Health literacy: A barrier to pharmacist-patient communication and medication adherence

Journal of the American Pharmacists Association

Volumn 49, Issue 5, 2009, Pages

  Ngoh, Lucy Nkukuma ^a  

^a FERRIS STATE UNIVERSITY   (United States)

Author keywords

Health literacy; Medication adherence; Pharmacist patient communication

Indexed keywords

COMMUNICATION DISORDER; CONSUMER HEALTH INFORMATION; COST OF ILLNESS; HUMAN; HUMAN RELATION; INTERPERSONAL COMMUNICATION; METHODOLOGY; PATIENT COMPLIANCE; PATIENT EDUCATION; PHARMACY; PSYCHOLOGICAL ASPECT; REVIEW; STATISTICS;

COMMUNICATION; COMMUNICATION BARRIERS; COST OF ILLNESS; HEALTH LITERACY; HUMANS; MEDICATION ADHERENCE; PATIENT EDUCATION AS TOPIC; PHARMACEUTICAL SERVICES; PROFESSIONAL-PATIENT RELATIONS;

EID: 77649208191     PISSN: 15443191     EISSN: 15443450     Source Type: Journal    
DOI: 10.1331/JAPhA.2009.07075     Document Type: Review

References (175)

1. Atreja A, Bellam N, Susan R, Levy SR. Strategies to enhance patient adherence: making it simple. Accessed at www.medscape.com/viewarticle/498339, March 10, 2007.
2. Katz MG, Kripalani S, Weiss BD. Use of pictorial aids in medication instructions: a review of the literature. Am J Health Syst Pharm. 2006;63:2391-7.
3. Haynes RB. Introduction. In: Haynes RB, Taylor DW, Sackett DL, Eds. Compliance in health care. Baltimore, MD: Johns Hopkins University Press; 1979.
4. Fawcett J. Compliance: definitions and key issues. J Clin Psychiatry. 1995;56:4-8.
5. Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of America's adults: results from the 2003 National Assessment of Adult Literacy (NCES 2006-483). Washington, DC: National Center for Education Statistics; 2006.
6. Hausman A. Taking your medicine: relational steps to improving patient compliance. Health Marketing Q. 2001;19:49-71.
7. Gottlieb H. Medication non-adherence: finding solutions to a costly medical problem. Drug Benefits Trends. 2000;12:57-62.
8. Dusing R, Lottermoser K, Mengden T. Compliance with drug therapy: new answers to an old question. Nephrol Dial Transplant. 2001;16:1317-21.
9. Kripalani S, Henderson LE, Chiu EY, et al. Predictors of medication self-management skill in a low-literacy population. J Gen Intern Med. 2006;21:852-6.
10. DiMatteo MR. Enhancing patient adherence to medical recommendations. JAMA. 1994;271:79-83.
11. World Health Organization. Adherence to long-term therapies: evidence for action. Accessed at www.who.int/chronic-conditions/adherencereport/en, March 10, 2007.
12. American Pharmacists Association. Enhancing patient adherence: proceedings of the Pinnacle Roundtable Discussion. Highlights News Letter. 2004;Oct:7.
13. Krueger KP, Felkey BG, Berger BA. Improving adherence and persistence: a review and assessment of interventions and description of steps toward a national adherence initiative. J Am Pharm Assoc. 2003;43:668-79.
14. Jarboe KS. Treatment nonadherence: causes and potential solutions. J Am Psychiatr Nurses Assoc. 2002;8:S18-25.
15. Center for Health Care Strategies, Inc. Health literacy and understanding medical information. Accessed at www.healthliteracy.com/hlmonth/pdfs/4.pdf, February 15, 2007.
16. Doak CC, Doak LG, Friedell GH, Meade CD. Improving comprehension for cancer patients with low literacy skills: strategies for clinicians. CA Cancer J Clin. 1998;48:151-62.
17. Nielsen-Bohlman LN, Panzer AM, Kindig DA. Eds. Health literacy: a prescription to end confusion. Washington, DC: National Academies Press; 2004.
