Journal of Clinical Pharmacy and Therapeutics (1990) 1 5 , 1 5 1 9.
RESEARCH AND REPORTS EFFECT OF INFORMATION ORGANIZATION ON RECALL OF MEDICATION INSTRUCTIONS* M. Gardner, P. D. Hurdt and M. Slack Departments of Pharmacy Practice, College of Pharmacy, The University of Arizona, Tucson, A Z and t S t Louis College of Pharmacy, St Louis, MO, U.S.A.
SUMMARY
This study compared immediate recall of prescription information when the message content was presented in a highly organized format versus a lessorganized approach. Two groups of pharmacy students viewed separate videotapes, which described information for a patient about three fictitious medications. Students were then asked to recall the medications’ name, colour, purpose, dosage, duration, side-effects and quantity prescribed. Students who viewed the organized version correctly recalled more information in every category except drug colour. Both groups made more errors in recalling dosage than any other category. Thus, organizing information facilitates recall of medication information. INTRODUCTION Pharmacists play an important role in the counselling of patients with regard to the proper use of medication, and numerous studies have shown that pharmacist intervention has a significant impact on compliance with prescribed medication regimens (1-6).
Medication counselling can be likened to a teaching situation in which the pharmacist instructs or advises the patient about specific medication-related facts. In doing so, two components are involved: the content of counselling (what is said), and the process of counselling (how it is said). T h e content of medication counselling involved the communication of specific facts about the medication, such as type, name, dosage, and duration. T h e process of medication counselling has some roots in teaching and, specifically, in verbal learning theory. Verbal learning research has examined the effects of various process behaviours on learning as measured by information recall. Some of these processes are directly applicable to medication counselling. Examples include repetition of important points, the use of cues or signals (words which draw attention), Correspondence: Dr Marie Gardner, Department of Pharmacy Practice, College of Pharmacy, The University of Arizona, Tuscon, AZ, U.S.A. Editor: Professor D. Worthen.
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M . Gardner, P. D. H u r d and M . Slack
and the logical structure of message content. These techniques are associated with improved recall of information (7-9). Studies involving verbal patient education have not examined the effects of these techniques on learning outcomes. As a fair amount of technical information can be communicated during patient counselling, we chose to study the variable of message organization on recall. T h e study compared immediate recall of prescription information when the message content was presented in a highly organized format versus a less organized approach. METHODS Script design A script was written to reflect information for a patient about three fictitious medications. T h e information was contrived to prevent the bias of prior knowledge about medication. T h e medications were prescribed for ‘irregularities of heart rhythm and function’. Script A contained an opening statement which listed the medications by name (Appendix A), then provided these six additional points of information about each medication: purpose, dosage, when to take the medication, possible side-effects, duration of therapy, and the quantity of medication dispensed with the number of refills. All the information about each medication was subsumed under the medication name so that the information was logically separated into three sections. T h e name of each medication was mentioned four times throughout and the information was provided in the same order for each medication. Script B contained the same opening statement and information, however, the statements for each medication were arranged in pairs and the pairs were presented in a less organized manner (Appendix B). A pharmacist unknown to the study group learned both scripts. T h e pharmacist videotaped each script separately. Each tape ran for approximately 2 min. Evaluation of the scripts A second-year pharmacy class was randomly assigned by designating alternate individuals to one of two groups. Group I viewed Script A, the highly organized version. Group I1 was shown Script B at the same time but in a separate room. These students had not had any formal training in medication counselling. They were not aware of the study before coming to class. T h e students were told that a tape would be shown which reflected medication counselling. After showing the tape, each student was given a form on which they were to list all the information recalled from the videotape. T h e form also collected information about age, sex, number of internship hours, and the frequency with which students and their preceptors counselled patients at the internship sites. Directions were included on the form to eliminate the need for instructions to be given by those involved in the project. No time limit was imposed. Evaluation of the data T h e data were tabulated independently by two of the authors. Each response was coded as correct or incorrect. A correct response was defined as data on any point (colour, use, etc.) which corresponded to medication name according to Script A. An incorrect response was that which did not correspond to the medication named. For
Recall of medication instructions
15
example, if the student listed the medication name as Cardiotonic and stated the correct use and side-effects but Artrol’s dosage schedule, three correct and one incorrect response were coded. T h e data were analysed for statistical significance using the %’-test, a z-test for proportions, Student’s t-test, and Pearson correlations where appropriate. RESULTS A total of 36 students viewed the tapes. Group I comprised 17 students who viewed the highly organized version; Group I1 included 19 students who saw the less organized version, Students in Group I recalled significantly more data and made fewer recall errors than those viewing the less organized presentation. Group I correctly recalled 59.7Oh of the information, while Group I1 correctly recalled 28.6% (t = 4.86, P < 0.001). Expressed as number of responses, Group I had 12.71k5.52 correct responses compared with Group I1 having 6.00 f2.28 responses on recall. A score of 21 .O is perfect recall, representing seven points for each of the three medications. T h e percentage of correct responses by both groups is shown in Table 1. Organized tape viewers (Group I) remembered six of the seven content areas correctly at least half the time but remembered dosage information less than half the time. However, those viewing the less organized version recalled only the purpose of the medication more than half the time, followed by colour (43.8%) and name (35Ob). Statistically significant differences in correct recall between groups were seen for all categories of information except colour (for all other categories z > 1.67, P
RESEARCH AND REPORTS EFFECT OF INFORMATION ORGANIZATION ON RECALL OF MEDICATION INSTRUCTIONS* M. Gardner, P. D. Hurdt and M. Slack Departments of Pharmacy Practice, College of Pharmacy, The University of Arizona, Tucson, A Z and t S t Louis College of Pharmacy, St Louis, MO, U.S.A.
