• Marcia Vervloet, Liset van Dijk, RademakersJany J D J MJJDJMNivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Maastricht University, The Netherlands., Marcel L Bouvy, De SmetPeter A G MPAGMRadboud University Medical Center, Radboud Institute for Health Sciences, Departments of Clinical Pharmacy and IQ Healthcare, Nijmegen, The Netherlands., Daphne Philbert, and Ellen S Koster.
• Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. Electronic address: M.Vervloet@nivel.nl.
• Res Social Adm Pharm. 2018 Sep 1; 14 (9): 805-811.

BackgroundIn the context of medication use, pharmaceutical literacy skills are crucial for appropriate and safe use of medication. Recognition of patients with inadequate pharmaceutical literacy in daily pharmacy practice is difficult. No instrument is yet available to support pharmacists herein. The aim of this study was therefore to develop an interview guide for pharmacists to Recognize and Address Limited PHarmaceutical literacy (RALPH).MethodsThe RALPH interview guide was constructed in three phases: (1) development including a literature search, expert group discussion, and feasibility test with 15 patients; (2) pilot-test with 421 patients throughout 30 community pharmacies, and (3) final test with 508 patients to optimize the interview guide.ResultsThe development phase resulted in a first interview guide comprising 15 questions: seven in the functional domain (understanding instructions), four in the communicative domain (finding and understanding medication information) and four in the critical domain (critically analyzing medication information). This version was pilot-tested in 30 pharmacies, with 147 patients during medication reviews and another 274 patients were interviewed while waiting to collect their medication. This test phase led to removal of questions that proved difficult to interpret and to rephrasing some questions. The second version including 11 questions was tested by 109 pharmacists trainees with 508 patients, resulting in the final RALPH interview guide comprising 10 questions, all directly linked to the patient's own medication: three in the functional, three in the communicative and four in the critical domain. Besides instructions on how to use the interview guide, recommendations are provided for pharmacists on how to support patients with limited pharmaceutical literacy skills.ConclusionsThe practice-based RALPH interview guide supports pharmacists in recognizing patients with limited pharmaceutical literacy. With this insight, pharmacists can tailor their medication counseling to patients' pharmaceutical literacy level to better support patients in their medication use.Copyright © 2018. Published by Elsevier Inc.

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