18. Williams MV, Baker DW, Parker RM, Nurss JR. Relationship of functional health literacy to patients' knowledge of their chronic disease: a study of patients with hypertension and diabetes. Arch Intern Med. 1998;158:166-72.
19. Gazmararian JA, Williams MV, Peel J, Baker DW. Health literacy and knowledge of chronic disease. Patient Educ Couns. 2003;51:267-75.
20. Williams MV, Baker DW, Honig EG, et al. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998;114:1008-15.
21. Schillinger D, Grumbach K, Piette J, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288:475-82.
22. Gazmararian J, Baker D, Parker R, Blazer DG. A multivariate analysis of factors associated with depression: evaluating the role of health literacy as a potential contributor. Arch Intern Med. 2000;160:3307-14.
23. Weiss BD, Hart G, McGee DL, D'Estelle S. Health status of illiterate adults: relation between literacy and health status among persons with low literacy skills. J Am Board Fam Pract. 1992;5:257-64.
24. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101-7.
25. Baker DW, Gazmararian JA, Williams MV, et al. Functional health literacy and the risk of hospital admission among Medicare managed care enrollees. Am J Public Health. 2002;92:1278-83.
26. Baker DW, Parker RM, Williams MV, Clark WS. Health literacy and the risk of hospital admission. J Gen Intern Med. 1998;13:791-8.
27. Strömberg A. Patient-related factors of compliance in heart failure: some new insights into an old problem. Eur Heart J. 2006;27:379-81.
28. Sabate E. Adherence to long term therapies: evidence for action. Geneva: World Health Organization; 2003.
29. Tabor PA, Lopez DA. Comply with us: improving medication adherence. J Pharm Pract. 2004;17:167-81.
30. Ernst FR, Grizzle AJ. Drugrelated morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc. 2001;41:192-9.
31. Wroth TH, Pathman DE. Primary medication adherence in a rural population: the role of the patient-physician relationship and satisfaction with care. J Am Board Fam Med. 2006;19:478-86.
32. Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999; 21:1074-90.
33. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487-97.
34. Vik SA, Maxwell CJ, Hogan DB. Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother. 2004;38:303-12.
35. Krueger KP, Berger BA, Felkey B. Medication adherence and persistence: a comprehensive review. Adv Ther. 2005;22:319-62.
36. Wagner GJ, Rabkin JG. Measuring medication adherence: are missed doses reported more accurately than perfect adherence? AIDS Care. 2000;12:405-8.
37. Dunbar-Jacob J, Sereika S, Rohay JM, Burke LE. Electronic methods in assessing adherence to medical regimens. In: Krantz D, Baum A, Eds. Technology and methods in behavioral medicine. Mahwah, NJ: Lawrence Erlbaum Associates; 1998:95-113.
38. De Geest S, Vanhaecke J. Methodological issues in transplant compliance research. Transplant Proc. 1999;31:81S-83S.
39. Steiner JF, Prochazka AV. The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol. 1997;50:105-16.
40. Martin LR, Williams SL, Haskard KB, DiMatteo MR. The challenge of patient adherence. Ther Clin Risk Manag. 2005;1(Sep):189-99.
41. National Community Pharmacists Association. Take as directed: a prescription not followed. Accessed at www.ncpanet.org/media/releases/2006/take- as-directed.php, November 11, 2007.
42. DiMatteo MR, DiNicola DD. Achieving patient compliance: the psychology of the medical practitioner's role. New York: Pergamon Press; 1982.
43. U.S. Pharmacopeia. Examining medication errors that occur in the patient's home. Accessed at www.usp.org/pdf/EN/patientSafety/capsLink2004-03-01. pdf, February 15, 2007.
44. Cameron C. Patient compliance: recognition of factors involved and suggestions for promoting compliance with therapeutic regimens. J Adv Nurs. 1996;24:244-50
45. Insel KC, Reminger SL, Hsiao CP. The negative association of independent personality and medication adherence. J Aging Health. 2006;18:407-18.
