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Res Social Adm Pharm. 2016 Nov - Dec;12(6):885-892. doi: 10.1016/j.sapharm.2015.12.003. Epub 2016 Jan 5.

Don't assume the patient understands: Qualitative analysis of the challenges low health literate patients face in the pharmacy.

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School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 4G3, Canada.
School of Pharmacy, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 4G3, Canada. Electronic address:



Low health literacy populations have difficulty understanding health information and making appropriate health decisions. Pharmacists need to ensure patients have a basic understanding of how to take their medications and understand the risks and benefits of their prescriptions.


To explore the major challenges low health literate adults face when trying to understand their medication therapy.


One-on-one semi-structured interviews were used to gather data on the major challenges low health literate adults face regarding their medication. Each interview began with a verbal health literacy assessment, followed by open-ended questions focused on medication information. After each interview was complete, a written health literacy assessment was given in English, which was later used to compare self-assessed health literacy to written health literacy scores. All interviews were audio-recorded, transcribed and analyzed using thematic analysis.


The population sample had an average age of 67 years old and 90% had been education outside of North America. Low health literacy levels were found in 75% of participants based on the S-TOFHLA and demonstrated a generally over estimated self-assessed health literacy levels. After thematic analysis, a flow chart that describes the low health literate population's pharmacy experience with medication information was developed to explain the cause and effect of challenges faced with current pharmacy medication information. Also, the major challenges patients with low health literacy face with current medication information from the pharmacy were limited time with pharmacists, understanding medication information, forgetting to take medication, side effects and food-drug interactions.


Future interventions targeted to improving pharmacy medication information for the low health literate population should focus on addressing the challenges with limited time with pharmacists, poor understanding of medication information, forgetting to take medications, side effects and food instruction/interactions.


Health literacy; Medication challenges; Medication information; Patient-perspective; Pharmacy

[Indexed for MEDLINE]

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