Table 1: Similarities and Dissimilarities between Pharmacists and Patients on the ‘Take with Food’ Label

Themes of Similarity / Quotes of Similarity
Include “MILK” on the picture / “I don't know if there's any way of getting the word milk on this carton because we don't have really cartons of milk anymore. They're all plastic now. So you may or may not know” (Pt 1)
“I think maybe writing milk on here, you know, would be helpful so people know it's a milk carton.” (P3)
Add Timeframe to the ‘just after eating’ / “Now, it's like, just as soon as you get done eating you're supposed to take it? Or do you take it through your meal while you're eating it? That would be my question.” (Pt 8)
“So I think the picture itself doesn't help define a timeline in terms of after a meal.” (P2)
Specify ‘this medicine’ purposively in the instruction / “It said take this medication and not just take this medicine. I think that's to me sounds better.” (Pt 3)
“And I think I like that medicine is in there rather than just take this, that it's specific. You know, by saying medicine more than just take this with food. I like that extra word in there.”(P5)
Themes of Dissimilarity / Quotes of Dissimilarity
Add ‘WARNING’ to the PWL / “I think it would be helpful to say warning, because like, well, what if I take it without the food is, you know, am I going to start getting violently ill” (Pt 16)
“So it, I think we probably associate warnings with bad things, you know, like, whereas, with the food, it wasn’t a bad thing, just a reminder.”(P6)
Big PWLs are better / “Like they, those are just, and they will probably have it on the side of a bottle, so you have to literally spin the bottle around to find the warning label. But the big one is just in a big spot, and you can see it much better. And you can read it much better.” (Pt 2)
“This one's too long, and I just think realistically you need more than, it's very rare to have a medication that only requires one label. So from a practical standpoint, you want to have enough room to put more than one label (P4)

Legend:

P: Pharmacist

Pt: Patient

Table 2: Similarities and Dissimilarities between Pharmacists and Patients on the ‘Do not Chew’ Label

Themes of similarity / Quotes of Similarity
Confusion about the broken tablet in the picture / “The picture doesn't make any sense to me. Without the words, I don't think I get what they're getting at, what they're trying to say with take your pill, don't step on it, broken glass, I don't know.”(Pt 13)
“It looks a lot like food. And so, to me, initially, I, my first impression was that this… you shouldn’t eat with this tablet. And that's, I don't think what the picture is trying to say.” (P2)
Use a yellow background for the picture and white background for the instructions / “.. number two would be my preferred label choice...having the picture with the yellow behind it, when the yellow's behind the letters I have a harder time reading the letters. It might stand out better in the white to me…” (Pt 13)
“I think that black and white text.., is going to be easier for most folks to read. I think the yellow background in the picture emphasizes the picture as well and kind of draws you to that text...” (P8)
Themes of Dissimilarity / Quotes of Dissimilarity
Picture has a racial stereotype / Not mentioned by the patients
“in today's, you know, environment of being politically correct, I don't think it should be black, because that somewhat, to some people, they might wonder why is that black? Is this, are black people not supposed to crush it? Are black people not supposed to take this?” (P1)
Using big PWLs / ”I don't like the small labels. It's hard to really look at the prescription. Like I said, you probably have to spin the bottle around to find those warning labels. I just like to look, soon as you get it, you see your name on the label, on the pill bottle. It should be right there in front of the pill bottle. And that you have to not turn it all the way around just to find the warning label. I like it right there in plain sight.” (Pt 2)
“I think number three is more practical. For an elderly patient, number one or two might be more visible or easier to read” (P4)
Include a glass of water/ any drink to the picture / “I'm just saying, some people may think that they can't take the medication with a glass of water or whatever, to swallow it ...Personally, I can't take anything without a beverage” (Pt 17)
Not mentioned by the pharmacists

Legend:

P: Pharmacist

Pt: Patient

Table 3: Similarities and Dissimilarities between Pharmacists and Patients on the ‘Protect from Sunlight’ Label