46. Fisher RC. Patient education and compliance: a pharmacist's Perspective. Patient Educ Couns. 1992;19:261-71.
47. Glanz K, Lewis FM, Rimer BK, Eds. Health behavior and health education: theory, research, and practice. 3rd ed. San Francisco, CA: Jossey-Bass; 2002.
48. Leventhal EA, Leventhal H, Robitaile C, Brownlee S. Psychosocial factors in the medication adherence: a model of the modeler. In Park DC, Morrell RW, Shifren K, Eds. Processing of medical information in aging patients. Mahwah, NJ: Lawrence Erlbaum; 1999:145-66.
49. Bandura A. Self-efficacy and health behaviour. In: Baum A, Newman S, Weinman J, et al., Eds. Cambridge handbook of psychology, health, and medicine. Cambridge, UK: Cambridge University Press; 1997:160-2.
50. Park DC, Jones TR. Medication adherence and aging. In: Fisk AD, Rogers WA, Eds. Handbook of human factors and the older adult. San Diego, CA: Academic Press; 1997:257-87.
51. Pignone MP, DeWalt DA. Literacy and health outcomes: is adherence the missing link? J Gen Intern Med. 2006;21:896-7.
52. Poss J. Developing a new model for cross-cultural research: synthesizing the Health Belief Model and the Theory of Reasoned Action. ANS Adv Nurs Sci. 2001;23:1-15.
53. Becker M, Maiman L. Sociobehavioral determinants of compliance with health and medical care recommendations. Med Care. 1975;13:10.
54. U.S. Department of Health and Human Services. Healthy People 2010: understanding and improving health. Washington, DC: U.S. Department of Health and Human Services; 2000.
55. Flores G. Language barriers to health care in the United States. N Engl J Med. 2006;355:229-31.
56. U.S. Congress. National Literacy Act of 1991. P.L. 102-73; 1991.
57. Doak CC, Doak LG, Root JH. The literacy problem. In: Teaching patients with low literacy skills. 2nd ed. Philadelphia: J.B. Lippincott; 1996:1-9
58. Williams MV, Davis T, Parker RM, Weiss BD. The role of health literacy in patient-physician communication. Fam Med. 2002;34:383-9.
59. American Medical Association. Health literacy: report for the American Medical Association Council on Scientific Affairs. JAMA. 1999;281:552-7.
60. Kutner M, Greenberg E, Baer J. National Assessment of Adult Literacy (NAAL): a first look at the literacy of America's adults in the 21st century. Accessed at http://nces.ed.gov/naal, December 29, 2006.
61. Marcus EN. The silent epidemic: the health effects of illiteracy. N Engl J Med. 2006;355:339-41.
62. Gazmararian JA, Curran, JW, Parker RM, et al. Public health literacy in America: an ethical imperative. Am J Prev Med. 2005;28:317-22.
63. Scudder L. Words and well being: how literacy affects patient health. J Nurse Pract. 2006;2:28-35.
64. Weiss BD. Epidemiology of low literacy. In: Schwartzberg JG, Van-Geest JB, Wang CC, Eds. Understanding health literacy: implications for medicine and public health. Chicago: American Medical Association Press; 2004:17-42.
65. Schloman B. Information resources column: health literacy: a key ingredient for managing personal health. Accessed at http://nursingworld.org/ ojin/infocol/info-13.htm, March 13, 2007.
66. Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetes patients who have low health literacy. Arch Intern Med. 2003;163:83-90.
67. Vastag B. Low health literacy called a major problem. JAMA. 2004;291:2181-2
68. Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000
69. Kripalani S, Weiss BD. Teaching about health literacy and clear communication. J Gen Intern Med. 2006;21:888-90.
70. Partnership for Clear Health Communication Steering Committee. Eradicating low health literacy: the first public health movement of the 21st Century: overview. Accessed at http://clearhealthcommunication.com/contact.html, March 20, 2007.
71. Praska JL, Kripalani S, Seright AL, Jacobson TA. Identifying and assisting low-literacy patients with medication use: a survey of community pharmacies. Ann Pharmacother. 2005;39:1441-5.
