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The impact of textual elements on the comprehensibility of drug label instructions (DLIs): a systematic review.

Maghroudi, E., Hooijdonk, C.M.J. van, Bruinhorst, H. van de, Dijk, L. van, Rademakers, J., Borgsteede, S.D. The impact of textual elements on the comprehensibility of drug label instructions (DLIs): a systematic review. PLoS One: 2021, 16(5), p. e0250238.
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We provide an overview of textual elements that contribute to the correct interpretation of DLIs. Optimizing the textual instruction on drug labels may increase the safety and adherence to prescribed drugs, taking into account that a significant proportion of patients has low health literacy.

Herefore a systematic search was performed in PubMed, EMBASE, PsychINFO, and Smartcat (until April 2019) to identify studies investigating textual elements that facilitate or hinder the correct interpretation of DLIs in relation to patients' health literacy.

A total of 434 studies were identified of which 28 studies met our inclusion criteria. We found that textual elements contributing to the correct interpretation of DLIs were: using explicit time periods in dosage instructions, using plain language, presenting numbers in a numerical format, and providing DLIs in patients' native language. Multistep instructions per instruction line, using abbreviations and medical jargon seem to hinder the correct interpretation of DLIs. Although health literacy was taken into account in a majority of the studies, none of them assessed the effectiveness of specific textual elements on patients' comprehensibility of DLIs.