The Pharmaceutical Journal
Vol 269 No 7215 p371
14 September 2002

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World Congress of Pharmacy and Pharmaceutical Sciences summary

What do children know and want to know about their medicines?

A congress session, presented by FIP's pharmacy information section on 4 September looked at how to develop and evaluate medicines education programmes and materials for children and adolescents.

The first speaker, Françoise Pradel, assistant professor at University of Maryland School of Pharmacy, introduced her talk by explaining that children are eager to learn about medicines. They receive daily messages about them from television, radio, magazines and their parents, and, of course, children take medicines themselves. In the United States, where there is direct-to-consumer advertising, sometimes the messages do not meet children's information needs. Professor Pradel said that pharmacists have an important role to play.

"Children," she said, "present us with many challenges. They are not small adults; their views about health and illness vary with their level of cognitive development and the complexity of children's thinking increases with age. This should determine how we present information to children."

Professor Pradel referred to a study in which children had been asked what causes asthma. A young child had said "you get sick a lot and you have to go to hospital" whereas an older child said "asthma is caused by a tightening of the ligaments around the bronchi which causes air to get caught in the lungs". That illustrates how we must adapt our messages for each age, she said.

Professor Pradel's work has shown that young children describe medicines in terms of colours. Children had said: "I take my puffer, it is white, I take it in the morning" and "I took the blue puffer, I didn't take the white one". Older children, she said, tend to know both the generic and brand names of their medicines.

Professor Pradel explained that the implications of this are that information materials should be designed to meet children's age and educational level. A good place to start is with the US Pharmacopoeia guide to developing medical information and materials for adolescents, which pharmacists can view at www.usp.org/information/ uspprograms/children.

We must, she said, avoid medical jargon and only introduce medical and technical terms progressively. We should provide complete explanations of meanings of terms in language that is used by young children. For older children more complex information may be provided. There should be a good mixture of text and illustrations. Older children can have more text whereas younger children need mainly illustrations. The reading level for materials for older adolescents and also in fact for adults, she said, should be aimed to be for 13-year-olds. Younger children need words with fewer syllables and shorter sentences. Young children can deal with around two or three messages and older children seven to 14 messages.

"Children," Professor Pradel continued, "are very interested in why people take medicines. We should address some key behaviours, like training children about reading the label on a medicine or getting an adult to read it for them to make sure they follow all the instructions."

It is also important, she said, in asthma for example, that children understand the difference between relievers and preventers. The USP guidelines have a useful list of key behaviours by age. We also need, she said, to address misconceptions: for example, the difference between street drugs and medicines.

Professor Pradel concluded by saying that we can also use these guidelines to evaluate existing materials.

Irina Kazarian, head of pharmacy at the National Institute for Health in Armenia, told the section about a survey she had carried out about what children know, do and want to know about medicines. Most children, she said, knew what a medicine was and what it was for. They also tended to know that medicines could be both helpful and harmful. Knowledge about medicines, she explained was related to income, education and health status of the family members and the child.

Patricia Bush, former professor at Georgetown medical school, US, described four studies about children and medicines that had been carried out in the US, Nepal, Malaysia and Armenia. Unfortunately, there had not been a co-ordinated approach and different methodologies had been used in different countries. In broad terms, the studies had found that children have considerable autonomy in medicine taking and that they are currently ill-informed and want more information about medicines.

The final speaker, Marja Airakinsen, University of Kupio, Finland, explained that pharmacists and pharmacy students need more communication skills training. She called for an integrated curriculum that addresses theory and practice. She suggested that children were used as standardised patients and that pharmacists could also use techniques from sociodrama to help children learn about medicines.
— Contributed by Claire Anderson