Methods of reading information on labels of prescription medications by persons who are visually impaired

The prevalence of visual impairment (that is, blindness and low vision) is increasing in the United States, especially in persons aged 65 and older, with more than half of all people who are blind in this age demographic (Centers for Disease Control and Prevention, 2004; National Eye Institute, 2006; Strobel, 2003). It has been estimated that about 6.5 million Americans aged 55 and older report vision loss, and this number is expected to double by 2030 (Dinsmore & Kirchner, 2004; Shi & Singh, 2004; Strobel, 2003). Furthermore, the use of prescription medications will rise because persons who are older also tend to use more prescription medications (American Foundation for the Blind, 2007), with more than 40% of older persons taking at least five different prescription drugs (Wilson et al., 2007). Because of these factors, it is important to determine if, and how, these individuals are reading the labels of their prescription medications. The lack of access to the printed information related to medication can be a barrier for a person who is visually impaired to manage his or her prescriptions and health information optimally (Dinsmore & Kirchner, 2004). The Rehabilitation Act of 1973 and the Americans with Disabilities Act mandate that the print information commonly used by sighted persons (referred to as "effective communication") must be accessible to those who cannot access the information in the typical manner (U.S. Department of Health & Human Services, Office for Civil Rights, n.d.; U.S. Department of Justice, Civil Rights Division, Disability Rights Section, 2005). In addition, Little (2006) reported that the Health Insurance Portability and Accountability Act (2002) requires protected health information to be made available in print and other accessible media. These print-accessibility mandates, combined with the increasing number of persons who are elderly and visually impaired and the greater risk of being ill or hospitalized because of adverse medication outcomes (Lombardi & Kennicutt, 2001), make it important to determine what, if any, accessibility issues exist for this population. The survey reported here addressed how often, and using what methods, persons who are visually impaired access or independently read the labels on their prescription medications. METHODOLOGY Participants We randomly sampled 1,000 eligible participants in one northeastern U.S. state from a mailing list of 1,900 persons who received services from a blindness rehabilitation agency and were aged 55 and older. The agency mailed the surveys to eligible participants, who then returned completed surveys directly to the researcher to preserve the participants' anonymity. The final sample we analyzed consisted of 283 respondents; 290 surveys were returned (for a response rate 29%), but 7 were excluded because of missing data. Survey procedure We conducted a review of the literature and consulted four experts, who were current researchers and university instructors in the field of blindness, to design and assess the content validity of the survey instrument. In addition to the standard mailed format, the survey instrument was made available in braille, large print, and electronic formats and was sent to the participants in the format that they reported to prefer. MEASURES The survey tool contained two questions pertaining to the types of methods that the participants used to read their prescription medication labels. The participants were asked, "When you pick up a new prescription medication, what best describes the way you read the information on the label of the prescription bottle?" The participants could choose only one method in answering this question. The participants were then asked, "Think of the times you took a prescription medication in the past month. What percentage of time did you use each of the following methods to read your prescription medication labels? …