessel disease or kidney disease;• are on a strict low-sodium diet or dialysis, or use low-salt milk or salt substitutes;• have had a kidney transplant
Source: Day, R. S. (1999) Optimizing patient comprehension through
medicine information leaflets: Cognition experiments. In A.G. Hartzema, S. Tolleson-Rinehart, B.L. Sleath, and R.S. Day, Optimizing Patien Comprehension through Medicine Leaflets. Rockville, MD: U.S. Pharmacopeia. Pp. 60-176.
~~~~~~~~~~~~~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~• ~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~
Ruth Day
Tell your doctor, nurse, and pharmacist if you have:
Allergic to Medicines --prescription medicine --nonprescription medicine (OTC)
Pregnancy --are pregnant --intend to become pregnant --are breast-feeding
Other Medicines --prescription medicine --nonprescription medicine (OTC) --especially: --diuretics (water pills)
--potassium-containing medicines --potassium-containing supplements
Medical Conditions --any other medical problems --especially: --heart disease --blood vessel disease --kidney disease
--kidney transplant --on dialysis
Diet --on a strict low-sodium diet --use low-salt milk --use salt substitutes
Chunked & Coded
Ruth Day
CONTRAINDICATIONS AND WARNINGS
PREGNANCY MUST BE EXCLUDED BEFORE THESTART OF TREATMENT WITH DRUG-X. DRUG-X ISCONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT.
Ruth Day
RARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE.
CONTRAINDICATIONS AND WARNINGS
PREGNANCY MUST BE EXCLUDED BEFORE THESTART OF TREATMENT WITH DRUG-X. DRUG-X ISCONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT.
Ruth Day
RARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE.
CONTRAINDICATIONS AND WARNINGS
PREGNANCY MUST BE EXCLUDED BEFORE THESTART OF TREATMENT WITH DRUG-X. DRUG-X ISCONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT.
Ruth Day
CONTRAINDICATIONS AND WARNINGS
PREGNANCY MUST BE EXCLUDED BEFORE THESTART OF TREATMENT WITH DRUG-X. DRUG-X ISCONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT. RARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE.
Ruth Day
CONTRAINDICATIONS AND WARNINGS
PREGNANCY MUST BE EXCLUDED BEFORE THESTART OF TREATMENT WITH DRUG-X. DRUG-X ISCONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT.
RARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE.
Ruth Day
CONTRAINDICATIONS AND WARNINGS
PREGNANCY MUST BE EXCLUDED BEFORE THESTART OF TREATMENT WITH DRUG-X. DRUG-X ISCONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT.
RARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE.
Chunked
Ruth Day
CONTRAINDICATIONS AND WARNINGS
PREGNANCYPREGNANCY MUST BE EXCLUDED BEFORE THESTART OF TREATMENT WITH DRUG-X. DRUG-X ISCONTRAINDICATED IN PREGNANT WOMEN, OR WOMEN OF CHILDBEARING POTENTIAL WHO ARE NOT USING RELIABLE CONTRACEPTION. (SEE CONTRAINDICATIONS AND WARNINGS.) PREGNANCY MUST BE AVOIDED DURING DRUG-X TREATMENT OR PRIOR TO THE COMPLETION OF THE DRUG ELIMINATION PROCEDURE AFTER DRUG-X TREATMENT.
LIVER TOXICITYRARE BUT LIFE-THREATENING LIVER TOXICITY HAS BEEN REPORTED, INCLUDING ACUTE LIVER FAILURE.
CHUNKING & CODING
Chunked & CodedRuth Day
CONTRAINDICATIONS AND WARNINGS
PREGNANCYPregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. (See “Contraindications and Warnings.”) Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment.
LIVER TOXICITYRare but life-threatening liver toxicity has been reported, including acute liver failure.
Visual Contrast
Ruth Day
READABILITY
# Words = 48# Sentences = 3
Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. (See “Contraindications and Warnings.”) Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment.
Ruth Day
READABILITY
# Words = 48# Sentences = 3
Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. (See “Contraindications and Warnings.”) Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment.
