RESEARCH Addressing low health literacy with “Talking Pill Bottles”: A pilot study in a community pharmacy setting Annie Y. Lam * , Juliet K. Nguyen, Jason J. Parks, Donald E. Morisky, Donna L. Berry, Seth E. Wolpin article info Article history: Received 17 April 2016 Accepted 5 July 2016 abstract Objectives: To test the effect of “Talking Pill Bottles” on medication self-efficacy, knowledge, adherence, and blood pressure readings among hypertensive patients with low health literacy and to assess patients' acceptance of this innovation. Design: Longitudinal nonblinded randomized trial with standard treatment and intervention arms. Setting and participants: Two community pharmacies serving an ethnically diverse population in the Pacific Northwest. Participants were consented patients with antihypertension pre- scriptions who screened positive for low health literacy based on the Test of Functional Health Literacy Short Form. Participants in the intervention arm received antihypertensive medica- tions and recordings of pharmacists' counseling in Talking Pill Bottles at baseline. Control arm participants received antihypertensive medications and usual care instructions. Main outcome measures: Comparison and score changes between baseline and day 90 for medication knowledge test, Self-Efficacy for Appropriate Medication Use Scale (SEAMS), Morisky Medication Adherence Scale (MMAS-8), blood pressure, and responses to semi- structured exit interviews and Technology Acceptance Model surveys. Results: Of 871 patients screened for health literacy, 134 eligible participants were enrolled in the trial. The sample was elderly, ethnically diverse, of low income, and experienced regarding hypertension and medication history. In both arms, we found high baseline scores in medi- cation knowledge test, SEAMS, and MMAS-8 and minimal changes in these measures over the 90-day study period. Blood pressure decreased significantly in the intervention arm. Accept- ability scores for the Talking Pill Bottle technology were high. Conclusion: Our results suggest that providing audio-assisted medication instructions in Talking Pill Bottles positively affected blood pressure control and was well accepted by pa- tients with low health literacy. Further research involving newly diagnosed patients is needed to mitigate possible ceiling effects that we observed in an experienced population. © 2016 Published by Elsevier Inc. on behalf of the American Pharmacists Association. The 2004 Institute of Medicine Report “Health Literacy: A Prescription to End Confusion” brought attention to the fact that approximately 90 million Americans face challenges when encountering basic health information. 1 Health literacy has been defined as a constellation of skills that constitute the ability to perform basic reading and numeric tasks for func- tioning in the health care environment and acting on health care information. 2 Limited health literacy skills may result in poorer self-management skills, 3,4 more difficulty coping with chronic health problems, 5,6 higher rates of certain chronic conditions and avoidable hospitalizations, 7-9 increased use of emergency room services, 1,10 increased risk of death, 7,11,12 and higher health care costs. 1,13-15 Poor health literacy also affects medication adherence, because investigators have reported that patients with low health literacy have more difficulty Disclosures: The authors declare no conflict of interest, including financial interests, in any product or service mentioned in this article. Funding: This study was funded by the National Institute for Nursing Research, National Institute for Health: NIH (1R21NR010706-01A1). The funding source has no involvement in the execution of study design, data collection, and interpretation. Previous presentations: Preliminary results of this study were previously published: Lam A, Wolpin S, Nguyen J, Berry DL, Kurth A, Morisky DE. Is 60 seconds enough? Can talking pill bottles be used in the community pharmacy setting? J Am Pharm Assoc. 2011;51:569-570. A poster on these preliminary findings was presented at the Annual Conference of American Society of Consultant Pharmacists in Seattle, WA, November 1, 2013. * Correspondence: Annie Y. Lam, BS Pharm, PharmD, CGP, 8116 SE 77th Place, Mercer Island, WA 98040. E-mail address: aylam@uw.edu (A.Y. Lam). Contents lists available at ScienceDirect Journal of the American Pharmacists Association journal homepage: www.japha.org http://dx.doi.org/10.1016/j.japh.2016.07.003 1544-3191/© 2016 Published by Elsevier Inc. on behalf of the American Pharmacists Association. Journal of the American Pharmacists Association xxx (2016) 1e10 SCIENCE AND PRACTICE