Predictors of misunderstanding pediatric liquid medication instructions

Stacy Cooper Bailey, Anjali U. Pandit, Shonna Yin, Alex Federman, Terry C. Davis, Ruth M. Parker, Michael S. Wolf

Research output: Contribution to journalArticle

62 Scopus citations

Abstract

Background and Objectives: Our objective was to determine the level of adult understanding of dosage instructions for a liquid medication commonly prescribed for children. Methods: Structured interviews were conducted with 373 adults waiting for an appointment at family medicine clinics serving low-income populations in Shreveport, La; Chicago; and Jackson, Mich, from July 2003-August 2004. Subjects were asked to read a prescription label for amoxicillin and explain how they would take the medication. Correct interpretation was determined by a panel of blinded physician reviewers who coded subjects' verbatim responses. Qualitative methods were used to determine the nature of incorrect responses. Results: Twenty-eight percent of subjects misunderstood medication instructions. The prevalence of misinterpreting instructions among subjects with adequate, marginal, and low literacy was 18%, 34%, and 43%, respectively. Common causes for misunderstanding included problems with dosage measurement (28%; ie, tablespoon instead of teaspoon) and frequency of use (33%; ie, every 3 hours instead of every 6-8 hours). In an adjusted analysis that excluded literacy, African Americans were more likely to misunderstand instructions than Caucasians (adjusted odds ratio [AOR] 1.63, 95% confidence interval [CI]=1.02-2.61). When literacy was included in the model, the effect of race on misunderstanding was reduced and nonsignificant. Inadequate and marginal literacy remained independent predictors of misunderstanding (inadequate - AOR 2.90, 95% CI=1.41-6.00; marginal - AOR 2.20, 95% CI=1.19-3.97). Conclusions: Misinterpretation of pediatric liquid medication instructions is common. Limited literacy is a significant risk factor for misunderstanding and could contribute to racial disparities. Instructions should be written in a concise manner and standardized to ensure comprehension.

Original languageEnglish (US)
Pages (from-to)715-721
Number of pages7
JournalFamily medicine
Volume41
Issue number10
StatePublished - Nov 1 2009

ASJC Scopus subject areas

  • Family Practice

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