Skip to main content

Advertisement

SpringerLink
Log in

A critical evaluation of pictogram based patient information leaflet on hypothyroidism patients with metabolic syndrome: a visual approach to enhance health literacy

  • Original Paper
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Introduction

Hypothyroidism is a condition with an underactive thyroid gland. Since thyroid hormones play a significant role in metabolism, hypothyroidism is often associated with metabolic syndrome. Thus, the patient’s awareness regarding metabolic syndrome is crucial.

Objectives

To develop and evaluate a Pictogram-based Patient Information Leaflet (P-PIL) for hypothyroidism with metabolic syndrome.

Materials and methods

This is a quasi-experimental study without a control group. The P-PIL was developed and validated using the Lawshe Method, translated, and evaluated with 72 patients (24 patients each for English and regional languages, Kannada and Malayalam).

Results

The leaflet’s Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) scores were 62.0 and 7.1, respectively. The Baker Able Leaflet Design (BALD) index of English, Kannada, and Malayalam versions of the P-PIL were 28, 27, and 27, respectively. The user testing of the P-PIL was assessed in 72 patients. The overall mean knowledge assessment scores significantly improved from 52.92 ± 6.90 to 77.92 ± 9.31. The majority of patients, precisely 84.72%, expressed a positive opinion regarding the design and layout of the P-PIL.

Conclusion

The evaluation results strongly suggest that this P-PIL can be an effective educational tool for hypothyroidism patients with metabolic syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

Data are available from the corresponding author on reasonable request.

References

  1. B. Shaji, J.J. Joel, Impact of Hypothyroidism on Metabolic and Cognitive Dysfunction: A Comprehensive Review. J Young Pharm 14, 349–354 (2022)

    Article  CAS  Google Scholar 

  2. Y. Rochlani, N.V. Pothineni, S. Kovelamudi, J.L. Mehta, Metabolic syndrome: pathophysiology, management, and modulation by natural compounds. Ther. Adv. Cardiovasc Dis. 11, 215–225 (2017)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. J.R. Garber, R.H. Cobin, H. Gharib, J.V. Hennessey, I. Klein, J.I. Mechanick; American Association of Clinical Endocrinologists and American Thyroid Association Taskforce on Hypothyroidism in Adults, Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr. Pract. 18(6), 988–1028 (2012). https://doi.org/10.4158/EP12280.GL

    Article  PubMed  Google Scholar 

  4. S. Bagcchi, Hypothyroidism in India: more to be done. Lancet Diabetes Endocrinol. 2(10), 778 (2014). https://doi.org/10.1016/S2213-8587(14)70208-6

    Article  PubMed  Google Scholar 

  5. A.G. Unnikrishnan, S. Kalra, R.K. Sahay, G. Bantwal, M. John, N. Tewari, Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian J. Endocrinol. Metab. 17(4), 647–652 (2013). https://doi.org/10.4103/2230-8210.113755

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. M. Feller, M. Snell, E. Moutzouri, Association of thyroid hormone therapy with quality of life and thyroid-related symptoms in patients with subclinical hypothyroidism: a systematic review and meta-analysis. Endocrinol. | JAMA | JAMA Netw. (2018). Retrieved June, 2023, from https://jamanetwork.com/journals/jama/fullarticle/2705188

  7. O.B. Alluhayyan, R.J. Alsahly, A.A. Aldawsari, K.A. Alghabawy, R.S. Alqaan, A.F. Almutairi, S.A. Alharbi, Illness perception and medication adherence among patients with primary hypothyroidism in Al Qassim, Saudi Arabia. Patient Prefer. Adherence 14, 1111–1117 (2020). https://doi.org/10.2147/PPA.S257703

    Article  PubMed  PubMed Central  Google Scholar 

  8. I.M. Bensenor, R.D. Olmos, P.A. Lotufo, Hypothyroidism in the elderly: diagnosis and management. Clin. Interv. Aging 7, 97–111 (2012). https://doi.org/10.2147/CIA.S23966

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. R. Kumar, F. Shaukat, Adherence to levothyroxine tablet in patients with hypothyroidism. Cureus 11(5), e4624 (2019). https://doi.org/10.7759/cureus.4624

    Article  PubMed  PubMed Central  Google Scholar 

  10. A. Yadav, S.K. Gupta, R.M. Piryani, Impact of pharmacist intervention on improving knowledge, attitude and practice among hypothyroid patients. Nepal Mediciti Med. J. 3(1), 1–7 (2022). https://doi.org/10.3126/nmmj.v3i1.48518

