COMMUNICATING INFORMATION ABOUT MEDICATION: THE BENEFITS OF MAKING IT PERSONAL

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1 Psychology and Health, 2003, Vol. 18, No. 1, pp COMMUNICATING INFORMATION ABOUT MEDICATION: THE BENEFITS OF MAKING IT PERSONAL DIANNE C. BERRY*, IRENE C. MICHAS and ELISABETTA BERSELLINI Department of Psychology, University of Reading, Earley Gate, Whiteknights, Reading, RG6 6AL, UK (Received 9 October 2001; In final form 23 April 2002) Two experiments, using a controlled empirical methodology, investigated the effects of presenting information about medicines using a more personalised style of expression. In both studies, members of the general public were given a hypothetical scenario about visiting the doctor, being diagnosed with a particular illness, and being prescribed a medication. They were also given a written explanation about the medicine and were asked to provide ratings on a number of measures, including satisfaction, perceived risk to health, and intention to comply. In Experiment 1 the explanation focused only on possible side effects of the medicine, whereas in Experiment 2 a fuller explanation was provided, which included information about the illness, prescribed drug, its dosage and contraindications as well as its side effects. In both studies, use of a more personalised style resulted in significantly higher ratings of satisfaction and significantly lower ratings of likelihood of side effects occurring and of perceived risk to health. In Experiment 2 it also led to significantly improved recall for the written information. Over the past 20 years, numerous studies have reported beneficial effects of providing patients with written information about their medicines, on both their knowledge about the medication and their compliance (e.g., Ley, 1988; Weinman, 1990; Gann, 1995; Newton et al., 1998). Ley (1988), for example, reviewed a large number of studies and found that in 97 percent of these, provision of written information resulted in an increase in patients knowledge and in 60 percent it resulted in increased compliance. Similarly, Weinman (1990) concluded that psychological studies provide clear evidence of the efficacy of written information for increasing patients knowledge of and adherence to treatment. Although there is a fair amount of agreement about the value of providing patients with written information about their medicines, there is much less agreement about what form that information should take. Weinman (1990), for example, pointed out that the beneficial effects of written information are not uniform and depend on the adequacy of the information and the extent to which it meets the needs of the patients. Similarly, Marteau (1995) has argued that the way in which information is presented to *Corresponding author. Tel.: þ Fax: þ D.C.Berry@Reading.ac.uk ISSN print: ISSN online ß 2003 Taylor & Francis Ltd DOI: /

2 128 D.C. BERRY et al. patients may well influence their decisions regarding the uptake of a recommended health behaviour. The question of whether to inform patients about possible side effects of prescribed medication has given rise to considerable debate in recent years. On the one hand, several surveys and studies have shown that people do want to be told about the possibility of any adverse effects they might suffer as a result of taking medicines (e.g., Berry et al., 1997; Mottram and Reed, 1997; Coulter et al., 1999; Stevenson et al., 1999). On the other side of the debate, however, many doctors are reluctant to inform patients about possible side effects, particularly those with a low probability of occurring (Lamb et al., 1994; Berry et al., 1997; Mottram and Reed, 1997). Studies by our research group (e.g., Berry et al., 1997, 1998, 2002) have shown that if people are given a written explanation about prescribed medication which conveys information about possible negative side effects (for example, that there is a risk of blurred vision) they then judge the explanation to be less satisfactory, they perceive risk to health to be higher, and say that they would be less likely to take the medication, than if the explanation did not include information about negative side effects. Given that in everyday life, people frequently do have to take medicines that are associated with adverse side effects, the present study examines whether information about side effects can be presented in such a way as to increase judgements of satisfaction and of likelihood of taking the medication. Specifically, two experiments investigate the effects of presenting information using a more personalised style of expression. In the broader context, it is recognised that the way in which the information is framed is only one of the many factors that can impact upon actual and intended compliance. A number of studies (e.g., Horne and Weinman, 2002) has shown that patients beliefs about the necessity of the medicine, as well as their concerns about taking it, will affect their reported adherence. These beliefs and concerns also interact with a variety of demographic and situational factors (see Horne, 1998, for a review). However, given that the way in which information is presented to patients is likely to be more easy to modify as a result of research findings than many of the wider demographic and situational factors, experiments focussing solely on the former can play a significant role in relation to informing practice. On the basis of both the health psychology and social psychology literatures, there are reasons to suspect that personalisation may be an effective manipulation in the present study. Within health psychology, several writers have proposed that personalising or individualising patient information should have beneficial effects on patient satisfaction (e.g., Sellu, 1987; Raynor, 1992; Newton et al., 1998). Newton et al. (1998), for example, suggested that reading ease can be supported by personalising the text by addressing the information to the reader (p. 170). To date, however, no studies have systematically evaluated the extent to which personalisation does have positive effects on patient satisfaction, nor on indices such as risk perception or intention to take the medication. Within the social psychology literature, there is evidence that information pertaining to self is processed in special ways. Rogers (1981), for example, argued that the self concept acts as a fixed reference point for the interpretation of information (p. 199). Numerous experimental studies have supported this position. Bargh (1982), for example, used a dichotic listening task in which subjects attended to, or ignored, relevant stimuli and found that self-relevant information required less attentional resources when presented to the attended channel, but more when presented to the rejected channel, compared with neutral words.

