he simple fact is that Consumer Medicine Information (CMI) in Australia has been ready for a makeover since the 1990s, even before we published the first edition of Writing About Medicines for People in 1994.1Sless, David, and Rob Wiseman. Writing About Medicines for People: Usability Guidelines and Glossary for Consumer Product Information. Canberra: Department of Health and Human Services, 1994 Back then, we had to use the constraining printing technology (such as dot matrix and proportional spacing printers) for the design template controlling the appearance of CMI, because many pharmacies did not then have laser printers to print them out for handing to consumers. (For those of you interested in such matters as fonts and layout, you can download the cmi style we created in 1994 alongside the Guidelines for writing and testing CMI.)
Nothing has changed. CMI are still ugly, awkward to read, and disrespectful of readers. Despite numerous new and better CMI designs created since 1994, every attempt to persuade those in control of the software and hardware that determine the appearance of CMI at the point of distribution has failed. I have commented on this at length already2Consumer Medicine Information and the pharmacists and will not do so again. Suffice to say that the finger points clearly towards pharmacists and the Pharmacy Guild.
Why is a makeover being considered now?
This question is easy to answer. In Australia we are heading for a general election, probably in May, and Ministers in the current government are desperate to show that they are doing something to help the rest of us. Late last year, I and a number of other CMI researchers and consumer advocates were asked by a diligent investigative reporter, Dana McCauley, about the current state of CMI. After talking to us she must have asked the Minister to explain why CMI are so inaccessible to consumers3Greg Hunt warns pharmacists and doctors on medicine information—with the result that I and 27 other ‘CMI stakeholders’ have been invited by the Australian Government Department of Health to a workshop in Canberra on February 1:
The workshop is the first step to collaboratively endorsing a revised CMI template that will make it easier for patients to read and understand the important information that is provided in these documents.
The Department is in a hurry!
Will it succeed this time?
I am not optimistic. I have wasted many days already at such meetings, some ending in promise, most in simple refusal to change. But before we all rush to embrace change, we need to proceed with caution. Unusable medicine information can lead to harm and death. A new template for CMI must, like the medicines it explains, reach the highest standards before it is released to the public.
In 1994 CRI set the usability standards for CMI which are still in use today:
If you develop or revise a CMI using these Guidelines:
1. at least 90% of literate consumers should be able to find information on the CMI quickly and easily
2. at least 90% of those who find the information should be able to act appropriately on the information
3. thus at least 81% of literate consumers should be able to use the CMI appropriately.
…The testing methods included in these Guidelines will help you find out whether at least 81% of literate consumers can use the CMI according to pre-determined requirements, and if not, what changes you need to make to the CMI to ensure that they can.4 Sless, David, and Ruth Shrensky. Writing About Medicines for People. 3rd edition. Sydney Australian Self Medication Industry, 2006, page 7.
Most CMI are written and tested using the Guidelines, so they should be usable at least at a basic level. Yet as part of the general misleading rhetoric about CMI, it has been claimed that they are hard to use; indeed, this is the implied reason for the current change. Certainly, after being in use unchanged for 25 years some deterioration in performance is to be expected, but apart from opinions, no published evidence has been offered to substantiate this case or the reasons for it, and our research for private clients does not support this claim either.
The reason why CMI has always needed better design is not because they are unusable, but (constricted as they are by the original printing problems) they do not reach the other standards expected in information documents. The current standards for CMI only cover two aspects of acceptable public document performance: at least 90% finding what they are looking for, and at least 90% using what they find. There are seven other standards for good public document design to achieve if they are to meet public expectations for use.5Standards 1 Standards 2 Without these, many CMI, though just about usable, as we currently suspect, never get read.
Watch this space…