ARTICLE WomenÕs Understanding of Different Dosing Instructions for a Liquid Pediatric Medication Lorraine S. Wallace, PhD, Amy J. Keenum, DO, PharmD, Jennifer E. DeVoe, MD, DPhil, Shannon K. Bolon, MD, MPH, & Julie S. Hansen, MPH ABSTRACT Introduction: Dosing errors by caregivers are common and often are directly attributed to poorly designed instructions. The purpose of this study was to assess whether instruction wording—that is, implicit versus explicit dosage intervals— was associated with participantsÕ ability to describe and correctly measure a dose of a commonly prescribed liquid pediatric prescription medication. Methods: English-speaking women (N = 193) of child- bearing age were recruited to participate in this study from an outpatient residency clinic in the southeastern United States. Based on a priori randomization, each participant was presented with one of two medication bottles that were identical except for the instructions: (1) ‘‘SHAKE LIQUID WELL AND GIVE (CHILDÕS NAME) 6 ML BY MOUTH EVERY 12 HOURS’’ (‘‘implicit’’ dosage interval),’’ or (2) ‘‘SHAKE LIQUID WELL AND GIVE (CHILDÕS NAME) 6 ML BY MOUTH AT 7 AM AND 7 PM’’ (‘‘explicit’’ dosage interval). Participants completed a structured interview to assess socio- demographic characteristics, health literacy skills, ability to describe and demonstrate the dosage of the liquid medica- tion, and preferences for label format. Results: Seventy-two participants (37.3%) were able to cor- rectly describe how they would give the medicine to a child during a 24-hour period, while 145 women (75.1%) were able to correctly demonstrate how they would give one dose of the medication. Approximately one third of partici- pants (32.1%) were able to correctly describe and measure a dose of the medication. Slightly more than half of partici- pants (n = 103, 53.4%) indicated that they would prefer instructions with ‘‘explicit’’ dosage intervals. Discussion: This study suggests that few people can accu- rately describe how liquid medications are to be adminis- tered, while more people can demonstrate the correct dose to be administered. J Pediatr Health Care. (2012) 26, 443-450. KEY WORDS Medication use, patient comprehension, literacy, pediatrics Because nearly 30% of U.S. parents have health literacy (HL) skills that are at or below the basic level (Yin et al., 2009), much of the medical-related informa- tion presented to them is arduous to decipher and ulti- mately use. Mounting evidence depicts the challenges faced by patients in their attempts to interpret written dosing instructions and warning stickers routinely affixed to prescription medication bottles (Davis et al., Lorraine S. Wallace, Associate Professor, Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH. Amy J. Keenum, Associate Professor, University of Tennessee Graduate School of Medicine, Department of Family Medicine, Knoxville, TN. Jennifer E. DeVoe, Associate Professor, Oregon Health and Science University, Department of Family Medicine, Portland, OR. Shannon K. Bolon, Primary Care Medical Education Branch Chief, Health Resources and Services Administration, U.S. Department of Health & Human Services, Rockville, MD. Julie S. Hansen, Graduate Research Assistant, University of Tennessee Graduate School of Medicine, Knoxville, TN. Conflicts of interest: None to report. Correspondence: Lorraine S. Wallace, PhD, Department of Family Medicine, The Ohio State University College of Medicine, 2231 North High St, Columbus, OH 43201; e-mail: Lorraine.Wallace@ osumc.edu. 0891-5245/$36.00 Copyright Q 2012 by the National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved. Published online August 8, 2011. http://dx.doi.org/10.1016/j.pedhc.2011.06.006 www.jpedhc.org November/December 2012 443