3 BENEFITS OF PERSONALISING INFORMATION 129 Similarly, several studies have shown that processing information in relation to self, results in improved memory performance (see Symons and Johnson, 1997, for a review). The present study addresses the question of whether personalising patient information leaflets has beneficial effects, using a controlled experimental methodology in which people were given a hypothetical scenario about visiting a doctor, being diagnosed as having a particular illness, and being prescribed a medication. They were also given an explanation about the medication and were then asked to rate the explanation on a number of measures, including satisfaction, perceived risk to health and intention to comply. In Experiment 1, the explanation focused only on the possible side effects of the medicine, whereas in Experiment 2 a fuller explanation was provided, which included information about the illness, the prescribed drug, its dosage and contraindications, as well as its side effects. EXPERIMENT 1 Participants were given a booklet which contained a hypothetical scenario about visiting the doctor and being prescribed a medication, together with an explanation which, as in Berry et al. (2002), focused solely on the possible side effects of the medicine. They were asked to read the scenario and the explanation and then to provide ratings on a number of measures. The explanation was presented in either a personalised or non-personalised style of expression. Method Participants The participants were 95 volunteers from the general population, aged between 18 and 60. There were 45 males and 50 females. They had a wide range of occupations (including, for example, shop assistants, manual workers, clerical and managerial staff, teachers and students, as well as some who were retired or unemployed), and educational backgrounds (35% had no post-16 qualifications, 40% had GCE A levels or equivalent and 25% had degrees or professional qualifications). They were recruited from various local clubs and organisations and in public places such as shopping precincts and libraries. The vast majority were residents of the Reading area. They were asked if they would be willing to take part in a study looking at people s views about information regarding medication side effects. Only two people declined to complete the questionnaire. Design The participants were allocated at random to one of two experimental conditions (personalised, non-personalised). Within each condition, two matched scenarios/ explanations were used, with half of the participants receiving each.

4 130 D.C. BERRY et al. Materials Participants received a four page booklet. The first page contained a scenario about visiting a doctor, being diagnosed as having a particular illness, and being prescribed a (hypothetical 1 ) medication, together with an explanation which focused on the side effects of the medication. Two different scenarios were used: both involving severe diseases. The particular diseases were selected from a larger set of 20, which had been rated for severity by 40 members of the general population (not included in the current sample). An example of one of the severe disease scenarios is shown in Appendix 1. Two different sets of severe side effects were used for the explanations. These were selected from a database of 75 side effects, which had been rated for severity, familiarity and personal importance by 40 members of the general population (not included in the current sample). The side effects were selected on the basis of their mean severity ratings, matching (as far as possible) for familiarity and personal importance. Attempts were also made to ensure that the selected side effects were ones which could have been associated with a medication given for the particular illness in question. The paragraph describing the side effects was written in either a non-personalised form (as in Berry et al., 2002) or in a personalised form, where the words you and your were used wherever appropriate. Examples of personalised and non-personalised versions of one set of side effects are shown in Appendix 1. The following pages contained a number of questions about the information in the explanation. These are described below. Procedure Participants were asked if they would be willing to take part in study looking at information about medication side effects. If they agreed, they were given a copy of the booklet and a pen, and were asked to read the first page carefully and then to work through the questions on the subsequent pages. They were told that if they did not want to continue with the study after reading the material, they could withdraw at any point, although none did so. The majority of participants completed the booklet within 5 to 10 min. Measures The following measures were taken. 1. How satisfied are you with the information that you have been given about the side effects of Epidoxin, measured on a 6-point scale, ranging from 1 (not at all satisfied) to 6 (very satisfied). 2. How likely do you think it is that you would experience one or more of these side effects if you took Epidoxin, measured on a 6-point scale, ranging from 1 (not at all likely) to 6 (very likely). 1 A fictitious drug name was used to avoid possible familiarity with existing medications.