72. National Council on Patient Information and Education. Talk about prescription - Rx compliance: moving beyond the tip of the iceberg. Bethesda, MD: National Council on Patient Information and Education; 1994;1-16.
73. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research: a comprehensive review. J Clin Pharm Ther. 2001;26:331-42.
74. Cipolle CL, Cipolle RJ, Strand LM. Consistent standards in medication use: the need to care for patients from research to practice. J Am Pharm Assoc. 2006;46:205-212.
75. Lee PP. Why literacy matters: links between reading ability and health. Arch Ophthalmol. 1999;117:100-3.
76. Baker DW, Parker RM, Williams MV, et al. The health care experience of patients with low literacy. Arch Fam Med. 1996;5:329-34.
77. Houts PS, Doak CC, Doak LG, Loscalzo MJ. The role of pictures in improving health communication: a review of research on attention, comprehension, recall, and adherence. Patient Educ Couns. 2006;61:173-90.
78. Davis TC, Williams MV, Marin E, et al. Health literacy and cancer communication. CA Cancer J Clin. 2002;52:134-49.
79. Svarstad BL, Bultman DC, Mount JK. Patient counseling provided in community pharmacies: effects of state regulation, pharmacist age, and busyness. J Am Pharm Assoc. 2004;44:22-9.
80. Ong LM, de Haes JC, Hoos AM, et al. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995;40:903-18.
81. Hadlow J, Pitts M. The understanding of common health terms by doctors, nurses and patients. Soc Sci Med. 1991;32:193-6.
82. Centers for Disease Control. Health beliefs and compliance with prescribed medication for hypertension among black women: New Orleans, 1985-86. MMWR Morb Mortal Wkly Rep. 1990:39:701-4.
83. Partnership for Clear Health Communication. Good questions for your good health. Accessed at www.npsf.org/askme3, May 10, 2008.
84. Morasch LJ. I hear your talking, but I don't understand you! Medical jargon and clear communication. Accessed at www.familydocs.org/assets/ Multicultural-Health/MedicalJargon.pdf, May 10, 2008.
85. Schillinger D, Bindman A, Stewart A, et al. Functional health literacy and the quality of physician-patient communication among diabetes patients. Patient Educ Couns. 2004;52:315-23.
86. Shrank W, Avorn J, Rolon C, Shekelle P. Effect of content and format of prescription drug labels on readability, understanding, and medication use: a systematic review. Ann Pharmacother. 2007;41:783-801.
87. Weiss BD, Coyne C: Communicating with patients who cannot read. N Engl J Med. 1997;387:272-4.
88. Kirksey O, Harper K, Thompson S, Pringle M. Assessment of selected patient educational materials of various chain pharmacies. J Health Commun. 2004;9:91-3.
89. Morris LA, Halperin JA. Effects of written drug information on patient knowledge and compliance: a literature review. Am J Public Health. 1979;69:47-52.
90. Gibbs S, Waters WE, George CF. The benefits of prescription information leaflets (1). Br J Clin Pharmacol. 1989;27:723-9.
91. Gibbs S, Waters WE, George CF. The benefits of prescription information leaflets (2). Br J Clin Pharmacol. 1989;28:345-51.
92. Lisper L, Isacson D, Sjoden P, Bingefors K. Medicated hypertensive patients' views and experience of information and communication concerning antihypertensive drugs. Patient Educ Couns. 1997;32:147-55.
93. Morris LA, Tabak ER, Gondek K. Counseling patients about prescribed medications: 12-year trends. Med Care. 1997;35:996-1007.
94. Gal I, Prigat A. Why organizations continue to create patient information leaflets with readability and usability problems: an exploratory study. Health Educ Res. 2005;20:485-93.
95. Buck ML. Providing patients with written medication information. Ann Pharmacother. 1998;32:962-9.
96. Koo MM, Krass I, Aslani P. Patient characteristics influencing evaluation of written medicine information: lessons for patient education. Ann Pharmacother. 2005;39:1434-40.