Grade level = 12
Passives = 66%
Ruth Day
LINGUISTIC STRUCTURE
Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception.
Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment.
Ruth Day
LINGUISTIC STRUCTURE
Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception.
Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment.
Ruth Day
LARD FACTOR
Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment.
Original High LF
Ruth Day
LARD FACTOR
Pregnancy must be excluded before the start of treatment with Drug-X. Drug-X is contraindicated in pregnant women, or women of childbearing potential who are not using reliable contraception. Pregnancy must be avoided during Drug-X treatment or prior to the completion of the drug elimination procedure after Drug-X treatment.
Exclude pregnancy before starting Drug-X treatment. Drug-X is contraindicated in pregnant women or women of childbearing potential who are not using reliable contraception. Avoid pregnancy during Drug-X treatment and after treatment (until completing the drug elimination procedure).
Original High LF
RevisedLower LF
Ruth Day
0
2
4
6
8
10
12
Text Bullets
Gra
de
Le
vel
Readability
0
10
20
30
Text Bullets
% P
assiv
es
Gra
de
Lev
el%
P
assi
ves
Ruth Day
Readability
0
10
20
30
Text Bullets
% P
assiv
es
%
Pas
sive
s
ComprehensionMemoryBehavior
0
2
4
6
8
10
12
Text Bullets
Gra
de
Le
vel
Gra
de
Lev
el
Ruth Day
Task: --see/hear list of items --report them
Typical Results:
0
20
40
60
80
100
1 2 3 4 5 6 7 8 9% C
OR
RE
CT
LOCATION
COGNITIVE PRINCIPLE:Serial Position Effect
Ruth Day
Task: --see/hear list of items --report them
Typical Results:
0
20
40
60
80
100
1 2 3 4 5 6 7 8 9% C
OR
RE
CT
LOCATION
COGNITIVE PRINCIPLE:Serial Position Effect
Ruth Day
Task: --see/hear list of items --report them
Typical Results:
0
20
40
60
80
100
1 2 3 4 5 6 7 8 9% C
OR
RE
CT
LOCATION
COGNITIVE PRINCIPLE:Serial Position Effect
Ruth Day
Task: --see/hear list of items --report them
Typical Results:
0
20
40
60
80
100
1 2 3 4 5 6 7 8 9% C
OR
RE
CT
LOCATION
COGNITIVE PRINCIPLE:Serial Position Effect
Ruth Day
Risks
Structure & content
--Like typical ads
--Purpose --vary specific factors --observe effects on cognition
Flu Aide
Produced New TV AdHypothetical Drug
Ruth Day
See ad
time
Favorable UnFavorable
LOCATION of Side Effects
Experiment
Same visualSame auditory
Differ only in location of side effects
FluAide
Ruth Day
OR
Readability = Comprehensibility
However, --easy to measure --has predictive value --therefore = quick “proxy” for comprehensibility
READABILITY
Ruth Day
Alternative Representations
High Sev Low Sev
High Freq Low Freq
Good State Bad State
Severity
Frequency
Health State
Ruth Day
Alternative Representations
High Sev Low Sev
High Freq Low Freq
Good State Bad State
Severity
Frequency
Health State
Ruth Day
Alternative Representations
High Sev Low Sev
High Freq Low Freq
Good State Bad State
Severity
Frequency
Health State
Ruth Day
Alternative RepresentationsLinear Orderings
MildDiarrheaDrowsinessNausea
Life-ThreateningChest painShortness of breathSlurred speech
Ruth Day
Alternative RepresentationsLinear Orderings
MildDiarrheaDrowsinessNausea
Life-ThreateningChest painShortness of breathSlurred speech
Ruth Day
Alternative RepresentationsLinear Orderings
MildDiarrheaDrowsinessNausea
Life-ThreateningChest painShortness of breathSlurred speech
Ruth Day
PARAGRAPH
PlainPossible side effects include chest pain, slurred speech, seizure, anxiety, joint pain, weakness, dry mouth, headache, and nausea.
