Whether dealing with Patient Information Leaflets in the UK or EU, medication guides in the USA, IFUs for medical devices, or health information in other regions, the same design problems repeatedly arise. These issues involve not only the content, i.e. words and phrases, but also how the information is structured and presented. This article explores some of these issues.

One problem that is common is having dense text blocks without breaks. These are long paragraphs that overwhelm readers and put them off from continuing. Imagine an emergency where someone feels unwell or is anxious and needs quick and clear guidance. Wading through long blocks of text can cause frustration. This causes the reader to overlook important safety information. This is especially so particularly the information is presented in rigid, newspaper-style columns with no ‘ragged’ justification.

To improve readability, text should be broken into shorter paragraphs for easier digestion. Bullet points help organise key information. This can aid quick scanning, as can clear, descriptive headings. For example, in the European QRD template, grouping content under headings like “What the medicine is for,” “How to Take,” and “Possible side effects” helps patients find necessary information. This minimises any possibility of users of the information feeling overwhelmed.

Poor hierarchy and structure also affect usability. Information that is not organised logically makes it hard to find crucial details like dosage instructions or safety warnings. Burying drug interaction warnings within dense paragraphs about general side effects can lead to dangerous oversights. For starters, information about contraindications in a section for side effects is in the wrong place. Information should be organised into clearly labelled sections with consistent formatting.

Using a structured approach also enhances usability. This includes presenting key safety information first and grouping related topics together, enhances usability. Headings and subheadings should have a different appearance to the rest of the text, such as using larger fonts or bold text. Numbered sections for step-by-step instructions contribute to a logical flow. This allows patients to follow guidelines more accurately. Although guidance around written patient information in Europe and medication guides in the USA already covers this, other regions still lack standardisation and is more of a free-for-all.

Another prevalent issue is the use of small, hard-to-read fonts, which pose a significant barrier to older adults or those with sight loss. This can be the single most important obstacle for people with sight loss to access critical information, such as dosage instructions or safety precautions. This issue particularly affects patients with chronic conditions who need to take multiple medications and rely on clear guidance to avoid harmful interactions. To improve legibility, leaflets should use larger fonts, with a minimum size of 12 points, ensuring the text is readable for most people, including those with mild visual impairments. This would benefit not only older adults, but also younger people increasingly affected by myopia due to screen use.

There is ongoing debate about whether serif or sans-serif fonts are better for readability. Sans-serif fonts are generally considered better for on-screen reading, while serif fonts are recommended for printed materials. High contrast between the text and background, such as black text on a white background, enhances readability. It is also beneficial to avoid using all capital letters for long sections of text, as this can hinder the natural flow of reading. Then, there is the issue of the lightweight paper commonly used for patient information, which is almost transparent, Bible paper, further diminishes readability, leading many to give up on reading altogether.

The absence of visual aids or illustrations significantly limits patients' understanding of complex instructions, such as how to use an inhaler or measure liquid medication accurately. Written descriptions alone can be confusing, not just for patients with limited health literacy or those who speak a different primary language, but for everyone. Visual aids like step-by-step diagrams, icons, and illustrations can bridge this communication gap by showing exactly how to perform tasks. For example, a diagram showing the correct way to use an inhaler, with arrows indicating airflow, can be far more effective than text alone. Universally recognisable icons, such as a clock to indicate dosage schedules, also improve comprehension. However, it is crucial to ensure that illustrations are culturally sensitive and relevant to the target audience to avoid misunderstandings or feelings of alienation.

Confusing dosage instructions and ambiguous warnings are also prevalent in many medication leaflets. Inconsistent terminology, vague warnings, and multiple dosing schedules without clear explanations can easily confuse patients. For example, the instruction “Take three times daily” is ambiguous without specifying the intervals, leading to improper dosing. This confusion is compounded when different schedules are given for various age groups or conditions without clear separation. To eliminate ambiguity, dosage instructions should be as specific as possible, including precise timing, units of measurement, and any necessary conditions, such as “Take one tablet every 12 hours with food.” Using tables or charts to differentiate dosing schedules for different groups, such as adults and children, also helps reduce confusion. On that note, we have encountered leaflets with ‘take thrice daily’, where the writer is apparently commuting in from the 17th century.

Cultural insensitivity can significantly impact the effectiveness of medication leaflets. Culturally irrelevant examples, jargon, or pictograms that do not resonate with the target audience can alienate patients from diverse backgrounds. This leads to misunderstandings or non-adherence to medication instructions.

Finally, many medication leaflets fail to provide clear calls to action, especially in emergencies, such as overdose or severe allergic reactions. Critical actions, like contacting emergency services or stopping the medication immediately, should be prominently highlighted. Bold text or warning symbols help draw attention to urgent instructions. Clear headings like “Emergency Action” or “When to Seek Help” guide patients to vital information quickly. Additionally, including contact information for healthcare providers or health authorities provides patients with immediate resources for assistance. Calls to action should be concise, direct, and prominently displayed to enhance patient safety and health outcomes.

These common issues highlight the need for improved design, clearer language, and culturally sensitive communication in written health information, such as Patient Information Leaflets, Medication Guides, and Instructions for Use. Addressing these challenges can greatly enhance patient understanding, safety, and adherence to prescribed treatments.

Thank you for reading.

Mark Gibson

Leeds, United Kingdom, February 2025