97. Davis TC, Crouch MA, Wills G, et al. The gap between patient reading comprehension and the readability of patient education materials. J Fam Pract. 1990;31:533-8.
98. Svarstad BL, Mount JK, Tabak ER. Expert and consumer evaluation of patient medication leaflets provided in U.S. Pharmacies. J Am Pharm Assoc. 2005;45:443-51.
99. Cardinal BJ. Readability of printed materials on exercise. Wellness Perspectives: Research, Theory and Practice. 1993;9:48-55.
100. Davis TC, Wolf MS, Bass III PF, et al. Low literacy impairs comprehension of prescription drug warning labels. J Gen Intern Med. 2006;21:847-51.
101. National Work Group on Literacy and Health. Communicating with patients who have limited literacy skills. J Fam Pract. 1998;46:168-76.
102. Weiss BD. 20 common problems in primary care. New York: McGraw-Hill; 1999.
103. Brez SM, Taylor M. Assessing literacy for patient teaching: perspectives of adults with low literacy skills. J Adv Nurs. 1997;25:1040-7.
104. Ogedegbe G, Harrison M, Robbins L, et al. Barriers and facilitators of medication adherence in hypertensive African Americans: a qualitative study. Ethn Dis. 2004;14:3-12.
105. Arnsten JH, Gelfand JM, Singer DE. Determinants of compliance with anticoagulation: a case-control study. Am J Med. 1997;103:11-7.
106. .Yilmaz MB, Pinar M, Naharci I, et al. Being well-informed about statin is associated with continuous adherence and reaching targets. Cardiovasc Drugs Ther. 2005;19:437-40.
107. Windsor RA, Bailey WC, Richards JM Jr, et al. Evaluation of the efficacy and cost effectiveness of health education methods to increase medication adherence among adults with asthma. Am J Public Health. 1990;80:1519-21.
108. Powell SG. Medication compliance of patients with COPD. Home Healthc Nurse. 1994;12(3):44-50.
109. Williams MV, Parker RM, Baker DW, et al. Inadequate functional health literacy among patients at two public hospitals. JAMA. 1995;274:1677-82.
110. Gazmararian JA, Baker DW, Williams MV, et al. Health literacy among Medicare enrollees in a managed care organization. JAMA. 1999;281:545-51.
111. Davis TC, Wolf MS, Bass III PF, et al. Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006;145:887-94.
112. Holt GA, Dorcheus L, Hall EL, et al. Patient interpretation of label instructions. Am Pharm. 1992;NS32:58-62.
113. Powell CK, Kripalani S. Resident recognition of low literacy as a risk factor in hospital readmission. J Gen Intern Med. 2005;20:1042-4.
114. Miller N, Hill M, Kottke T, Ockene IS. The multilevel compliance challenge: recommendations for a call to action. Circulation. 1997;95:1085-90.
115. Squier RW. A model of empathic understanding and adherence to treatment regimens in practitioner-patient relationships. Soc Sci Med. 1990;30:325-39.
116. Frank JC, Hirsch SH, Chernoff J, et al. Determinants of patient adherence to consultative comprehensive geriatric assessment recommendations. J Gerontol A Biol Sci Med Sci. 1997;52:M44-51.
117. Martin LR, DiMatteo MR, Lepper HS. Facilitation of patient involvement in care: development and validation of a scale. Behav Med. 2001;27:111-20.
118. Martin LR, Jahng KH, Golin CE, et al. Physician facilitation of patient involvement in care: correspondence between patient and observer reports. Behav Med. 2003;28:159-64.
119. Safeer RS, Keenan J. Health literacy: the gap between physicians and patients. Am Fam Physician. 2005;72:463-8.
120. DeWalt DA, Berkman ND, Sheridan S, et al. Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med. 2004;19:1228-39.
121. Svarstad BL, Bultman DC, Mount JK. Patient counseling provided in community pharmacies: effects of state regulations, pharmacist age, and busyness. J Am Pharm Assoc. 2004;44:22-9.