Ruth Day
PARAGRAPH
PlainPossible side effects include chest pain, slurred speech, seizure, anxiety, joint pain, weakness, dry mouth, headache, and nausea.
CategorizedPossible dangerous side effects include chest pain, slurred speech, and seizure. Some are worrisome such as anxiety, joint pain, and weakness. Others are mild such as dry mouth, headache, and nausea.
Ruth Day
PARAGRAPH
PlainPossible side effects include chest pain, slurred speech, seizure, anxiety, joint pain, weakness, dry mouth, headache, and nausea.
CategorizedPossible dangerous side effects include chest pain, slurred speech, and seizure. Some are worrisome such as anxiety, joint pain, and weakness. Others are mild such as dry mouth, headache, and nausea.
Ruth Day
LIST Plain
--chest pain--slurred speech--seizure--anxiety--joint pain--weakness--dry mouth--headache--nausea
Ruth Day
LIST Plain Chunked +
--chest pain--slurred speech--seizure--anxiety--joint pain--weakness--dry mouth--headache--nausea
Dangerous--chest pain--slurred speech--seizure
Worrisome--anxiety--joint pain--weakness
Mild--dry mouth--headache--nausea
Ruth Day
LINE dry mouth anxiety chest painheadache joint pain slurred speech nausea weakness seizure
Mild Dangerous
Ruth Day
LINE
ARROW
dry mouth anxiety chest painheadache joint pain slurred speech nausea weakness seizure
Mild Dangerous
dry mouth anxiety chest painheadache joint pain slurred speech nausea weakness seizure
Ruth Day
LINE
ARROW
ARROW +
dry mouth anxiety chest painheadache joint pain slurred speech nausea weakness seizure
Mild Dangerous
dry mouth anxiety chest painheadache joint pain slurred speech nausea weakness seizure
dry mouth anxiety chest painheadache joint pain slurred speech nausea weakness seizure
Ruth Day
MATRIX
MildWorrisomeDangerous
MoreCommon
LessCommon
Rarechest painslurred speechseizure
anxietyjoint painweakness
dry mouthheadachenausea
Ruth Day
MATRIX
MildWorrisomeDangerous
MoreCommon
LessCommon
Rarechest painslurred speechseizure
anxiety
joint pain
weakness
dry mouthheadache
nausea
Ruth Day
MildDangerous
Common
Rarechest painslurred speechseizure
dry mouth
headache nausea
Mild
dry mouth
headachenauseaanxiety
MATRIX
Ruth Day
Alternative Representationsof Same Information
--Text--List--Linear Ordering--Matrix--Lots More (…..)
Ruth Day
Alternative Representationsof Same Information
--Text--List--Linear Ordering--Matrix--Lots More (…..)
CognitiveConsequences
Ruth Day
--Text--List--Linear Ordering--Matrix--Lots More (…..)
CognitiveConsequences
Day, R. S. Alternative representations. In G. H. Bower (Ed.), The Psychology of Learning and Motivation. New York: Academic Press, 1988, 22, 261-305.
Effects on --Perception --Attention --Comprehension --Memory --Problem Solving
Alternative Representationsof Same Information
Ruth Day
--Text--List--Linear Ordering--Matrix--Lots More (…..)
CognitiveConsequences
Day, R. S. Alternative representations. In G. H. Bower (Ed.), The Psychology of Learning and Motivation. New York: Academic Press, 1988, 22, 261-305.
Effects on --Perception --Attention --Comprehension --Memory --Problem Solving
--Behavior & Health
Alternative Representationsof Same Information
Ruth Day
Alternative Representations
TextListLineMatrix(etc.)
Effects
Original Enhanced DISPLAY
0
20
40
60
80
100
Per
form
ance
Ruth Day
Alternative Representations
TextListLineMatrix(etc.)
Effects
Original Enhanced DISPLAY
0
20
40
60
80
100
Per
form
ance
Ruth Day
7.5
16.1
0
5
10
15
20
Original Enhanced
# Correct
One Task
“What are the possible side effects?