5 BENEFITS OF PERSONALISING INFORMATION In general, what do you think is the risk to your health from taking Epidoxin, bearing in mind its side effects, measured on a 6-point scale, ranging from 1 (no risk) to 6 (very high risk). 4. If you had been diagnosed as having (e.g., pneumonia) and had been prescribed Epidoxin, how likely is it that you would take the medication, bearing in mind the drug s side effects, measured on a 6-point scale, ranging from 1 (definitely would not take) to 6 (definitely would take). On the final page, participants were asked their sex, age and highest educational qualification. Statistical methods Statistical analyses were carried out with the SPSS for Windows statistical software package. Analyses of variance (ANOVA) were used throughout. Results Preliminary analyses showed that the two groups did not differ significantly in terms of their sex, age, or level of education. Preliminary analyses also showed there was no overall effect of scenario, or side effect set, so results were averaged across the two scenarios and side effect sets used for each experimental condition. Satisfaction with the Information A one factor ANOVA showed that participants who received the personalised explanation gave significantly higher ratings of satisfaction (2.92, SD ¼ 1.19) than those who received a non-personalised explanation (2.16, SD ¼ 0.88), F(1,93) ¼ 12.43, p< Risk to Health Participants who received the personalised explanation believed that they were significantly less likely to experience the side effects (4.18, SD ¼ 0.94) than those who were given the non-personalised version (4.71, SD ¼ 0.89), F(1,93) ¼ 7.9, p<0.01. They also perceived the risk to their health to be lower (3.74, SD ¼ 0.96, for personalised, 4.20, SD ¼ 1.10 for non-personalised), F(1,93) ¼ 4.72, p<0.03. Intention to Comply The personalised explanation was associated with higher ratings of intention to comply (3.80, SD ¼ 1.21) than the non-personalised version (3.38, SD ¼ 1.37). The difference was not statistically significant, however, F(1,93) ¼ 2.54, p ¼ 0.1. DISCUSSION The findings of this experiment were very clear cut. Participants who received the personalised version of the explanation about the drug s side effects gave significantly

6 132 D.C. BERRY et al. higher ratings of satisfaction with the explanation, and significantly lower ratings of likelihood of experiencing the side effects and perceived risk than participants who received the non-personalised version. Thus, a minor change in wording in four sentences (of a five-sentence explanation) was sufficient to lead to significant differences on three of the four measures. Although the personalised explanation was associated with numerically higher ratings of intention to comply, the difference between groups was not statistically reliable. Given the potential importance of these findings, it would be sensible to attempt to replicate them using a different explanation. In the present experiment, the explanation basically consisted of a description of the drug s side effects. It would be interesting to see whether benefits of presenting information in a more personalised form extend to other aspects of an explanation about medication, such as information about the drug and dosage instructions. Experiment 2 therefore investigates this. EXPERIMENT 2 Experiment 1 showed significant benefits of presenting an explanation, consisting of a short description of a drug s side effects, in a more personalised form (using words such as you and your where appropriate). Experiment 2 examines whether similar benefits occur when the explanation is fuller and consists of information about the illness for which the medication has been prescribed, the drug, dosage instructions, side effects, and contraindications (Berry et al., 1998). Given that it is important for people to be able to remember information about their medicines, even when this information has been provided in written form (e.g., Ley, 1988; Berry et al., 1998), the experiment also examines whether presenting the explanatory text in a more personalised style aids people s subsequent recall for the information. As reported above, several studies in the social psychology literature have found that processing information in relation to self results in improved memory performance (Symons and Johnson, 1997). Method Participants The participants were 100 volunteers from the general population, aged between 18 and 60. There were 39 males and 61 females. They had a wide range of occupations and educational backgrounds, and were drawn from the same sample as in Experiment 1. None, however, had participated in Experiment 1. Participants were recruited in the same manner as in Experiment 1; three declined to take part in Experiment 2. Design Participants were allocated at random to one of two experimental conditions; personalised, non-personalised information.

