Publications

Published: January 2002

Talking the Talk

Prescriber Update 23(1): 10-11
January 2002

Pauline Norris, PhD, Senior Research Fellow; Kiri Bird, BSc; Jack Kirifi; Tamika Simpson, BA.
Health Services Research Centre, Victoria University, Wellington

A New Zealand survey conducted to determine the level of understanding of some common medicine-related terms found that many people do not know the meaning of words such as hypertension and decongestant.  The scope of understanding varied according to ethnic group, gender and education status.  Health professionals have an obligation to ensure that consumers understand the information given to them.  The results of this survey illustrate how and why misunderstandings can arise in regard to health information.  Take this into consideration when communicating with consumers.  Use patient-friendly language and check that your patients have understood the information.

Low level of consumer understanding previously identified

Previous studies have shown that consumers find it difficult to understand medical terms.1-4  A United States (US) researcher asked 145 people waiting in pharmacies to define a list of medical terms and found that overall only 53% of responses were correct.5  A subset of these terms was chosen to look at the level of understanding amongst New Zealand consumers, and whether this varied between different ethnic groups.

Pharmacy customers from three ethnic groups surveyed

Three summer students (Maori, Pakeha and Tokelauan) each interviewed approximately 40 males and 40 females from each of these three ethnic groups.  There were 244 participants in total, selected from the greater Wellington area including central city and suburbs.  The study was funded by the Health Research Council and the Health Services Research Centre.

Most participants were recruited off the street.  They were all over 15 years of age and had collected a prescription medicine from a pharmacy (for themselves or someone else) in the last 12 months.  Participants were asked to define nine terms (see Table 1).  The words were placed in simple, non-leading verbal sentences like "This medicine is an antibiotic".  Answers were compared with correct definitions used by the US study, and checked by New Zealand pharmacists. T here was a range of acceptable answers, e.g. antibiotic could be correctly defined as an agent that fights, kills or treats infections, bacteria, germs or bugs.  All answers were coded as either 'correct', 'vague', 'incorrect', or 'no definition' by all four members of the research team working together.

Comprehension varies with ethnicity, education and gender

37% of all responses given were correct. Only three words (i.e. orally, allergic, and inflammation) were defined correctly by over half the respondents.  Decongestant was the least understood word (5.3% of respondents defined it correctly).

The level of understanding was found to be related to ethnicity.  Pakeha respondents gave on average 5.3 correct responses, Maori 3.1 and Tokelauans 1.7.  For Tokelauans born in the Tokelau Islands, the figure was particularly low (1.2 correct answers on average).  This could be due to English being a second language for most of the older Tokelauans interviewed.

Education also affected the number of correct responses.  Participants who had attended a tertiary institution correctly defined an average of 4.2 words; those who had finished their education at secondary school scored 2.6; and those who had only been to primary school could correctly define 1.1 words.

Women could correctly define more of the words than men. On average, female respondents defined 3.8 words correctly, while males defined 2.8.

Table 1: Respondents understanding of medical terms (n=244)

Term Correct1
definition (%)
Vague2
definition (%)
Incorrect3
definition (%)
No4
definition (%)
Allergic 59 17 13 11
Orally 67 1 16 16
Cough suppressant 49 20 12 19
Antibiotic 36 13 36 15
Hypertension 22 2 36 40
Antihistamine 29 4 13 55
Diuretic 16 3 21 60
Inflammation 52 5 21 22
Decongestant 5 5 39 50
Total (%) 37 8 23 32

1 = a clear definition given; 2 = explanation incomplete or ambiguous; 3 = erroneous understanding;
4 = no attempt or word not recognised; Note: percentages have been rounded to whole numbers so rows may not total 100.

Perceived meaning often vastly different from correct definition

Overall, almost a quarter of responses (23.2%) were incorrect.  In some of these, participants thought they understood the term but were unable to provide a correct definition.  Others attempted to guess the meaning, often choosing words that sounded similar, e.g. diet or diabetes to define diuretic.

Common misunderstandings included that to take a medicine orally meant to take it regularly or at a certain time; that antibiotics were painkillers or were used to treat viruses or 'flu; that having hypertension meant being stressed, tense or hyperactive; that inflammation was the same as infection; and that decongestants cleared the lungs or were for the digestive system.

Findings show minimal knowledge of common words

The overall level of understanding of these common medical terms was very low, and there were significant differences by ethnicity, education and gender.  This could reflect a poor understanding of the English language in general, however some tertiary educated pakeha respondents were unable to correctly define all the terms.  This suggests that health professionals need to take care to use everyday language when communicating to consumers, particularly to those for whom English is a second language.

The high level of incorrect answers is particularly worrying.  Some consumers believed they understood the words but did not.  Other incorrect answers were given by people guessing what a word meant.  Possible consequences are that people may adopt this 'guessing' strategy in a situation where a health professional uses a word they do not understand.  Also, consumers may use these medical words when talking to their doctor, but have a completely different understanding of the words.  Both scenarios could lead to potentially harmful misinterpretations.

Health professionals can minimise misunderstandings by using consumer-friendly language

Even though the sample size was not large, the findings of this study do highlight the importance of using simple, clear language when communicating to consumers.  Many of these medicine-related terms are frequently used on the presumption that all consumers comprehend their true meaning.  Health professionals have a responsibility to ensure that consumers understand the information given to them.  Use language that your patients will comprehend and check that the health information provided has been understood.  This will assist patients to understand the treatment regimen that is being recommended, and to be active participants in shared decision-making about their health care.

Further details about this study are available in New Zealand Pharmacy 2001;22(4):13-16 and in the International Journal of Pharmacy Practice 2001;9:269-274.

Competing interests (authors): none declared.

Correspondence: Dr Pauline Norris, School of Pharmacy, University of Otago, PO Box 913, Dunedin. E-mail: pauline.norris@stonebow.otago.ac.nz

References
  1. Smeltzer C. Hypertensive patients' understanding of terminology. Heart and Lung 1980;9(3):498-502.
  2. Spiro D, Heidrich F. Lay understanding of medical terminology. The Journal of Family Practice 1983;17(2):277-279.
  3. Gibbs RD, Gibbs PH, Henrich J. Patient understanding of commonly used medical vocabulary. The Journal of Family Practice 1987;25(2):176-178.
  4. Byrne TJ, Edeani D. Knowledge of medical terminology among hospital patients. Nursing Research 1984;33(3):178-181.
  5. Shaughnessy AF. Patients' understanding of selected pharmacy terms. American Pharmacy 1988;NS28(10):38-42.