Educational materials on NSAIDs hard to read for many SG patients

Currently used patient education materials (PEMs) on NSAIDs are not reader-friendly for the majority of patients in Singapore, reveals a study.

“Current NSAIDs-related PEMs are pegged too high at a level for a significant portion of population in Singapore to read and comprehend the information for them to take appropriate actions to ensure safe use of NSAIDs to manage their medical conditions,” the investigators said. “However, they are generally well-designed to facilitate reading of the materials.”

Using the Flesch-Kincaid Grade Level (FKGL) and Simple Measure of Gobbledygook (SMOG), two reviewers analysed PEMs obtained from healthcare institutions in Singapore and from two commonly used internet search engines to assess the readability of these materials.

The investigators then used Patient Education Materials Assessment Tool for printable materials (PEMAT-P) and United Kingdom Association for Accessible Formats (UKAAF) to evaluate the understandability, actionability, and physical properties of the PEMs. [Proc Singap Healthc 2024;doi:10.1177/20101058241268487]

Seventy-four PEMs underwent review and all, except for one, were deemed to be difficult to read for the general population, with readability defined as a grade of 6 and below. The current PEMs had a mean FKGL score of 13.3 and a mean SMOG score of 14.4. No significant differences in the FKGL (p=0.20) and SMOG scores (p=0.52) between local and nonlocal PEMs.

On the other hand, these PEMs met most of the requirements by UKAAF. The understandability and actionability scores of the PEMs were 80.5 percent and 52.5 percent, respectively.

Readability

“Only one [PEM] met the recommended readability level of grade 6 and below (the equivalent of primary school education) as recommended by the American Medical Association and the National Institute of Health,” the investigators said. [Cureus 2019;11:e4184]

“Notably, the older individuals who may be most at-risk for NSAID-related adverse events formed almost half of those with lower formal education, possibly due to limited educational opportunities during early nation-building,” they added.

A 2016 Economic Cooperation and Development (OECD) report stated that fewer than a third of Singapore adults could read dense or length text, which compels a reader to identify, evaluate, and gather information. [https://www.oecd-ilibrary.org/education/skills-matter_9789264258051-en]

The NSAID-related PEMs examined in the current study covered several categories of drug information, but these materials “may not be properly understood by patients or their caregivers,” according to the investigators, noting previous studies on PEMs that were found to be above the reading capability and comprehension level of the average patient. [AJR Am J Roentgenol 2015;204:111-116; BMC Ophthalmol 2016;16:133; J Bone Joint Surg Am 2016;98:e70]

“Such mismatches may result in imperative information being misunderstood or missed by the patients, which in turn may lead to inappropriate or even erroneous NSAID use, thus posing a medication safety concern when PEMs are used to supplement medication counselling,” they said.

“However, as the literacy rate increases in subsequent years, future research will be required to re-evaluate the findings to determine the appropriate target education level for NSAID-related PEMs,” the investigators said.