7 BENEFITS OF PERSONALISING INFORMATION 133 Materials Participants were given a five-page booklet, based on that used by Berry et al., (1998). The first page contained some general information about the study, followed by a scenario about visiting a doctor and being prescribed some medication (shown in Appendix 2). The second page contained an explanation about the prescribed medication which was said to be provided by the doctor 2. The information fell into five categories; details of the condition, the prescribed drug, dosage instructions, possible side effects and contraindications. Two different versions of the explanation were used. The non-personalised version was very similar to that used by Berry et al. (1998). The wording of the personalised version was kept as similar as possible, but words such as you and your were used wherever appropriate. Both versions of the explanation are shown in Appendix 2. The remainder of the questionnaire was the same as that used in Experiment 1, including the same four measures and the questions requesting the demographic information. Two short consumer behaviour questionnaires were used as distractor tasks before the unexpected memory test. The data was collected for another study and is not considered further here. Procedure Participants were tested individually or in small groups. In the latter case, they were seated such that they could not see the booklets of their neighbours. Participants were given a copy of the booklet and asked to read the scenario and the explanation. They were then asked to answer the questions in the remainder of the booklet. This took between 5 and 10 min. The questionnaires were collected and participants were given the two distractor questionnaires to complete. They were stopped after 15 min, and given a blank sheet of paper. They were asked to recall everything they could about the explanation which they had read and answered questions about in the first part of the experiment. There was no time limit for this, but all participants had stopped writing within 10 min. At the start of the experiment, they were reminded that participation was voluntary and that they could withdraw at any time, although none did so. Results Preliminary analyses showed that the two groups did not differ in terms of sex, age, or level of education. Satisfaction with the Information The personalised explanation resulted in higher ratings of satisfaction (4.38, SD ¼ 0.93) than the non-personalised version (3.97, SD ¼ 0.87 ), F(1,98) ¼ 4.02, p< The scenario and explanation were based on a genuine illness and medication, provided by Dr. Betrand Sene of Eclimed, Paris. The name of the medication (Solupred) is used in France but is not a brand name in the UK.

8 134 D.C. BERRY et al. Risk to Health Participants who received the personalised explanation believed that they were significantly less likely to experience the side effects (3.30, SD ¼ 0.79) than those who were given the non-personalised version (3.85, SD ¼ 0.74), F(1,98) ¼ 4.23, p < They also perceived the risk to their health to be lower (3.50, SD ¼ 0.81, for personalised, 3.93, SD ¼ 0.92, for non-personalised), F(1,98) ¼ 4.52, p<0.05. Intention to Comply The personalised explanation was associated with higher ratings of intention to comply (4.43, SD ¼ 1.18), than the non-personalised version (4.00, SD ¼ 1.10). The difference was not statistically significant, however, F(1,98) ¼ 2.84, p > Memory Performance The free recall data was scored by an independent marker, who was blind to the nature of the experimental manipulation. The text was scored out of a possible maximum of 50 marks, 10 for each of the five categories of information (condition, drug, dosage, side effects, contraindications). Each category was divided into five units, with two marks being given for each unit which was recalled completely correctly and one mark given for each unit recalled partially correctly. Table I shows the recall scores for the five different categories of information for the two groups of participants. It can be seen that in each case recall performance was better for participants who received the personalised explanation. A two-factor mixed ANOVA showed a significant effect of personalisation, F(1, 98) ¼ 11.38, p < 0.001, and a significant effect of information category, F(4, 95) ¼ 44.86, p< The interaction did not reach significance, F(4, 95) ¼ 1.97, p > 0.1, showing that the benefit of personalisation held across all information categories. Posthoc Newman Keuls tests showed that, across the two conditions, information about drug dosage, side effects, and contraindications was recalled significantly better than information about the illness and class of drug. Discussion The main findings from the previous experiment have been replicated, namely that presenting the explanation in a more personalised form resulted in significantly TABLE I Mean recall scores for the five different categories of information for the two groups of participants (standard deviations shown in brackets) Information category Personalised Non-personalised Condition 3.10 (1.38) 0.96 (0.82) Drug 3.10 (1.26) 2.10 (0.78) Dosage 6.06 (1.48) 4.90 (1.28) Side effects 5.90 (1.11) 4.80 (1.34) Contraindications 4.86 (1.34) 4.60 (1.20) Total 23.0 (4.38) (2.92)

