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Continuing Professional Development
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1. Low health literacy:
a) is associated with lower rates of
hospitalisation as consumers don't
engage with health services.
b) is a similar predictor of health status as
education and socioeconomic status.
c) requires consideration of how health
information will be provided and
interpreted, not just the consumer's
d) is associated with people with a higher
self-assessed health status.
2. Of all Australian adults,
approximately what proportion does
NOT have the level of health literacy
required to meet the demands of
everyday life and work?
3. Implementing universal precautions
to health literacy means:
a) minimising the risk of blood-borne
b) using gloves and proper disposal
c) promoting better understanding for all
d) promoting better understanding to
those you can identify as needing
4. Which of the following strategies
is MOST appropriate for improving
a) Using written communication with all
b) Presenting essential information to
c) Checking consumer understanding,
such as with the teach-back technique.
d) Avoiding visual aids as they will be
distracting to the consumer.
5. Which of the following statements
relating to dosing would be MOST
likely to be understood by a patient
reading a medicines label?
a) Take one tablet in the morning and
one tablet in the evening.
b) Take one tablet at 9 am and one tablet
c) Take one tablet twice a day.
d) Take one tablet every 12 hours.
A score of 4 out of 5 attracts 1 CPD credit.
the currently approved versions of these
ancillary labels are used in practice.
Pharmacists should also be aware that
consumers may not perceive additional
warning labels as being essential
information, particularly if they are in second
or third position on the medicine container.15
A practical approach may be to limit these
ancillary warning labels to only the one
or two deemed most critical to the safe
and appropriate use of the medicine, and
include other warnings in supplementary
written information.15 Further, providing
information through labelling should never
replace verbal communication that allows
understanding of information presented to
be confirmed with the consumer.
Examples of resources available to support
pharmacists improve health literacy, and
manage the risks associated with poor
health literacy, are listed in Table 1.
Case study continued
Recognising that if Mrs Smith has not
understood the instructions you have
provided, it is very likely other customers
are also misunderstanding instructions
relating to medicines and are at risk
of medication misadventure. As such,
you discuss with the other pharmacists
possible strategies that could be easily
introduced in the pharmacy to improve
consumer understanding of instructions
about their medicines. You:
• agree to adopt a 'universal precautions'
approach -- promoting better
understanding for all consumers, not
just for those that obviously need
• agree to consistently change the way
dosing instructions are expressed
on medicine labels so that they are
explicit about time periods for doses
(e.g. morning, afternoon, evening,
bedtime), rather than using vague
instructions (e.g. three times daily)
• confirm that you only stock approved
ancillary labels, and discuss with the
other pharmacists how best to use
the recommended labels for different
medicines and different consumers to
optimise their effect
• review the consumer information available
from your pharmacy and discuss with the
other pharmacists the appropriateness
of the content and design for people of
varying levels of health literacy
• identify training opportunities that
will allow you to learn and practice
communication techniques that will
support people with low health literacy,
e.g. the teach-back technique.
1. Code of conduct for registered health practitioners. Melbourne:
Pharmacy Board of Australia; 2010.
2. Barber M, et al. Up to a quarter of the Australian population
may have suboptimal health literacy depending upon the
measurement tool: results from a population based survey. Health
Promotion International. 2009; 24(3):252--61.
3. Australian Bureau of Statistics. Health literacy, Australia 2006
[online]. 2008 [accessed 15 Nov 2011]. At: www.abs.gov.au
4. Keleher H, Hagger V. Health literacy in primary health care. Aust J
Prim Health. 2007; 13(2):24--30.
5. USA Department of Health and Human Services. Healthy People
2010: Understanding and improving health, 2nd edn. Washington
DC: US Government Printing Office; 2000.
6. Berkman N, et al. Low health literacy and health outcomes: an
updated systematic review. Ann Intern Med. 2011; 155(2):97--107.
7. Victorian Quality Council. Evaluation report. Forum: Getting the
most out of the clinical conversation. Melbourne: State of Victoria,
Department of Health; 2011.
8. US Department of Health and Human Services, Office of Disease
Prevention and Health Promotion. National action plan to
improve health literacy. Washington DC: US Department of Health
and Human Services; 2010.
9. North Carolina Network Consortium, University of North Carolina.
Health literacy universal precautions toolkit. Rockville: Agency for
healthcare research and quality; 2010.
10. RTI International -- University of North Carolina Evidence-based
Practice Center. Health literacy interventions and outcomes: an
updated systematic review [online]. 2011 [accessed 15 Nov 2011].
11. Jackson Bowers E, et al. RESEARCH ROUNDup: Health literacy and
primary health care [online]. 2011 [accessed 15 Nov 2011]. At:
12. Tkacz V, Metzger A, Pruchnicki M. Health literacy in pharmacy. Am
J Health-Syst Pharm. 2008; 65:974--81.
13. Davis T, et al. Improving patient understanding of prescription
drug label instructions. J Gen Intern Med. 2009; 24(1):57--62.
14. Sansom L (ed). Australian Pharmaceutical Formulary and
Handbook, 21st edn. Canberra: Pharmaceutical Society of
15. Wolf M, et al. Improving prescription drug warnings to promote
patient comprehension. Arch Intern Med. 2010; 170(1):50--6.
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