Written medicine information for patients and public: An international perspective

There are numerous sources of medicine information, including written medicine information (WMI), verbal information, health-related websites, and others. Patient information leaflets (PILs) are increasingly required in many countries. The aim of this thesis was to identify the scope of studies on medicine information, to identify problems in providing WMI to patients and the general public, and to examine the needs of the general public regarding WMI and other sources of medicine information.

Mixed methods were used in this Thesis. Scoping review and study appraisal were firstly conducted to identify the scope and quality of published research concerning WMI conducted in Asia, Africa and the UK. Regulations on WMI provision from four countries on four continents were examined. The quality, in terms of their content and design, of available Ibuprofen leaflets in the UK (n=18) and Thailand (n=18) were examined. Two surveys were conducted with 652 participants in the UK (n=300) and Thailand (n=352), as well as 15 online face-to-face in-depth interviews in the UK.

In comparison to the UK, Asia and Africa had fewer studies on WMI. Some trends were identified; studies were concentrated in specific countries and research groups. The topics were varied including of source of patient's medicine information, impact of WMI on patient's knowledge and behaviour, and the development and use of pictograms. Studies focussed on factors affecting reading and usefulness of PILs, content, design and format, and regulatory aspects on PILs. The quality of the studies was varied. The majority of randomised controlled trial (RCTs) and qualitative studies adhered to their respective standards whereas the quality of some of the non-RCT and cross sectional surveys were questionable.

In terms of the regulating WMI provision, the key important aspects of medication information were covered in all regulations. The content, details included and layout, were mostly appropriate although some aspects differed between countries. The Ibuprofen leaflets from the UK were generally consistent in terms of information provided and format. However, the information was assessed as difficult to understand. In respect of Thai Ibuprofen leaflets, greater variability was observed in both the information provided and the leaflet appearance. The majority of the leaflets collected provided information for healthcare professionals not patients or the public as provision of a PIL in Thailand is advisory, but not a legal requirement. The Thai leaflets had a wide range of content, text design and format. The evaluation showed that the Thai leaflets were not appropriate for patients or the public.

In the UK, the major source of medicine information was WMI, while verbal information was the common source in Thailand. The PILs were read at the first time of being given medicines. The side effect information was the most frequent reading. The existing leaflets still did not meet patients' needs regarding the information provided, and design. Participants in both countries preferred receiving information both verbally and in writing. In terms of WMI, the most preferred way among the UK participants was a leaflet, whereas, because of lacking experience in reading PILs, The Thai participants preferred information on the medicine container. Tailoring information for individual needs were a suggestion from the participants.

There should be a requirement for PILs to be compulsory by law to be made available to the public in Thailand with all medicines. Regulation revision, guideline updates, and end-user comprehension and satisfaction surveys are all required on a regular basis to ensure PILs adhere to local guidelines, are appropriate for patients/the public, and are continuously improved.