9 BENEFITS OF PERSONALISING INFORMATION 135 higher ratings of satisfaction with the information, and significantly lower ratings of likelihood of experiencing the side effects and perceived risk to health. Again, there was no significant effect on intention to comply. Interestingly, the benefits of presenting information in a more personalised style was also associated with significantly higher levels of recall for the information. The fact that there was no significant interaction between style of presentation and type of information showed that the benefit of personalisation held across all information categories. GENERAL DISCUSSION In two experiments, use of a more personalised style of presentation resulted in significantly increased satisfaction with a written explanation and significantly reduced perception of risk to health from taking the medication. In Experiment 2, it also led to significantly improved recall for the written information. Although there was no significant effect on intention to comply in either experiment, there were clear and consistent differences in mean ratings between the people who received the personalised and nonpersonalised explanations respectively. The enhanced memory effects are in line with studies in the social psychology literature which have shown that cognitive processing of information relevant to self is more efficient than processing of other types of information. Higgins and Bargh (1987), for example, argued that personal information is most likely to capture attention, be retained in memory, and recalled easily. Similarly, after reviewing a number of studies, Baumeister (1998) concluded that, information bearing on self is processed more thoroughly and deeply and hence is remembered better than other information (p. 684). Other researchers (e.g., Klein and Loftus, 1988; Symons and Johnson, 1997) have suggested that these beneficial effects occur because personal information encourages more elaborative processing and is easier to process categorically. Interestingly, the Symons and Johnson (1997) meta-analysis revealed that the beneficial memory effects were less likely to occur when tasks involved imagery instructions. Participants in Experiment 2 in the present study were required to imagine that they had a particular illness and were visiting a doctor. We nevertheless found clear and significant memory benefits for the personalised information. The Symons and Johnson review also noted, however, that most facilitation occurs in studies where the personalised information to be remembered is judged to be important to participants. In our study, information relating to drug dosage, side effects and contraindications was remembered better than other types of information. Our earlier study using a similar explanation (Berry et al., 1998) found that these three classes of information were judged as being more important by participants than information about the illness or class of medication. The beneficial effects associated with the personalised version of the explanation have important implications for the design of Patient Information Leaflets. The fact that the personalised explanation resulted in significantly higher ratings of satisfaction could be accounted for by Newton et al. s (1998) suggestion that personalisation has beneficial effects because it supports reading ease. However, it is not clear why an improvement in reading ease would result in significantly lower ratings of likelihood of experiencing

10 136 D.C. BERRY et al. the side effects and perceived risk to health. An alternative explanation is that use of a more personalised style of communication increases people s unrealistic optimism (e.g., Weinstein, 1989), whereby they believe that they are less at risk than other medicine takers. Although personalisation did not result in significant differences in relation to our measure of intention to comply, there were fairly clear and consistent effects in the two experiments. Our previous studies have shown that lower ratings of likelihood of experiencing side effects and perceived risk are associated with significantly increased ratings of intention to comply. It is possible that clearer (and significant) effects might have been obtained if we had used individualisation rather than personalisation. Individualising explanations so that they actually referred to the participant in question (e.g., using their name) may well have produced stronger effects on our measures. Other researchers (e.g., Raynor, 1992) have argued that individualised explanations are likely to result in improvements in both patient satisfaction and compliance, although this has not been empirically tested, nor have any direct comparisons been made with personalisation (as opposed to individualisation). Given that, from a practical standpoint, individualisation is more difficult to achieve than simply using words such as you and yours in standard generic explanations, however, it would clearly be worth doing the latter until any additional benefits from individualisation have been empirically evaluated. More generally, research on medication compliance has shown that there are likely to be numerous factors that will influence intended and actual compliance, many involving an interaction between personal and situational variables (e.g., Horne, 1998). Recent work (e.g., Horne and Weinman, 2002), in particular, has emphasised the importance of people s beliefs in the necessity of taking a medicine, as well as their concerns about any negative effects (including likely dependence on the medicine and adverse side effects). In Experiment 2 of the present study, some participants may have associated corticosteroids with negative health effects and this may have reduced their ratings of likelihood of taking the medicine. Finally, it is worth noting that one limitation of the present study is that it was an analogue study involving healthy volunteers rather than actual patients. The advantage of using a non-clinical sample is that it enabled us to test a relatively large number of people under controlled experimental conditions, which was particularly important for the unexpected recall test in Experiment 2. In order to increase the validity of our findings, we tested a wide sample of the general population from a range of backgrounds and ages. Although we used hypothetical scenarios, we selected situations that would readily apply to participants, and that they or close friends or relatives may well have experienced. Despite these precautions, it may be that different results would have been obtained with real patients suffering from real illnesses. However, recent studies by our research group, using very similar scenarios, have found a close correspondence between findings from studies using a hypothetical scenario and members of the general population and those using real patients taking actual medicines (e.g., Knapp et al., 2001; Berry et al., 2002). The positive findings from the present study suggest that it would also be worth extending this work to assess the effectiveness of personalising written explanations in a clinical sample.