    Article  Google Scholar 

  11. S. Vooradi, L.D. Acharya, S. Seshadri, G. Thunga, K. Vijayanarayana, Preparation, validation and user-testing of patient information leaflets on diabetes and hypertension. Indian J. Pharm. Sci. 80(1), 118–125 (2018). https://doi.org/10.4172/pharmaceutical-sciences.1000336

    Article  Google Scholar 

  12. M. Sustersic, M. Tissot, J. Tyrant, A. Gauchet, A. Foote, C. Vermorel, J.L. Bosson, Impact of patient information leaflets on doctor–patient communication in the context of acute conditions: a prospective, controlled, before–after study in two French emergency departments. BMJ Open 9(2), e024184 (2019). https://doi.org/10.1136/bmjopen-2018-024184

    Article  PubMed  PubMed Central  Google Scholar 

  13. K.S.G.A. Kumaran, S. Palanisamy, A. Rajasekaran, Development and implementation of patient information leaflets in diabetes mellitus. J. Pharm. Health Serv. Res. 1(2), 85 (2010)

    Article  Google Scholar 

  14. B.C. Vinay, C.S. Shastry, S. Kodangala, U.V. Mateti, K. Bhat, Development and validation of patient information leaflet for coronary heart disease patients. Perspect. Clin. Res. 12(2), 83–86 (2021). https://doi.org/10.4103/picr.PICR_58_19

    Article  CAS  PubMed  Google Scholar 

  15. T. Sukartini, X.E. Hasibuan, M. Abu Bakar, The effect of health education by giving leaflets media on behavior changes in prevention of asthma relapse in asthma patients. Eurasia. J. Biosci. 14(1), 1699–1702 (2020)

    Google Scholar 

  16. W. Wrench, L. van Dyk, S. Srinivas, R. Dowse, Outcome of illustrated information leaflet on correct usage of asthma-metered dose inhaler. Afr. J. Prim. Health Care Fam. Med. 11(1), 1–9 (2019). https://doi.org/10.4102/phcfm.v11i1.2079

    Article  Google Scholar 

  17. P.L. Huang, A comprehensive definition for metabolic syndrome. Dis. Models Mech. 2, 231–237 (2009)

    Article  CAS  Google Scholar 

  18. L. Chaker, A.C. Bianco, J. Jonklaas, R.P. Peeters, Hypothyroidism. Lancet (Lond., Engl.) 390(10101), 1550–1562 (2017). https://doi.org/10.1016/S0140-6736(17)30703-1

    Article  CAS  Google Scholar 

  19. R. Ghamri, R. Babaker, S. Ezzat, H. Alsaedi, M. Alkhamisi, R. Arbaein, S. Alamri, Assessment of quality of life among patients with primary hypothyroidism: A case-control study. Cureus. (2022). https://doi.org/10.7759/cureus.29947

  20. D.L. Kasper, A.S. Fauci, S.L. Hauser, D.L. Longo, J.L. Jameson, J. Loscalzo, Thyroid Gland Disorders. In Harrison’s Manual of Medicine (19th ed.). New York, NY: McGraw-Hill Education (2016). Retrieved from arxiv://accessmedicine.mhmedical.com/content.aspx?aid=1128787704

  21. R. Flesch, A new readability yardstick. J. Appl. Psychol. 32, 221–233 (1948). https://doi.org/10.1037/h0057532

    Article  CAS  PubMed  Google Scholar 

  22. C.H. Lawshe, A quantitative approach to content validity. Pers. Psychol. 28(4), 563–575 (1975). https://doi.org/10.1111/j.1744-6570.1975.tb01393.x

    Article  Google Scholar 

  23. S.J. Baker, Who can read consumer product information? Aust. J. Hosp Pharm. 27(2), 126–131 (1997)

    Article  Google Scholar 

  24. U.V. Mateti, A.N. Nagappa, R.P. Attur, M. Bairy, S.P. Nagaraju, S. Mallayasamy, R. Balkrishnan, Preparation, validation and user-testing of pictogram-based patient information leaflets for hemodialysis patients. Saudi Pharm. J. 23(6), 621–625 (2015). https://doi.org/10.1016/j.jsps.2015.01.022

