In this study we found that 16% of medication users in a general adult population aged 40 years and above expressed a need for more information about their own medications. We also identified several characteristics associated with unmet information need and the strongest associations were for concerns about own medications and disagreeing having received information about side effects or interactions from health care providers.
To our knowledge, there are few comparable studies investigating medication information need in a general adult population. Another Norwegian study reported that 56% of the respondents would like to know more about their medications [7]. This study was, however, small and included only elderly adults (n = 162, age ranged from 62 to 96 years). The group of medication users expressing unmet information need about their own medication may be seen in relation to the high percentage of medication users agreeing to have received information about their medications from their GP or pharmacy. Presumably, this group of medication users felt informed, regardless of their current level of medication knowledge. Especially information regarding why and how to take medications had a high agreement rate from the GP and, to a lesser extent, the pharmacy. It has been reported that medication users were satisfied with receiving a minimum of information and had no expectations of more information [15]. Giving medication information is important to contribute to knowledge about own medications. However, if not given correctly it may also defeat its purpose. This is illustrated in the study by Duggan et al., where patients who were satisfied with limited knowledge and who did not express a wish for more information, felt less empowered and more worried after being given additional information [20]. This emphasizes the importance of identifying the medication users interested in more information about own medications and avoid information overload for those not interested. A Finnish study showed a seven-fold increase in patients who stated that they did not receive medication information from any source from 1999–2014 [23]. As neighbouring countries with similar healthcare systems, this may also apply to Norway and indicate that an increasing proportion of the population is unaccustomed to receiving medication information which might lead to less expressed need. Overall, our respondents agreed to a higher degree that they have received information from GP compared to the pharmacy. This corresponds with previous literature indicating the GP as the preferred information source and emphasize that the pharmacy has an unfulfilled information potential [5, 7].
We identified several characteristics associated with unmet information need. Medication users who were concerned about their own medications had high odds for needing more medication information. Kusch et al. describes how concerns about medications is a central factor related to non-adherence, and how receiving too much unsolicited information or not enough information both may amplify concerns [24]. Therefore, health care providers should be attentive and attempt to unveil such concern among medication users and ensure that their medication information needs are met, and that information overload is prevented. The self-reported variable education is recently validated [25] and lower education (primary school) gave lower odds for expressing need for more information about own medications. Lower education has been associated with higher adherence [26] in addition to overestimation of own knowledge and understanding of received information [27] which may support this finding.
Importance of a trusting patient-doctor relationship has been thoroughly investigated and found to be essential for adherence [28]. Medication users with low faith in doctors had an expressed need for more information in our study. According to a literature review by Clarke et al., this may be related to the necessity of some patients to seek a second opinion after consultations to validate the received information and to explore alternative treatments [5]. Anxiety and depression are among the strongest predictors for non-adherence, making a huge impact on health, especially if the patient has chronic illnesses [11]. In our study, an unmet medication information need was expressed by those reporting to be moderately (but not severely) depressed or anxious, or worried about own health. Depression and anxiety disorders are the leading cause of disability worldwide [29], and consequently it is important to identify moderately depressed, anxious, and worried medication users and provide tailored medication information needed to prevent or limit disease progression. As physical attendance at the study site was mandatory for participation, we presume that invitees with severe mental illnesses attended to a lesser degree (< 1.5% in our study) since they are known to experience pessimisms, cognitive impairments, and withdrawal from social support [11]. The number of participants may consequently be too small to show a relationship between medications need in the severely anxious or depressed medication users.
Medication use investigated in this study comprises large medication groups such as blood pressure medications and other heart disease medications (e.g., nitroglycerin, antiarrhythmics, anticoagulants) along with more specific medications such as insulin and hypothyroidism medication. We found that current users of heart disease medications (e.g., nitroglycerin, antiarrhythmics, anticoagulants) and hypothyroidism medication had higher odds of needing more information than medication users not using these medications. The complex treatment regimens these medications often comprise may be confusing to the patient and lead to increased information need. Cardiac rehabilitation patients have previously reported that the greatest information needs have been related to medication, diagnosis, and treatments, together with emergency and safety [30]. Others have, on the other hand, reported that patients using cardiovascular medications had less expressed desire for information [13]. Hypothyroidism and information need have, to our knowledge, not previously been investigated and this unmet need may be underestimated by health care providers due to limited medication treatment alternatives. Still, hormone treatment is complex and require close individual follow-up to achieve optimum dosage as a fixed-dose treatment is infeasible [31]. At the same time, medication information need is shown to vary over time and related to patients experience with medication regimen [14] which increasing the intricacy of giving medication information.
Medication users who disagreed to have received information about side effects and interactions had higher odds of expressed need for more information. The strongest association was found for information on side effects. This corresponds with previous studies reporting that patients interested in more information mainly addressed matters about side effects and interactions [7, 8, 24]. A lower proportion medication users agreed to have received information about side effects and interactions from health care providers compared to information about how and why to take medications. Such information tends to be intricate and may represent a communication threshold compared to information on practical use and storage. Health care providers may also overestimate patients’ understanding or attentiveness [32]. Dissatisfied patients on information given from health care providers seek out information elsewhere to narrow information gaps [5]. At the same time, medication users who disagreed to have received information about reason-for-use had lower odds for information need. A complementary source of health information is the Internet, and the search for such information has increased tremendously the last decades [33,34,35]. Surprisingly, in our study, with data from 2015/16, more than half of medication users reported that they had never used any of the given internet sources (apps, search engines, social media, or video services) for seeking information or advice on health and disease issues. Interestingly, these medication users expressed less information need compared to those who had used these sources in a model adjusted for age. Patients not using internet sources for health advice have been shown to rely more on family and friends for health information and to trust their GP and prescribed treatment to an extended degree compared to those seeking such information online [5]. These medication users may also be unfamiliar with available internet sources or rather find it frustrating to obtain desired information online [2]. Consequently, the use of internet sources does not explain the low need for medication information in our study population.
The main strength of our study is the use data from a well-established, population-based health survey (Tromsø7). Tromsø7 invited all inhabitants ≥ 40 years in Tromsø municipality (Norway) and an acceptable attendance rate (65%) provided a large study sample of 10,231 medication users. One in ten did not report any use of medication although they answered yes to regular use of medication during the last four weeks and were thereby included in the study population. These may be non-current or non-regular users who have misinterpreted the question, or they do not want to disclose their medication use. We chose to include these as they may be in need of medicines information. The main limitation is that all health and socio-economic variables were self-reported, however, some variables have been validated (e.g., the education variable [25]). It is important to emphasize that physical attendance was required for inclusion in the study, which will limit the generalizability to inhabitants who are unable to physically attend the study site. The cross-sectional design does not allow for any conclusions regarding a causal relationship between the examined characteristics and medication information needs.