11 BENEFITS OF PERSONALISING INFORMATION 137 Acknowledgements We are very grateful to the Medical Research Council for funding this research through a project grant awarded to the first two authors. We are also grateful to Kylie Milne Holme and Kate Pattenden for testing some of the participants in Experiment 2. References Bargh, J. (1982). Attention and automaticity in the processing of self-relevant information. Journal of Personality and Social Psychology, 43, Baumeister. (1998). The self. In: Gilbert, D., Fiske, S.T. and Lindzey, G. (Eds), Handbook of Social Psychology, 4th Edn., pp McGraw Hill, New York. Berry, D.C., Michas, I.C. and Bersellini, E. (2002). Communicating information about medication side effects: effects on satisfaction, perceived risk to health and intention to comply. Psychology and Health, 17, Berry, D.C., Michas, I.C. and DeRosis, F. (1998). Evaluating explanations about drug prescriptions: effects of varying the nature of information about side effects and its relative position in explanations. Psychology and Health, 13, Berry, D.C., Michas, I.C., Gillie, T. and Forster, M. (1997). What do patients want to know about their medicines and what do doctors want to tell them? A comparative study. Psychology and Health, 12, Berry, D.C., Raynor, D.K. and Knapp, P. (2002). Provision of information about side effects to patients. The Lancet, 359, Coulter, A., Entwistle, V. and Gilbert, D. (1999). Sharing decisions with patients: is the information good enough? British Medical Journal, 318, Gann, R. (1995). Consumer health information: information for the public, patients and carers. In: Carmel, M. (Ed.), Health Care Librarianship and Information Work, pp Library Association Publishing, London. Higgins, E.T. and Bargh, J.A. (1987). Social cognition and social perception. Annual Review of Psychology, 38, Horne, R. (1998). Adherence to medication: a review of existing research. In: Myers, L.B. and Midence, K. (Eds), Adherence to treatment in medical conditions, pp Harwood Academic Publishers, Amsterdam. Horne, R. and Weinman, J. (2002). Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychology and Health, 17, Klein, S.B. and Loftus, J. (1988). The nature of self-referent encoding: the contribution of elaborative and organisational processes. Journal of Personality and Social Psychology, 55, Knapp, P., Berry, D.C. and Raynor, D.K. (2001). Testing two methods of presenting side effect information about common medicines. International Journal of Pharmacy Practice, 9, R6. Lamb, G., Green, S.S. and Heron, J. (1994). Can physicians warn patients of potential side effects without fear of causing those side effects? Archives of Internal Medicine, 154, Ley, P. (1988). Communicating With Patients: Improving Communication, Satisfaction and Compliance. Croom Helm, London. Marteau, T.M. (1995). Health beliefs and attributions. In: Broome, A. and Llewellyn, S. (Eds), Health Psychology: Processes and applications, 2nd Edn., pp Chapman and Hall, London. Mottram, D.R. and Reed, C. (1997). Comparative evaluation of patient information leaflets by pharmacists, doctors and the general public. Journal of Clinical Pharmacy and Therapeutics, 22, Newton, L., Newton, D., Clark, J., Kenny, T., Moseley, D., Purves, I. and Wilson, R. (1998). Patient information leaflets: producing understandable PILS. Journal of Information Science, 24, Raynor, D.K. (1992). Patient compliance: the pharmacist s role. International Journal of Pharmacy Practice, 1, Rogers, T.B. (1981). A model of the self as an aspect of the human information processing system. In: Cantor, N. and Kihlstrom, J.F. (Eds), Personality, cognition and social interaction, pp Erlbaum, Hillsdale, N.J. Sellu, D.P. (1987). Computer generated information leaflets for surgical patients. British Journal of Clinical Practice, 41, Stevenson, F.A., Wallace, G., Rivers, P. and Gerrett, D. (1999). It s the best of two evils: a study of patients perceived information needs about oral steroids for asthma. Health Expectations, 2,

