critically appraise a leaflet created to enhance methotrexate adherence produced by clinical pharmacy students as a part of health promotion assignment.

Health promotion has become an essential component of pharmacy practice 2. The role of pharmacists is extending beyond the conventional dispensing and medicine-like services to include a wider involvement in health promotion 3. Now, community pharmacists provide a range of physical health promotion and mental wellbeing services through increasing awareness, giving advice, minimizing health inequities, and referring people to appropriate services 4. One of the most commonly used tools to promote Individual’ health is patient information leaflet, however, in order to meet this purpose, it must be well written, noticeable, understandable, believable, and rememberable5. This paper therefore aims to critically appraise a leaflet created to enhance methotrexate adherence produced by clinical pharmacy students as a part of health promotion assignment. The appraisal of the leaflet includes an explanation of the purpose of selecting this topic, a description of barriers to methotrexate adherence, critical analysis of its content, layout, and design.

Patient information leaflet is often used by wide range of health organisations and practitioners as part of patient education or health promotion serveries and thus to support prevention, therapeutic, and adherence objectives 6. This leaflet fits within these approaches by enhancing health-related knowledge, behaviors, and management conditions. It is designed to enhance adherence to methotrexate in adult who diagnosed with rheumatoid arthritis RA. The rational for choosing this topic is because pharmacists have extensive understanding of illness prevention and management, which places them in an excellent position within the health care system to promote medications adherence 7. In addition, Methotrexate is related with a higher likelihood of non-adherence among patients with RA 8. As in many chronic diseases where adherence to medication is critical for treatment effectiveness, adherence to methotrexate is essential for achieving the aim of disease remission and decrease disease activity 8. Non compliance to methotrexate has been linked to symptom deterioration and increasing disability, leading to increase morbidity and mortality 8,9. physical disability found to be associated with decreased ability to cope, increased mental health disorders, and more pain 10. Non-compliance will have an impact not only on the patient’s disease severity but also the treatment decisions made by the rheumatologists, potentially leading to greater health-care expenses 11. Hence Raising awareness toward medication adherence and disease knowledge by designing a leaflet might contribute to minmise these complications.

in light of the importance of patient information leaflet, it should be easy to comprehend
and customized to target population’s characteristics with a focus to overcome barriers 12. The information written in this leaflet are evidence-based medicine and designed to tackle common barriers to methotrexate adherence. Several studies demonstrate that lack of knowledge of slow action of methotrexate, fear of side effects, struggle to identify a need to persist on treatment, odd doses, forgottenness impact on methotrexate compliance 13,14. Alrubaye YS.el. add to that education levels have a major impact on compliance, patients with lower education showing better compliance than those with higher education. This could be due to patients’ knowledge and ability to use the internet to learn about the long-term adverse effects, which could seriously impact their adherence 14. Accordingly, this leaflet provided explanations and solutions to most of these factors to tackle the non-adherence issue.
This leaflet fits with the concept of health belief model and protective motivation theory in which Individuals’ likelihood of taking preventative action is significantly predicted by perceived both susceptibility, perceived severity and perceived benefits 15. Hence, the leaflet includes the complication of untreated rheumatoid arthritis and the side effects of methotrexate for purpose of supporting patients’ autonomy. Alongside this, side effects are given in both form descriptive and numerical format in order to minimize overestimated of harm. Dickinson et al. mentioned that
providing numerical information can promote more accurate evaluations of threats and benefits16. Owing to the challenging of providing all the required information on a small paper, the leaflet supported with the reliable rheumatoid arthritis sources to guide patients within accurate information. Overall, the content of the leaflet is adequately balanced between the benefits and harm; yet the leaflet layout and design are further concern that should be taken in consideration.

A well-written and designed leaflet can increase the number of who can utilise the information to make safely decisions regarding their treatment. To maintain this, the leaflet is designed to be in accordance with the majority of NHS principles. it is written in active and simple tense, short sentence with avoidance of jargon, suitable pictures, and bullet points to guide the text. Additionally, questions and answer format were used to help patients to navigate the information. Although it designed in “six-page leaflet “which is one of the recommended formats by NHS, leaflets printed on paper folded numerous times might not appear significant enough to read 17. Patients’ behaviour is influenced by poor readability and comprehension, resulting in a reduced level of medication compliance12. Considering this, according to the SMOG readability test, the leaflet readability age is between 12 and 14 years old, which is higher than the recommended (10 years); however, it is written in simple and patient friendly language.
the appearance of a leaflet may attract or dissuade patients from reading it. This leaflet thus includes relevant and eye-catching pictures to facilitate the comprehensive and aid recall the information. Using simple and relevant pictures in most case have been proved the effective of health communications in all four areas attention, comprehension, remembering and compliance.
two main colours used in the leaflet 18. It is noteworthy that, the tow colours used in the leaflet are in line with the rheumatoid arthritis symbol which expresses wisdom, knowledge, and hope.

To conclude, this leaflet is well prepared and designed to promote methotrexate adherence in RA. The leaflet content is up to date and evidence-based medicine to enhance people awareness and knowledge. It is designed in accordance with most NHS principles as well as it fits within the concept of health belief model and protective motivation theory. However, this leaflet has some limitation, the usage of this leaflet may be restricted owing to its readability score and the absence of such information that was not added due to space limitations.

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