SUMMARY
This study compared immediate recall of prescription information when the message content was presented in a highly organized format versus a lessorganized approach. Two groups of pharmacy students viewed separate videotapes, which described information for a patient about three fictitious medications. Students were then asked to recall the medications’ name, colour, purpose, dosage, duration, side-effects and quantity prescribed. Students who viewed the organized version correctly recalled more information in every category except drug colour. Both groups made more errors in recalling dosage than any other category. Thus, organizing information facilitates recall of medication information. INTRODUCTION Pharmacists play an important role in the counselling of patients with regard to the proper use of medication, and numerous studies have shown that pharmacist intervention has a significant impact on compliance with prescribed medication regimens (1-6).
Medication counselling can be likened to a teaching situation in which the pharmacist instructs or advises the patient about specific medication-related facts. In doing so, two components are involved: the content of counselling (what is said), and the process of counselling (how it is said). T h e content of medication counselling involved the communication of specific facts about the medication, such as type, name, dosage, and duration. T h e process of medication counselling has some roots in teaching and, specifically, in verbal learning theory. Verbal learning research has examined the effects of various process behaviours on learning as measured by information recall. Some of these processes are directly applicable to medication counselling. Examples include repetition of important points, the use of cues or signals (words which draw attention), Correspondence: Dr Marie Gardner, Department of Pharmacy Practice, College of Pharmacy, The University of Arizona, Tuscon, AZ, U.S.A. Editor: Professor D. Worthen.
13
14
M . Gardner, P. D. H u r d and M . Slack
and the logical structure of message content. These techniques are associated with improved recall of information (7-9). Studies involving verbal patient education have not examined the effects of these techniques on learning outcomes. As a fair amount of technical information can be communicated during patient counselling, we chose to study the variable of message organization on recall. T h e study compared immediate recall of prescription information when the message content was presented in a highly organized format versus a less organized approach. METHODS Script design A script was written to reflect information for a patient about three fictitious medications. T h e information was contrived to prevent the bias of prior knowledge about medication. T h e medications were prescribed for ‘irregularities of heart rhythm and function’. Script A contained an opening statement which listed the medications by name (Appendix A), then provided these six additional points of information about each medication: purpose, dosage, when to take the medication, possible side-effects, duration of therapy, and the quantity of medication dispensed with the number of refills. All the information about each medication was subsumed under the medication name so that the information was logically separated into three sections. T h e name of each medication was mentioned four times throughout and the information was provided in the same order for each medication. Script B contained the same opening statement and information, however, the statements for each medication were arranged in pairs and the pairs were presented in a less organized manner (Appendix B). A pharmacist unknown to the study group learned both scripts. T h e pharmacist videotaped each script separately. Each tape ran for approximately 2 min. Evaluation of the scripts A second-year pharmacy class was randomly assigned by designating alternate individuals to one of two groups. Group I viewed Script A, the highly organized version. Group I1 was shown Script B at the same time but in a separate room. These students had not had any formal training in medication counselling. They were not aware of the study before coming to class. T h e students were told that a tape would be shown which reflected medication counselling. After showing the tape, each student was given a form on which they were to list all the information recalled from the videotape. T h e form also collected information about age, sex, number of internship hours, and the frequency with which students and their preceptors counselled patients at the internship sites. Directions were included on the form to eliminate the need for instructions to be given by those involved in the project. No time limit was imposed. Evaluation of the data T h e data were tabulated independently by two of the authors. Each response was coded as correct or incorrect. A correct response was defined as data on any point (colour, use, etc.) which corresponded to medication name according to Script A. An incorrect response was that which did not correspond to the medication named. For
Recall of medication instructions
15
example, if the student listed the medication name as Cardiotonic and stated the correct use and side-effects but Artrol’s dosage schedule, three correct and one incorrect response were coded. T h e data were analysed for statistical significance using the %’-test, a z-test for proportions, Student’s t-test, and Pearson correlations where appropriate. RESULTS A total of 36 students viewed the tapes. Group I comprised 17 students who viewed the highly organized version; Group I1 included 19 students who saw the less organized version, Students in Group I recalled significantly more data and made fewer recall errors than those viewing the less organized presentation. Group I correctly recalled 59.7Oh of the information, while Group I1 correctly recalled 28.6% (t = 4.86, P < 0.001). Expressed as number of responses, Group I had 12.71k5.52 correct responses compared with Group I1 having 6.00 f2.28 responses on recall. A score of 21 .O is perfect recall, representing seven points for each of the three medications. T h e percentage of correct responses by both groups is shown in Table 1. Organized tape viewers (Group I) remembered six of the seven content areas correctly at least half the time but remembered dosage information less than half the time. However, those viewing the less organized version recalled only the purpose of the medication more than half the time, followed by colour (43.8%) and name (35Ob). Statistically significant differences in correct recall between groups were seen for all categories of information except colour (for all other categories z > 1.67, P