12 138 D.C. BERRY et al. Symons, C.S. and Johnson, B.T. (1997). The self-reference effect in memory: a meta-analysis. Psychological Bulletin, 121, Weinman, J. (1990). Providing written information for patients: psychological consequences. Journal of the Royal Society of Medicine, 83, Weinstein, N.D. (1989). Optimistic biases about personal risks. Science, 246, APPENDIX 1 Example of a Scenario used in Experiment 1 You have gone to your doctor with a very bad cough and a high temperature. The cough is accompanied by a severe pain in your chest. You are sent to the hospital for some tests. The doctor then makes a firm diagnosis of pneumonia and prescribes a medication called Epidoxin. The medication comes with an information leaflet, which includes the following paragraph about the drug s side effects. Example of One of the Personalised Explanations Used in Experiment 1 Epidoxin is associated with some side effects. If you take this medicine, there is a substantial chance of you getting one or more of its side effects. You may get convulsions and chest pain. There is also a risk of you getting loss of co-ordination and blurred vision. You may also experience stomach pains and anaemia. Example of one of the Non-personalised Explanations Used in Experiment 1 Epidoxin is associated with some side effects. A substantial proportion of people who take this medication get one or more of its side effects. Epidoxin can cause convulsions and chest pain. There is also a risk of loss of co-ordination and blurred vision. It can also cause stomach pains and anaemia. APPENDIX 2 Scenario Used for Experiment 2 You have gone to the doctor with a severe sore throat, progressive tenderness in the neck and a low grade temperature. Your doctor makes a firm diagnosis and prescribes some medication. You are given the following explanation. Personalised Explanation Your symptoms suggest that you are suffering from subacute thyroiditis. This is an acute inflammatory disease of your thyroid gland. This is a common condition and has probably resulted from your having contracted a viral infection. To solve the problem, there is one drug that I would like you to take. The drug you have been prescribed is marketed under the name Solupred. It is a corticosteroid, which should reduce your inflammation. In the majority of cases it will effectively treat people suffering from your condition and your symptoms should disappear after two or three days.

13 BENEFITS OF PERSONALISING INFORMATION 139 You should take two tablets, twice a day, for four weeks. You should eat before taking the tablets and wait at least eight hours between doses. You may experience some side effects while taking this drug. There is a small risk of you developing hypertension or diabetes. You may also suffer dizzy spells, a mild rash or increased appetite. This treatment may interact with other drugs you are taking. You should consult your doctor before taking non-prescription drugs such as aspirin. You must not take the drug if you are pregnant or it you are suffering from an infectious disease. Drinking alcohol while you are taking this medication is not recommended and you should avoid any strenuous exercise. Non-personalised Explanation The symptoms described suggest a diagnosis of subacute thyroiditis. This is an acute inflammatory disease of the thyroid gland. This is a common condition and probably results from contraction of a viral infection. To solve the problem, there is one drug that should be taken. The drug which has been prescribed is marketed under the name of Solupred. It is a corticosteroid, which should reduce any inflammation. In the majority of cases it will effectively treat this condition and the symptoms will disappear after two or three days. Two tablets should be taken, twice a day, for four weeks. The tablets should be taken after food and there should be a delay of at least eight hours between doses. The drug is associated with some side effects including hypertension and diabetes. Other side effects may include dizzy spells, a mild rash or increased appetite. This treatment may interact with other drugs being taken. A doctor should be consulted before taking non-prescription drugs such as aspirin. The drug is not suitable for use during pregnancy or by people suffering from infectious diseases. Consumption of alcohol when taking this medication is not recommended and any strenuous exercise should be avoided.