122. The Omnibus Budget Reconciliation Act of 1990. 42 U.S.C. 1396r-8. P.L. 101-508,§4401; 1990.
123. U.S. Food and Drug Administration. Medicine information received by consumers. Accessed at www.fda.gov/cder/Offices/ODS/y2ktitl.htm, November 28, 2007.
124. Martin LR, Williams SL, Haskard KB, DiMatteo MR. The challenge of patient adherence. Ther Clin Risk Manag. 2005;1:189-99.
125. American Academy of Family Physicians. Patient education. Accessed at www.aafp.org/online/en/home/aboutus/specialty/rpsolutions/eduguide/patiented. html, April 13, 2008.
126. Raehl CL, Bond C, Woods TJ, et al. Screening tests for intended medication adherence among the elderly. Ann Pharmacother. 2006;40:888-93.
127. Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med. 1999;14(5):267-73.
128. Davis TC, Fredrickson DD, Potter L, et al. Patient understanding and use of oral contraceptive pills in a southern public health family planning clinic. South Med J. 2006;99:713-8.
129. Youmans SL, Schillinger D. Functional health literacy and medication use: the pharmacist's role. Ann Pharmacother. 2003;37:1726-9.
130. Agency for Healthcare Research and Quality. Literacy and health outcomes, summary. Accessed at www.ahrq.gov/downloads/pub/evidence/pdf/literacy/literacy. pdf, April 27, 2007.
131. Smedley BD, Stith AY, Nelson AR. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press; 2002.
132. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533-43.
133. Lowry KP, Dudley T, Oddone E, et al. Intentional and unintentional nonadherence to antihypertensive medication. Ann Pharmacother. 2005;39:1198-203.
134. Wroe A. Intentional and unintentional nonadherence: a study of decision making. J Behav Med. 2001;25:355-72.
135. Rau J. Determinants of patient adherence to an aerosol regiment. Respir Care. 2005;50:1346-56.
136. American Pharmacists Association. Low health literacy: what pharmacists can do to help. J Am Pharm Assoc. 2006;46:6-11.
137. Reisfield GM, Paulian GD, Wilson GR. 'Johnny can't read ': another cause of failed analgesia. Am J Hosp Palliat Care. 2005;22:433-6.
138. Mayeaux ER Jr, Murphy PW, Arnold C, et al. Improving patient education for patients with low literacy skills. Am Fam Physician. 1996;53:205-11.
139. Davis TC, Bocchini JA, Fredrickson D, et al. Parent comprehension of polio vaccine information pamphlets. Pediatrics. 1996;97:804-10.
140. Bass III PF, Wilson JF, Griffith CH, Barnett DR. Residents' ability to identify patients with poor literacy skills. Acad Med. 2002;77:1039-41.
141. Davis TC, Michielutte R, Askov EN, et al. Practical assessment of adult literacy in health care. Health Educ Behav. 1998;25:613-4.
142. Parikh NS, Parker RM, Nurss JR, et al. Shame and health literacy: the unspoken connection. Patient Educ Couns. 1996;27:33-9.
143. Weiss BD. Health literacy: a manual for clinicians. 1st ed. Chicago: American Medical Association Foundation and American Medical Association; 2003.
144. Wilson JF. The crucial link between literacy and health. Ann Intern Med. 2003;139:875-8.
145. Baker DW. The meaning and the measure of health literacy. J Gen Intern Med. 2006;21:878-83.
146. Weiss BD, Mays MZ, Martz W, et al. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3:514-22.
147. Davis TC, Long SW, Jackson RH, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam Med. 1993;25:391-5.
148. Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. J Gen Intern Med. 1995;10:537-41.
149. Baker DW. Reading between the lines: deciphering the connections between literacy and health. J Gen Intern Med. 1999;14:315-7.
150. Wallace L. Patients' health literacy skills: the missing demographic variable in primary care research. Ann Fam Med. 2006;4:85-6.
151. Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med. 2004;36:588-94.
