Using change detection to objectively evaluate whether novel over-the-counter drug labels can increase attention to critical health information among older adults

Abstract

Over-the-counter (OTC) drugs have many benefits but also carry risks, such as adverse drug reactions, which are more prevalent in older adults. Because these products do not require the oversight of a physician or pharmacist, labeling plays a key role in communicating information required for their safe and effective use. Research suggests that current labels are not terribly effective at communicating potential risk. One reason for their lack of effectiveness is that few consumers attend to critical information (active ingredients and warnings) when making purchases. In two experiments, we used a change detection task to objectively evaluate how novel label designs that employ highlighting and a warning label placed on the package's front impact attention to critical information among older participants (65 and older). The change detection task is a unique form of visual search which allowed us to assess the attentional priority of critical information among participants who were not explicitly instructed to search for this critical information. This unique aspect of the task is important given research suggesting that consumers rarely have the explicit goal of seeking out warnings and active ingredients when making OTC selections. Our results provide empirical support that both highlighting critical information and positioning it on the package's front increase its attentional prioritization relative to current, commercial practice. Given that attending to the critical information is prerequisite to utilizing that information, strategies that elicit attention in this way are likely to reduce medication errors.

Conflict of interest statement

LB has served as a consultant to Vertex Pharmaceuticals, Inc., a biotech firm focused on drugs to treat cystic fibrosis, providing expertise on the development of protocols to evaluate packaging ease of use. LB has received an honorarium and travel reimbursement to speak at Baxter and Johnson & Johnson Companies and travel reimbursement to share work from her group at the International Quality and Productivity Center’s conference on Pharmaceutical Labeling. Travel reimbursement has also been provided by the US Food and Drug Administration (FDA) and the US Centers for Disease Control and Prevention (CDC) in support of her participation for ongoing efforts medication safety. LL’s work which also investigated OTC labeling strategies, was funded by the Consumer Healthcare Products Association (CHPA) and MWB and LB were co-PIs for these funds. None of these entities played any role in the design or conduct of the study; collection, management, analysis or interpretation of the date; preparation, review or approval of the manuscript or the decision to submit or publish the study.

Figures

Fig. 1

An example of one of the mock brands. For illustrative purposes, the principle display panel (PDP) and Drug Facts Label are labeled in red and the front warning label and active ingredients are labeled in blue. The actual stimulus did not show these colored labels, arrows, and circle

Fig. 2

Examples of the four label treatments

Fig. 3

Examples of the eight active ingredient changes. The left column depicts the complete label for the 4 label treatments. The middle depicts the altered images with a change to the PDP. The right depicts the altered images with a change to the active ingredient in the Drug Facts Label. The red squares in the top row are to illustrate the change location and did not appear

Fig. 4

Examples of the six warning changes for a given brand. The left column depicts the complete label for the 4 label treatments. The middle depicts the altered images with a change to the Drug Facts Label. The right depicts the altered images with a change to the front warning label. The red squares in the top row are to illustrate the change location and did not appear in the experiment

Fig. 5

a Presents the mean reaction time for changes to active ingredients by condition for Experiment 1. b The corresponding mean accuracy data. c, d Present the mean reaction time and accuracy data for changes to active ingredients by condition for Experiment 2. For accuracy the values are the estimated marginal means. For reaction time, rather than present the log transformed data that was used for the analyses, for illustrative purposes we present the means of the raw data. Error bars represent the standard error of the mean

Fig. 6

a The mean reaction time for changes to warnings by condition for Experiment 1. b The corresponding mean accuracy data. c, d present the mean reaction time and accuracy data for changes to warnings by condition for Experiment 2. For accuracy the values are the estimated marginal means. For reaction time, rather than present the log transformed data that was used for the analyses, for illustrative purposes we present the means of the raw data. Error bars represent the standard error of the mean