Ruth Day
0
5
10
15
20
Original Enhanced
# Correct
Consumers
Physicians
One Task
“What are the possible side effects?
Ruth Day
0
5
10
15
20
Original Enhanced
# Correct
Consumers
Physicians
One Task
“What are the possible side effects?
Ruth Day
0
5
10
15
20
Original Enhanced
# Correct
Consumers
Physicians
One Task
“What are the possible side effects?
Ruth Day
Much knowledge Little knowledgeMuch expertise Little expertise
Cognitive Processes
Ruth Day
Attention ComprehensionMemory
Much knowledge Little knowledgeMuch expertise Little expertise
Cognitive Cognitive Processes Factors .
Ruth Day
Attention ChunkingComprehension LocationMemory Readability
OTC
Drug FactsActive ingred PurposeUsesWarningsDirectionsInactive ingredients
Drug Facts
Package Insert
Package
Ruth Day
Drug Facts
Active Ingredient (in each tablet) PurposeIbuprofen 200 mg Pain reliever/fever reducer
Uses temporarily relieves minor aches and pains due to: minor pain of arthritis headache backache menstrual cramps the common cold muscular aches toothache temporarily reduces fever
WarningsAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shockAlcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctorwhether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen maycause stomach bleeding.
Do not use if you have ever had an allergic reaction to any other pain reliever/feverreducer.
Ask a doctor before use if you have problems or serious side effects from taking pain relievers or fever reducers stomach problems that last or come back, such as heartburn, upset stomach, or pain ulcers bleeding problems high blood pressure, heart or kidney disease, are taking a diuretic, or are over 65 yearsof age
Ask a doctor or pharmacist before use if you are under a doctor’s care for any serious condition taking any other product that contains ibuprofen, or any other pain reliever/feverreducer taking a prescription drug for anticoagulation (blood thinning) taking any other drug
When using this product take with food or milk if stomach upset occurs Ruth Day
Stop use and ask a doctor if an allergic reaction occurs. Seek medical help right away. pain gets worse or lasts more than 10 days fever gets worse or lasts more than 3 days stomach pain or upset gets worse of lasts redness or swelling is present in the painful area any new symptoms appear
If pregnant or breast feeding, ask a health professional before use. It is especiallyimportant not to use ibuprofen during the last 3 months of pregnancy unless definitelydirected to do so by a doctor because it may cause problems in the unborn child or complications during deliver.Keep out of reach of children. In case of overdoes, get medical help or contact a PoisonControl Center right away.
Directions do not take more than directed adults and children 12 years and over 1 table every 4 to 6 hours while symptoms persist if pain or fever does not respond to 1 tablet, 3 tablets may be used do not exceed 6 tablets in 24 hours, unless directed by a doctor children under 12 years: ask a doctor
Other information each tablet contains: ibuprofen store at 20 -25° C (68-77° F) avoid high humidity and excessive heat aove 40°C (104° F) do not use if seal on bottle has been opened
Inactive ingredients acetylated monoglyceride, beeswax and/or carnauba wax, croscarmellose sodium, iron oxides, lecithin, methylparaben, microcrystalline cellulose, pharmaceutical glaze, povidone, propylparaben, silicon dioxide, simethicone, sodium benzoate, sodium lauryl sulfate, starch, stearic acid, sucrose, titanium dioxide
Ruth Day
WarningsAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shockAlcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctorwhether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen maycause stomach bleeding.
Original
Ruth Day
WarningsAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shockAlcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctorwhether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen maycause stomach bleeding.
Original
Ruth Day
WarningsAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shockAlcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctorwhether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen maycause stomach bleeding.
Alternative RepresentationsOriginal
Ruth Day
WarningsAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shockAlcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctorwhether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen maycause stomach bleeding.
WarningsAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shockAlcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctorwhether you should take ibuprofen or other pain relievers/fever reducers. Stomach bleeding: Ibuprofen may cause stomach bleeding.
