การพัฒนาและประเมินผลของฉลากช่วยรูปภาพ "คำแนะนำการใช้ยา" สำหรับผู้ป่วยชาวไทยมุสลิมที่ไม่รู้หนังสือ

Abstract

This research aimed to develop and evaluate the communicability of pictorial auxiliary labels for instruction for drug use in illiterate Thai Muslim patients. The study was divided into three sub-studies. The first study was a survey of drug use instruction on auxiliary labels used in Yala Hospital from 52,929 prescriptions in the last 1 year with 260,297 drug items. It was found that 99,085 items (38.07%) requiring auxiliary labels. Ten most commonly used auxiliary labels covered 87.88% of the drugs needing auxiliary labels. However, pictograms of 4 of the top 10 labels had already been developed by Bowonrat. Angsuwattanakul (2013). Among 6 remaining labels, the researcher combined the instruction "Do not chew or grind medicine" and "Do not chew / grind the medicine / split the medication into the same pictogram. Therefore there are 5 pictograms to be developed including "Expire in 1 month after opening", "Do not take this drug more than 8 tablets per day", "Do not chew / crush medicine / split the medication", "Dissolve with water before taking" and "shake the bottle before taking". The second study was focus group discussion among Thai Muslims patients who were illiterate, one group at a time with 6 patient per group. The initial pictograms developed by the researcher were revised once for "medicine "Expire in 1 month after opening", twice for "Do not take this drug more than 8 tablets per day", three times for "Do not chew / crush medicine / split the medication", twice for "Dissolve or mix with water before taking" and twice for "shake the bottle before taking". The third study was a test of communicability of a total of 9 pictograms consisting of 5 pictograms developed in the study and 4 pictograms of Bowonrat Angsuwattanakul (2013). There were 5 rounds of test. The first test was terminated after testing in 30 illiterate Muslim patients because 4 pictograms were failed on the test with less than 40 percent of subjects with correct understanding. For the pictograms "Do not take this drug more than 8 tablets per day", no subjects could understand the meaning at all. Therefore it was not further developed because the results of the study showed the obstacles in communicating the meaning of the pictogram. The researcher reviewed the pictograms on "Do not chew / crush medicine / split the medication", "Expire in 1 month after opening", and "taking this drug as indicated every day until the drug is exhausted". After further test of the pictograms in 30, 10 and 10 patients, respectively, the pictograms were reviewed for 2, 3 and 3 times, respectively. The test of all 8 pictograms in 109 subjects (61-74 subjects per label) found that 85.10-100.00% of the subjects correctly understood the pictograms. All labels pass the ANSI criteria stipulating that the symbol must convey the correct meaning to at least 85 percent of the subjects. Three labels with the least proportion of subjects with correct answers were "taking this drug as indicated every day until the drug is exhausted" (89.20%), "taking this drug may cause drowsiness" (87.00%) and "Expire in 1 month after opening" (85.10%).