    Article  PubMed  PubMed Central  Google Scholar 

  25. H. Bacher, R. Schweyen, D. Vordermark, B. Leplow, J. Hey, Development and validation of an information leaflet on oral care for irradiated patients. Patient Prefer Adherence 14, 1791–1799 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  26. R. Piddennavar, P. Krishnappa, Preparation and evaluation of information leaflet for tobacco users. J. Educ. Health Promotion.4 (2015)

  27. C. Moorthi, R.T. Saravanakumar, C.S. Kumar, R. Manavalan, K. Kathiresan, Systematic assessment of the quality of patient information leaflets supplied by the pharmaceutical manufacturers. Pharm. Glob. 3(2), 1 (2012)

    Google Scholar 

  28. U.P. Nandakumar, J.J. Joel, K.J. Shetty, C.S. Shastry, C.K. Bhat, Development, validation and readability assessment of patient information leaflet on breast cancer. Indian J. Gynecol. Oncol. 19, 82 (2021)

    Article  Google Scholar 

  29. S. Satheendran, A.N. Nagappa, S. Pai, Pictogram-based information leaflet in patients with psoriasis. Asian J. Pharm. Clin. Res. 10, 405 (2017). https://doi.org/10.22159/ajpcr.2017.v10i7.17384

    Article  Google Scholar 

  30. R. Amin, F. Alam, B.K. Dey, Computer-assisted evaluation of patient information leaflets (PILs) for chronic kidney disease compared with marketed PILs. Arch. Pharm. Pract. 14(2), 25–29 (2023). https://doi.org/10.51847/zET9xN9dhk

    Article  Google Scholar 

  31. K.S. Arul Kumaran, S. Palanisamy, A. Rajasekaran, Development and implementation of patient information leaflets in diabetes mellitus. J. Pharm. Health Serv. Res. 1(2), 85–89 (2010)

    Article  Google Scholar 

  32. J. Protheroe, E.V. Estacio, S. Saidy-Khan, Patient information materials in general practices and promotion of health literacy: an observational study of their effectiveness. Br. J. Gen. Pract. 65(632), e192–e197 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank the faculties of the Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Department of General Medicine, KS Hegde Medical Academy, and Justice K S Hegde Charitable Hospital for their valuable guidance throughout the research process. We would like to express their sincere gratitude to Nitte (Deemed to be University), Mangaluru, for providing the necessary facilities to conduct the research. We would also like to thank Tallurs Translations Services, Udupi, for their support in translating the research documents.

Authors contributions

B.S. performed conceptualization, project development, patient screening and enrolment, data collection and management, and manuscript preparation. J.J. contributed to project development, data analysis, manuscript preparation, and proofreading. R.S contributed to project development, patient screening, data analysis, manuscript preparation, and proofreading. S.S designed the study, calculated the sample size, managed data, and performed the statistical analysis. C.S.S. contributed to project development, data analysis, manuscript preparation, and proofreading. U.V.M. contributed to project development, data analysis, manuscript preparation, and proofreading. All authors reviewed the manuscript.

Author information

Authors and Affiliations

  1. Nitte (Deemed to be University), NGSM Institute of Pharmaceutical Sciences (NGSMIPS), Department of Pharmacy Practice, Deralakatte, Mangaluru, India

    Bipin Shaji, Juno Jerold Joel & Uday Venkat Mateti

  2. Nitte (Deemed to be University), KS Hegde Medical Academy (KSHEMA), Department of General Medicine, Deralakatte, Mangaluru, India

    Raghava Sharma

  3. Nitte (Deemed to be University), KS Hegde Medical Academy (KSHEMA), Department of Biostatistics, Deralakatte, Mangaluru, India

    Shraddha Shetty

  4. Nitte (Deemed to be University), NGSM Institute of Pharmaceutical Sciences (NGSMIPS), Department of Pharmacology, Deralakatte, Mangaluru, India

    C. S. Shastry

Authors
  1. Bipin Shaji
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juno Jerold Joel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raghava Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shraddha Shetty
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. S. Shastry
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Uday Venkat Mateti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juno Jerold Joel.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethical approval

Ethical approval (Ref. no. NU/CEC/2022/317) was obtained from the Central Ethics Committee, Nitte (Deemed to be University).

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shaji, B., Joel, J.J., Sharma, R. et al. A critical evaluation of pictogram based patient information leaflet on hypothyroidism patients with metabolic syndrome: a visual approach to enhance health literacy. Endocrine 84, 185–192 (2024). https://doi.org/10.1007/s12020-023-03622-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-023-03622-1

Keywords

Search

Navigation