Misunderstanding Prescription Labels: The Genie Is Out of the Bottle

The U.S. health care system largely operates under the assumption that all patients have high English-language literacy skills (1). In fact, many patients do not. In this issue, Davis and coworkers (2) carefully show that a substantial proportion of users of the U.S. health care system don't understand the instructions on prescription bottle labels and are unable to correctly execute these instructions. For those interested in improving health care quality and safety for vulnerable populations, this multisite study has important implications for practice, research, and policy. It forces us to focus on developing better “operating instructions” for medication taking. We are left wondering whether we could improve current labeling practice to communicate instructions about taking medication. I know that we can. So, who should be accountable for implementing a better system?

Briefly, in a sample of ethnically diverse primary care patients from community health centers, the investigators demonstrated a high rate of misunderstanding instructions on prescription labels for 5 common medications. Although the highest rates of misunderstanding across each of the 5 bottle labels (13% to 48%) occurred among patients with the lowest literacy levels, misunderstanding was common even among those with the highest literacy levels (5% to 27%). In multivariate analyses, lower literacy and greater number of prescription medications taken were associated with misunderstanding. Even worse, among those who seemed to understand a standard prescription label—by correctly reading and restating the instructions—far fewer correctly demonstrated how they would take the medication at home. Specifically, participants were asked to show how many pills they would take in 1 day, using candy pills from the bottle. Lower literacy was also associated with failure to correctly execute pill-taking instructions.

Does the authors' evidence fully support their conclusion that poor reading skills were responsible for poor understanding? In fact, the evidence is …