While doctors and pharmacists always think that the directions they provide with prescription medications are as clear as daylight to patients, this isn’t always the case, and in fact, are frequently confusing to those having to follow them, reports CNN.
Does that mean two pills in one sitting? Can you take once at breakfast and once at lunch? Should they be taken with food at all? Can you take them at the same time as your other medications?
Recent research found that the instructions may seem clear, but they can often lead people to different interpretations, with misunderstandings and mistakes being widespread.
Nearly one-third of middle-aged Americans struggle with personal health tasks, including recalling information from a doctor’s visit, reading standard health materials and properly dosing out medication, according to the research published in the Journal of Internal Medicine.
Many of the participants in the study were not new to the healthcare system – some were managing multiple chronic conditions.
“Our study was able to really provide some validation to people,” said study co-author Abigail Vogeley, a research fellow and doctoral student at Northwestern University’s Feinberg School of Medicine in Chicago.
“They’re not alone in being confused by the healthcare system and by medications. It’s something that we, as the healthcare system, need to improve, and help people with, rather than just saying, ‘OK, good luck’.”
Nuanced language and short visits
The study asked 942 primary care patients with an average age of 52 to complete a series of tasks to test health literacy – meaning their ability to accurately interpret, understand and use the information given to them.
Those tasks included replicating a doctor visit – in which the patients were given a new diagnosis – and seeing what information they could remember and report back, as well as giving them a fake prescription bottle and seeing what information they could get from reading the label and dosage instructions.
Just 10 minutes later, it was difficult for people to remember all the specifics of the diagnosis they were given, Vogeley said. Also, problems with the prescriptions often came from nuanced language and the variation in labelling practices, she said.
“Some of the warnings are written differently or in different places that patients don’t think to look,” she said. “It’s a uniformity problem.”
People wanted to get their prescription information right and do the best they could for their health, but fostering health literacy can be difficult when doctors’ visits are short and the information may not be written in a straightforward way, said senior study author Dr Michael Wolf, Professor of Medicine and Director of Northwestern’s Centre for Applied Health Research on Ageing.
Misunderstandings become mistakes
“Medication generally works best when taken as instructed. When you take a medicine, if you take it with food, how often and even what it is for, can get lost in communication, particularly when patients don’t feel comfortable asking their healthcare providers questions,” said Dr Jan Carney, president of the American College of Physicians and Professor of medicine at The Robert Larner College of Medicine at the University of Vermont.
Misunderstandings in dosage instructions can lead to a patient taking too little or too much of a medication, taking it with another drug with which t it shouldn’t be combined, or taking it in a way that might make the patient more prone to side effects, Vogeley said.
Someone may not know to take a diuretic in the morning, for example, so they take it with dinner and end up waking up in the night to use the bathroom, said Stefanie Ferreri, Professor of Pharmacy Practice at the University of North Carolina at Chapel Hill Eshelman School of Pharmacy.
The study also found that a lack of clarity can lead to people overcomplicating their medication dosing, such as waking themselves up in the middle of the night for a third dose unnecessarily or trying to space out their medications so much that much of their day is spent stopping to take a pill.
“How do you sustain that behaviour if you’re literally having to take medications up to seven times a day, which, quite honestly, is what we see people doing,” Wolf said.
Although the study measured people’s ability to manage medications and healthcare, the results of the study are not an indictment on the individual, but rather a call to action for the health system to improve communication and collaboration with patients, Wolf said. While waiting for the medical field to make changes toward better communication, there are things patients can do to improve their health literacy.
“Do you have any questions?” That query probably ends most of doctors’ visits and prescription pick-ups, and for many people the answer is usually “no”. They should start saying yes, Ferreri said.
Even if patients don’t know specifically what information they might be missing, it is helpful to ask the doctor and pharmacist open-ended questions such as, “What do I need to know about this medication?” she added.
In fact, she suggested, they should ask both their healthcare provider and their pharmacist the first few times they pick up their medication to make sure they are getting all the information needed.
Ferreri also recommended that patients keep a list so they can reference them when being prescribed anything new, or, if it is allowed, to record the last few minutes of an appointment to keep track of the instructions and information so the detail aren’t forgotten later.
Study details
Prevalence of Limited Health Literacy During Middle Adulthood and Its Associations with Health Self-Management and Physical Function
Abigail Vogeley, Andrea Russell, Fangyu Yeh et al.
Published in Journal of General Internal Medicine on 10 June 2026
Abstract
Background
Although the relationship between health literacy and health self-management has been studied in older adults, it is understudied in middle-aged, primary care patients.
Objective
To determine the prevalence of limited health literacy and health self-management among middle-aged adults and associations with self-reported physical function.
Design
Cross-sectional analyses from interviews assessing health literacy, self-management capacity, and physical function.
Patients
A total of 942 middle-aged, primary care patients in Chicago, IL participating in a longitudinal cognitive aging cohort study (‘MidCog’).
Main Measures
We assessed health literacy using the Newest Vital Sign, health self-management skills using the Comprehensive Health Activities Scale Short Form, and self-reported physical function using the Patient Reported Outcomes Measurement Information System Physical Function Scale.
Key Results
About one in eight adults (13.2%) presented with low health literacy and 19.3% had marginal abilities. Low health literacy was associated with less education, lower income, unemployment, and identifying as non-Hispanic black or Hispanic/Latino. Those with low health literacy had more chronic conditions, more prescription medications, and worse performance on a cognitive screener. In multivariable models controlling for age, race, sex, education, income, and number of chronic conditions, compared to those with adequate health literacy, performance on health management tasks was worse among individuals with low (β = -15.5; 95% CI: -19.7 to -11.2; p < 0.001) and marginal health literacy (β = -8.4; 95% CI: -11.6 to -5.0; p < 0.001). Although initially significant, after adjusting for covariates, the relationship between health literacy and physical function was no longer significant for either low (β = -0.3; 95% CI: -2.2 to 1.6; p = 0.75) or marginal groups (β = -1.1; 95% CI: -2.6 to 0.3; p = 0.13).
Conclusions
Our results suggest a significant proportion of this middle-aged primary care sample, some already managing multiple chronic conditions, demonstrated limited health literacy and health self-management, potentially leading to greater risk of poorer physical health in later life.
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