Abstract
BackgroundResearch globally has shown that metered dose inhaler (MDI) technique is poor, with patient education and regular demonstration critical in maintaining correct use of inhalers. Patient information containing pictorial aids improves understanding of medicine usage; however, manufacturer leaflets illustrating MDI use may not be easily understood by low-literacy asthma patients.AimTo develop and evaluate the outcome of a tailored, simplified leaflet on correct MDI technique in asthma patients with limited literacy skills.SettingA rural primary health care clinic in the Eastern Cape, South Africa.MethodsPictograms illustrating MDI steps were designed to ensure cultural relevance. The design process of the leaflet was iterative and consultative involving a range of health care professionals as well as patients. Fifty-five rural asthma patients were recruited for the pre-post design educational intervention study. Metered dose inhaler technique was assessed using a checklist, and patients were then educated using the study leaflet. The principal researcher then demonstrated correct MDI technique. This process was repeated at follow-up 4 weeks later.ResultsThe number of correct steps increased significantly post intervention from 4.6 ± 2.2 at baseline to 7.9 ± 2.7 at follow-up (p < 0.05). Statistically significant improvement of correct technique was established for 10 of the 12 steps. Patients liked the pictograms and preferred the study leaflet over the manufacturer leaflet.ConclusionThe tailored, simple, illustrated study leaflet accompanied by a demonstration of MDI technique significantly increased correct MDI technique in low-literacy patients. Patients approved of the illustrated, simple text leaflet, and noted its usefulness in helping them improve their MDI technique.
Highlights
Patients who are diagnosed with a non-communicable disease are expected to adopt and learn new and sometimes complex behaviours
Patient-centric discussions to promote self-management of asthma facilitate the development of a partnership between patient and health care professional (HCP), which enables the acquisition of knowledge, confidence and skills, and in which patients are encouraged to participate in decisions about their treatment and given the opportunity to express their expectations and concerns.[3,4]
The aim of this research was to develop a simple, userfriendly information leaflet describing correct metered dose inhaler (MDI) usage, http://www.phcfm.org which contained simple text and pictograms, to evaluate the outcome of the leaflet combined with a technique demonstration on correct MDI use, and to assess its acceptability in rural patients with asthma who have limited literacy skills
Summary
Patients who are diagnosed with a non-communicable disease are expected to adopt and learn new and sometimes complex behaviours. This includes accepting the need for change, and learning and implementing new skills after a brief interaction with a health care professional (HCP).[1] For patients with pulmonary disease, this often occurs when experiencing an asthma exacerbation, at which time they may not be able to assimilate information given because of being distressed and unable to breathe . Patient information containing pictorial aids improves understanding of medicine usage; manufacturer leaflets illustrating MDI use may not be understood by low-literacy asthma patients
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