Alternative RepresentationsOriginal
NewLine & Coded
Ruth Day
WarningsAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shockAlcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctorwhether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen maycause stomach bleeding.
WarningsAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shockAlcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctorwhether you should take ibuprofen or other pain relievers/fever reducers. Stomach bleeding: Ibuprofen may cause stomach bleeding.
WARNINGSAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: --hives --facial swelling --asthma (wheezing) --shock
Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers.
Stomach bleeding: Ibuprofen may cause stomach bleeding.
Original
NewLine & Coded
Chunked & Coded
Alternative Representations
Ruth Day
WarningsAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shockAlcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctorwhether you should take ibuprofen or other pain relievers/fever reducers. Ibuprofen maycause stomach bleeding.
WarningsAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: hives facial swelling asthma (wheezing) shockAlcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctorwhether you should take ibuprofen or other pain relievers/fever reducers. Stomach bleeding: Ibuprofen may cause stomach bleeding.
WARNINGSAllergy alert: Ibuprofen may cause a severe allergic reaction which may include: --hives --facial swelling --asthma (wheezing) --shock
Alcohol warning: If you consume 3 or more alcoholic drinks every day, ask your doctor whether you should take ibuprofen or other pain relievers/fever reducers.
Stomach bleeding: Ibuprofen may cause stomach bleeding.
Alternative RepresentationsOriginal
NewLine & Coded
Chunked & Coded
Ruth Day
Generality of Results
People Information Cognitive Source Task
PatientsNonPatients
PhysiciansOther HCPs
Demographics --age --education --literacy --etc. Ruth Day
Generality of Results
People Information Cognitive Source Task
PatientsNonPatients
PhysiciansOther HCPs
Demographics --age --education --literacy --etc.
OTC labelOTC package Package insertProfessional LabelCMIMedication GuidesPrint AdsTV Ads
Ruth Day
Generality of Results
People Information Cognitive Source Task
OTC labelOTC package Package insertProfessional LabelCMIMedication GuidesPrint AdsTV Ads
AttentionSearchRecallRecognitionDefinitionComprehensionProblem SolvingDecision Making
PatientsNonPatients
PhysiciansOther HCPs
Demographics --age --education --literacy --etc. Ruth Day
Cognitive Accessibility Check-List
Uses Warnings ….
Chunking
Coding
Readability
Location
Format
[etc]
Ruth Day
Cognitive Accessibility Check-List
Uses Warnings ….
Chunking
Coding
Readability
Location
Format
[etc]
Ruth Day
+
CO
NT
EN
T
Tex
t
List
M
atrix
….
FORMAT
FORMAT SELECTION
Purposes
Uses
Warnings
Directions
….
Ruth Day
CO
NT
EN
T
Tex
t
List
M
atrix
….
FORMAT
Understand Remember
Use
COGNITIV
ETASK
FORMAT SELECTION
Purposes
Uses
Warnings
Directions
….
Ruth Day
CO
NT
EN
T
Tex
t
List
M
atrix
….
FORMAT
Understand Remember
Use
COGNITIV
ETASK
FORMAT SELECTION
Source: Adapted from Day, R.S. (1988) Alternative representations. In G.H. Bower (Ed.), The Psychology of Learning and Motivation, 22, 261-306. New York: Academic Press.
Purposes
Uses
Warnings
Directions
….
Cognitive Accessibilityof OTC Drug Information
[email protected]://www.duke.edu/~ruthday/medcog.html
Drug FactsActive ingred PurposeUsesWarningsDirectionsInactive ingredients
Day, R.S. (2006) Comprehension of prescription drug information: Overview of a research program. Proceedings of the American Association for Artificial Intelligence, Argumentation for Consumer Healthcare. http://www.aaai.org
Day, R. S. (1988) Alternative representations. In G.H. Bower (Ed.), The Psychology of Learning and Motivation. New York: Academic Press, 22, 261-305.
Day, R.S. (2000) Brandname.Com’ – Cognitive accessibility of drug information on drug product websites. Drug Information Association.