Which teaching method is the most effective when teaching patients about medications?

"It is estimated that three out of four Americans do not take their medication as directed."

This powerful quote comes from an American Heart Association (AHA) article on medication adherence, sometimes referred to as medication compliance (this recent blog discusses how using this terms interchangeably may be problematic). The AHA notes that poor medication adherence claims the lives of 125,000 Americans annually and costs our healthcare system nearly $300 billion a year due to additional doctor visits, emergency department visits, and hospitalizations. With so much at stake, the need for effective medication compliance education takes on ever greater importance.

Medication Compliance Education Tips and Tools

Here are seven ways you can improve your medication compliance education.

1. Take health literacy into consideration

As the Health Resources & Services Administration (HRSA) notes, "Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions." When working to deliver medication compliance education, providers should strive to determine a patient's health literacy and address any associated barriers that may reduce the value of such education. These include lack of understanding of medical language, low educational skills, and difficulty understanding English (discussed further below). HRSA states that low health literacy is more prevalent among older adults, minority populations, individuals with low socioeconomic status, and the medically underserved.

2. Factor in limited English proficiency

Non-English-speaking patients who have a limited ability to read, speak, write, and/or understand English can be limited English proficient (LEP). As a Patient Safety Network article notes, "Poor-quality communication between patients with LEP and clinicians leads to decreased medication adherence, diminished patient satisfaction with care, less patient-centered care, and negative clinical experiences.

Providers should take the time to determine if a patient is LEP and then work to ensure this is factored into any medication compliance education provided. To effectively do so, providers will need the ability to deliver education in languages other than English. Ways to do so include translating educational materials into other languages and having professional interpreters available to support the delivery of education.

3. Use patient education handouts

Using patient education handouts is such a worthwhile method for providing medication compliance education that we previously dedicated an entire blog to it. A few key takeaways from this column:

• Educational handouts are particularly helpful for patients on complex medication regimens.
• Handouts can help patients stay organized when multiple physicians prescribe medications.
• Keep handouts simple and based on reputable sources of information. Consider using a comic book format. This study, published in Global Health Promotion, reported that the use of comic books delivered noteworthy improvements in health literacy, medication compliance, knowledge deficiency, and knowledge retention.
• Ask a nurse or care coordinator to review the education handout with the patient, highlighting key points.
• Allocate time for patient questions about the material in the handouts.

4. Rely more on visuals

Here are a few interesting statistics from the Visual Teaching Alliance for the Gifted & Talented:

• Approximately 65% of the population are visual learners (i.e., individuals who need to see information to learn it).
• Although only 10% of secondary students are auditory learners, 80 percent of instruction is delivered orally.
• The brain processes visual information 60,000 times faster than text.

As the Centers for Disease Control and Prevention (CDC) states, "Visuals, such as pictures, drawings, charts, graphs and diagrams, can be effective tools for communicating health information. Visuals can make the presentation of complex information easier to comprehend, more attractive, and can also reinforce written or spoken health messages."

Visuals can prove very helpful in enhancing medication compliance education. For example, a pill card is an example of a simple way to list all of the medicines a patient should take. AHRQ dedicates a page of its website with directions on how to create a pill card, noting, "The pill card uses pictures and simple phrases to show each medicine, its purpose, how much to take, and when to take it. It is easier to understand than the complicated information and instructions that typically come with medicines."

In addition to pill cards, providers can leverage other visual tools, such as reminder charts, educational videos, and mobile apps. We discuss these and other medication adherence tools in this blog.

An important note: Visual communications are not without their potential shortcomings. CDC states that, "People can interpret visuals, just as they do words, in different ways. Choose visuals that support the main message and have clear headings, labels, and captions."

5. Identify cause(s) or noncompliance

If your medication compliance education is aimed at helping patients who are noncompliant with their medication regimen, first identify the individualized reason(s) for noncompliance. This may include the aforementioned health literacy or LEP. Other contributing factors may include the following:

• Fear of potential side effects
• Patient in denial about having the disease state
• Cost to fill and refill medications
• Polypharmacy. As the number of medications and dosing frequency increases, management becomes more difficult.
• Concern about becoming dependent/addicted
• Lack of symptoms, which contributes to a belief that continuing a regimen is unnecessary
• Mistrust of prescribers
• Inability to get transportation to the pharmacy

Once you have identified the cause(s) of noncompliance, you can more effectively focus medication compliance education on addressing those specific factors.

6. Leverage motivational interviewing

As discussed earlier, poor communication can greatly contribute to noncompliance. Using motivational interviewing can help address communication issues.

Psychology Today defines motivational interviewing as "… a counseling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior. It is a practical, empathetic, and short-term process that takes into consideration how difficult it is to make life changes."

Motivational interviewing has proven very effective. As a Michigan Pharmacists Association article discussing how to speak to patients about medication adherence notes, "Motivational interviewing has been shown to increase behavioral change and adherence in more than 70 clinical trials, and can increase a patient's adherence to many behavioral changes with a high risk of relapse…"

It goes on to explain that the simplest way to perform motivational interviewing is to begin sentences with "what, why, how and when." With these "leading words," statements will be formed as questions. This reduces the likelihood that providers deliver too many commands or advice. With motivational interviewing, patients are challenged to strategize for themselves while providers ask questions that help patients them reach their conclusion.

If you are interested in incorporating motivational interviewing into your medication compliance education, we suggest reading this article from the American Pharmacists Association.

7. Approach each patient's medication compliance education with a clean slate

While there are many recommended practices to improve medication compliance education, some of which we discussed above, it is important for providers to avoid taking a blanket approach to education. Each patient should be evaluated individually and without preconceived notions. For example, do not assume a patient's native language is English. Do not assume a patient has a high level of health literacy. Do not assume a patient can afford their medications.

By approaching medication compliance education in this manner, providers should be more successful in ensuring education addresses the specific needs of and challenge facing their patients.

Which portion of the learning process is involved in the cognitive domain?

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Which teaching tool is most suitable for the patients who have strong reading comprehension and psychomotor skills?

Which nursing action is an example of teaching to a patient's cognitive learning style?