Themes of Similarity / Quotes of Similarity
The picture and instructions don’t match / “I wouldn't necessarily assume this on a cloudy day, even though that's what the direction, I mean, the directions tell me that. But if I had a, if I was only relying on the photo, it doesn't really give me that indication that this is important to do also, even on cloudy days” (Pt 16)
“Because to me, there's no clouds that correspond to that picture either. There's an umbrella. I don't know. It just is confusing to me” (P3)
Add sunscreen to the instructions / “me wonder how much sunlight you are to avoid, you know, SPF-10, SPF-20, SPF-30, SPF-40, SPF-50, or are you supposed to just stay out altogether?” (Pt 19)
“I think what may be better is just a bottle of sunscreen or something, you know? And then a sun with a line through it or something like that. That would be my suggestion to that one” (P3)
No link between the medication and warning / “For me, if I was taking this medication and the pharmacist didn’t explain it to me, I would think, oh, I will not expose this (the medicine) to sunlight. I’ll put it in my bag…” (Pt 21)
“It looks like just something that would be like a public-service announcement, not necessarily an association with the medication… I would probably change, like medicine can make skin more sensitive to the sun, you know, something like that” (P6)
Change ‘sunbeds’ to ‘tanning beds’ / “What's a sun bed? ...I think a different word for, not, there are people as dumb as me. But I don't mess with those a lot so maybe it is a common word. But to me, that didn't explain a word. I think tanning bed would've worked better on that.” (Pt 9)
“Sun beds, yeah, I have never heard that. I mean, I've heard it, but I haven't seen it in print. I've seen tanning beds more so” (P2)
Themes of Dissimilarity / Quotes of Dissimilarity
Combination of picture with the instruction works well / “..That picture can depict a beach scene to me … you know, I would read that.But there are some people that don't read. So the picture does help somewhat but not much.” (Pt 7)
“I think it kind of, each of them individually don’t completely get the point across, but I think the two of them together do a better job at getting the point across.”(P8)
Sun as yellow color versus orange / “Label 2 (is preferred)- Direct, right to the point, and the sunlight is .. it seems to me, because of the colors (orange), it's more bold” (Pt 14)
“I think probably the first one (is preferred), just because there's more yellow, and people associate the yellow with the sunlight even though the sun there is not yellow.” (P5)
Add the word ‘WARNING’ / “.. I don't know if they didn't highlight warning or something of that nature, to really drive home the point. I like having the person in that, but, again, my, first is the warning is not on the (label), I think if the first one had warning on it, I probably would've gone with one.”(Pt 16)
Not mentioned by any of the pharmacists
Including a person in the picture / “It did not matter to patients whether there is a person in the picture or not
“I like number one, because you have the person holding the umbrella. It's showing someone actively protecting their skin from the sun. This one is okay, but it's just an umbrella with the sun. I really like having the person actually holding the umbrella, actively protecting themselves from the sun” (P4)

Legend:

P: Pharmacist

Pt: Patient

Table 4: Similarities and Dissimilarities between Pharmacists and Patients on the ‘Do not take with Alcohol’ Label

Themes of Similarity / Quotes of Similarity
There is clarity of the instruction and the picture / “In my mind, it is very clear, you know. The warning down here for some reason, do not drink alcohol while taking this medication. I think that's straightforward, straight to the point, very visible, attention getting. … I don't have any questions or uncertainties after looking at that.” (Pt 17)
“You know, it's kind of these are my two favorites as far as clarity, and this one even more so, because it's a little bit bigger, I think. It just seems more, yeah, it's a little bigger.” (P1)
Change the use of a red triangle to depict warning / “I just think there might be better thing than the triangle or whatever that is. I'm not quite sure what that is. Maybe a stop sign or something … Or anything. I don't quite know what that is… But something maybe a little more saying stop…” (Pt 9)
“It’s just, with some of my patients, I’m looking at that (the red triangle), and that’s going to scare them. They’ll see that, especially my people, non-English speaking… The red triangle, yeah, not even seeing the warning by it, just the red triangle, mainly non-English speaking people, that would scare because that’s a symbol they see, and it’s dangerous..”(P7)
Add a cocktail glass to the picture / “So I like the idea that they have the wine and the beer on here. But maybe adding like a little mixed drink or the shape of a Cosmo glass ... another type of something so that they get the point that it's not just these two” (Pt 1)
“… you'd be amazed at how specific some patients are. They may say, oh, I can't take wine or beer. What about hard liquor? It didn't say vodka. But maybe a shot glass or a liquor bottle or something might add to the meaning” (P4)
Combination of pictures and instruction is better / “Even if it was written in there (the instruction), I wouldn't have, again, it brings my eye to it (the picture), like, oh, yeah,…something's important about this that they need to remind me of.” (Pt 16)
“I think it (the picture) will help them because it's easy to understand. Often patients who are illiterate .. really, they do a very good job of hiding their literacy problems, and often pharmacists aren't able to detect that.” (P4)
Themes of Dissimilarity / Quotes of Dissimilarity
Yellow highlighting behind the picture versus the instruction (words) / “I would say three actually sticks out the most… I do think it’s the fact that the wording is all surrounded by yellow. Yellow is caution.” (Pt 19)
“Perhaps number two because it’s the yellow that calls your attention to the picture, as opposed to the yellow being behind the words…Sometimes when you see yellow, well, it does its job, it highlights what’s important. So I would think that number two would probably draw the most attention to the actual picture and the message.” (P6)

Legend:

P: Pharmacist

Pt: Patient

Table 5: Similarities and Dissimilarities between Pharmacists and Patients on the ‘Take with a Full Glass of Water’ Label

Themes of Similarity / Quotes of Similarity
Include a definition of ‘full glass’ / “I guess there's, this is nitpicking, but is a glass of water what you go into and get at 2:00 in the morning, or is it a 12-ounce bottle of water? Is that what it means? That would be my only confusion like how much, what is a glass of water?” (Pt 13)
“It’s kind of hard to tell proportion-wise. Sometimes it’s important to take medication with 8 ounces to 12 ounces of water versus just swallowing it with water like most folks do” (P8)
Themes of Dissimilarity / Quotes of Dissimilarity
The need to include a ‘Warning’ icon / “they don't have the warning sign on them like all the other ones. It's just got the red square or whatever. Where's the warning sign? (Pt 6)
Not mentioned by the pharmacists
Including a picture of a tablet on the PWL / Not mentioned by the patients
“if the particular medication inside of the bottle doesn’t look like a white, oblong tablet like this one does, if it’s a liquid or if it’s a capsule or something different than what that is, I can see how that potentially could cause some confusionThe risks, I think, are pretty low, and I’m not sure it’s possible to make unique warning labels for all these different things” (P8)

Legend:

P: Pharmacist

Pt: Patient

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