Introduction
The Institute of Medicine landmark report entitled Health Literacy: A Prescription to End Confusion documents that ninety million people in the United States (U.S.) have difficulty understanding and using health information [1]. Among persons over 65 years, 29% have below basic health literacy abilities [2]. By 2020 in the U.S., 16% will be 65 or older [3], [4]. Considering that over 85% of adults 65 and older use prescription drugs on a regular basis [5], polypharmacy may indeed be the new paradigm for quality drug therapy [6]. Given issues of low health literacy coupled with increasingly complex drug regimens, it is not surprising that the incidence of adverse drug events has been estimated to be 27.4% amongst community dwelling adults [7]. Further, 40–75% of older adults have difficulty taking medication as prescribed [8] with costs of poor adherence estimated to be approximately $100 billion dollars per year [9].
The availability of comprehensive and accurate medication history information in electronic medical records and through electronic prescribing provides the opportunity to create tailored interventions based on individuals’ particular medication information needs. To meet the challenges of providing medication information to low-literate English and Spanish speaking older adults, we developed a novel approach to providing consumers with medication information tailored to their specific drug regimen. That is, the information regarding medications included in either an electronic medical record or electronic prescribing system is used to select specific video segments resulting in an individualized educational video for a patient. Tailoring educational materials entails working from scratch to develop an appropriate communication mechanism, as well as appropriate content organization, illustration and motivation for each audience [10]. This strategy has been recommended to improve communication and comprehension among low-literate patients [11]. We used a DVD format because low-literate individuals in the U.S. frequently depend on non-written means of communication to obtain health-related information and at the time of the study most low income racially/ethnically diverse participants had DVD players, but not necessarily access to the Internet. However, once the content is developed, the format can be easily changed for new media including the Internet. Indeed, the number of Internet users is growing rapidly [12] providing an alternative modality for this approach.
The purpose of this study was to develop strategies using health information technology to create novel, individualized, culturally and linguistically inclusive education materials for older adults managing multiple conditions. We describe our multi-method research process for developing our tailored educational DVDs and provide preliminary findings regarding reactions to the DVDs.