152. Wallace LS, Rogers ES, Roskos SE, et al. Screening items to identify patients with limited health literacy skills. J Gen Intern Med. 2006;21:874-7
153. Betancourt JR, Carrillo JE, Green, AR. Hypertension in multicultural and minority populations: linking communication to compliance. Curr Hypertens Rep. 1999;1:482-8.
154. Haynes RB, McDonald H, Garg AX, et al. Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev. 2002;CD000011.
155. Davis TC, Fredrickson DD, Arnold C, et a;. A polio immunization pamphlet with increased appeal and simplified language does not improve comprehension to an acceptable level. Patient Educ Couns. 1998;33:25-37.
156. Reid JC, Klachko DM, Kardash CAM, et al. Why people don't learn from diabetes literature: Influence of text and reader characteristics. Patient Educ Couns. 1995;25:31-8.
157. Bailey BJ, Carney SL, Gillies AH, et al. Hypertension treatment compliance: what do patients want to know about their medications? Prog Cardiovasc Nurs. 1997;12:23-8.
158. Morris LS, Schulz RM. Patient compliance: an overview. J Clin Pharm Ther. 1992;17:183-95.
159. Andrus MR, Roth MT. Health literacy: a review. Pharmacotherapy. 2002;22:282-302.
160. Davis TC, Meldrum H, Tippy PKP, et al. How poor literacy leads to poor health care. Patient Care. 1996;30:94-127.
161. Hohn MD. Empowerment health education in adult literacy: a guide for public health and adult literacy practitioners, policy makers and funders. Lawrence, MA: System for Adult Basic Education Support at Northern Essex Community College; 1998.
162. Cramer JA. Overview of methods to measure and enhance patient compliance. In: Cramer JA, Spilker B, Eds. Patient compliance in medical practice and clinical trials. New York: Raven Press; 1991:3-10.
163. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002;288:2868-79.
164. Pfizer. Pfizer Clear Health Communication Initiative: Fry testing. Accessed at www.pfizerhealthliteracy.com/physicians-providers/fry-testing. html, July 10, 2008.
165. Center for Disease Control and Prevention, Agency for Toxic Substances and Disease Registry. Simply put: tips for creating easy-to-read print materials your audience will want to read and use. Accessed at www. cdc.gov/od/oc/ simpput.pdf, July 10, 2008.
166. Schrock K. Fry's readability graph: directions for use. Accessed at http://school.discoveryeducation.com/schrockguide/fry/fry.html, November 8, 2007.
167. Pfizer. Pfizer Clear Health Communication Initiative. Accessed at www.pfizerhealthliteracy.com/pdf/Using-Readability-Formulas.pdf, July 10, 2008.
168. Ngoh LN, Shepherd MD. Design, development, and evaluation of visual aids for communicating prescription drug instructions to non-literate patients in rural Cameroon. Patient Educ Couns. 1997;30:257-70.
169. Dowse R, Ehlers MS. The influence of education on the interpretation of pharmaceutical pictograms for communicating medicine instructions. Int J Pharm Pract. 2003;11:11-8.
170. Kassam R, Vaillancourt LR, Collins JB. Pictographic instructions for medications: do different cultures interpret them accurately? Int J Pharm Pract. 2004;12:199-209.
171. Hanson EC, Hartzema A. Evaluating pictograms as an aid for counseling elderly and low-literate patients. J Pharm Mark Manage. 1995;9:41-54.
172. Health Resources and Services Administration. Free online health literacy training. Accessed at www.hrsa.gov/healthliteracy/training.htm, December 17, 2007.
173. University of North Carolina at Chapel Hill Health Sciences Library. Health literacy. Accessed at www.hsl.unc.edu/Services/Guides/focusonhealthlit. cfm, November 16, 2007.
174. Schommer JC, Pedersen CA, Gaither CA, et al. Pharmacists' desired and actual times in work activities: evidence of gaps from the 2004 National Pharmacist Workforce Study. J Am Pharm Assoc. 2006;46:340-7.
175. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol. JAMA. 2006;296:2563-71.