The role of health literacy and written medicine information in nonsteroidal antiinflammatory drug risk awareness

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Age Factors; Aged; Alabama; Anti-Inflammatory Agents, Non-Steroidal; Cross-Sectional Studies; Drug Labeling; Female; Health Literacy; Humans; Insurance Coverage; Logistic Models; Male; Middle Aged; Patient Education as Topic; Pharmaceutical Services; Socioeconomic Factors


Bioinformatics | Biostatistics | Epidemiology | Health Services Research


BACKGROUND: Despite widespread use of prescription nonsteroidal antiinflammatory drugs (NSAIDs), patients are commonly unaware of their risks. Pharmacies regularly distribute written medicine information (WMI) describing the risks and benefits of NSAID therapy at the time of dispensing.

OBJECTIVE: To clarify the relationship among common sociodemographic factors, education, health literacy, reading of WMI routinely distributed at pharmacies, and NSAID risk awareness.

METHODS: Generalized linear latent and mixed models (GLLAMM) ordered logistic regression and confirmatory path analysis were used to evaluate multivariable relationships in a cross-sectional dataset of 382 patients in the second phase of the Alabama NSAID Patient Safety Study.

RESULTS: The majority of the analytical sample was female (72.0%) with 38.7% African American, 38.1% age 65 years or older, and 43.3% reporting at least some college education. Health literacy was positively associated with reading of WMI (p = 0.001) and NSAID risk awareness (p = 0.025), while age was negatively associated with reading WMI (p = 0.001) and NSAID risk awareness (p = 0.005). Medicaid/uninsured status was negatively associated with risk awareness (p = 0.013). Reading of WMI was not associated with NSAID risk awareness (p = 0.659). The final path model demonstrated excellent fit.

CONCLUSIONS: The lack of relationship between reading of WMI and NSAID risk awareness questions the current strategy of distribution of patient-targeted print education materials at pharmacies. To maximize limited resources, future research should identify more effective strategies to deliver risk information to patients and ensure its retention, especially in high-risk groups such as the elderly, the indigent, and those with inadequate health literacy.

DOI of Published Version



Ann Pharmacother. 2010 Feb;44(2):274-84. Epub 2010 Jan 26. Link to article on publisher's site

Journal/Book/Conference Title

The Annals of pharmacotherapy

PubMed ID


Related Resources

Link to Article in PubMed