HLTH 4900 Week 9 Capstone Paper Draft Example

Verified Translated Prescription Labels and How Well Adults With Limited English Proficiency Understand Their Doses at Community Pharmacies: A Capstone Review

Student Name

Walden University

HLTH 4900: Capstone

Instructor Name

Month Day, Year

Verified Translated Prescription Labels and How Well Adults With Limited English Proficiency Understand Their Doses at Community Pharmacies: A Capstone Review

Abstract

Adults with limited English proficiency often leave community pharmacies with labels they cannot read. This capstone reviewed studies published from 2006 onward on whether a label written in the reader's own language makes the dose easier for such adults to follow. Sources were sorted into those that carry the claim, those that supply context and those that pull against it. No study compared translated and English-only labels directly. A randomized study found that plainly worded, standardized instructions in five languages were understood and demonstrated better than standard translated instructions, while a pharmacy survey found that half of software-generated Spanish labels contained errors. Read together, the evidence supports a conditional claim: translated labels help when their wording is plain and standardized and their accuracy has been verified. The claim does not extend to adherence, to untested languages or to readers with limited literacy in their first language.

Introduction

Prescription labels are among the most frequently read health documents, and among the most frequently misread. Patients with limited English proficiency face a second barrier on top of the first. This paper argues that, at community pharmacies, translated labels that have been checked and are worded plainly and consistently help adults with limited English proficiency make sense of how to take each dose. The argument rests on four kinds of evidence: studies of how often labels are misunderstood, studies of language and understanding, a randomized test of translated instructions and a study of translation accuracy. It ends by naming what the evidence cannot show.

Background: Health Literacy and Language Access

A national health literacy report put the share of American adults who struggle to understand and use health information at close to one in two (Institute of Medicine, 2004). Labels are a particular hazard. Among 395 English-speaking adults at three primary care clinics, between 67.1% and 91.1% read each of five everyday label instructions correctly, and among readers with low literacy, about seven in ten could repeat a twice-daily, two-tablet instruction while only about a third could count out a full day's pills (Davis et al., 2006). The instructions themselves were part of the problem: misreadings were traced to vague wording, implicit intervals and distracting label content (Wolf et al., 2007).

Limited English adds to this. In California health interview data, limited English proficiency roughly tripled the odds of reported difficulty with prescriptions for Mexican, Central American and Korean respondents and quadrupled them for Chinese respondents, though the association was not significant among Vietnamese respondents (Masland et al., 2011). Federal law bars national origin discrimination in health programs receiving federal funds (42 U.S.C. § 18116), yet many pharmacies cannot offer translated labels; in a Milwaukee County survey, 47% of responding pharmacies were never or only sometimes able to print them (Bradshaw et al., 2007). A national workshop on medication labels identified patients with limited English proficiency among those the current system was failing (Institute of Medicine, 2008).

Methods

This is a structured review of published literature rather than an original study. The search covered PubMed, CINAHL and Google Scholar for the years 2006 onward, pairing terms for labels and dosing directions with terms for language access, translation, comprehension and pharmacy settings. Inclusion required a focus on adults collecting their own prescriptions in community pharmacy settings or a direct bearing on label understanding or translation. Studies of children, hospital discharge medications, spoken interpretation and legal compliance were excluded as primary evidence, though some were retained as context. Every included source was then assigned a role: carrying, meaning it bears directly on the claim; context, which explains the problem or setting; and contrary, which pulls against the claim. The full inventory appears in Appendix A.

Evidence: Wording Matters Within a Language

Before asking whether translation helps, the review asked whether wording helps, since a translation can only carry the wording it starts from. Reviewers who pooled studies of label content and layout concluded that larger fonts, clear headers, simple language and logical organization improve readability and comprehension (Shrank et al., 2007). The misreadings documented among English speakers point the same way: when instructions state explicit times rather than intervals such as twice daily, fewer patients misread them (Wolf et al., 2007). Clear, standardized wording is therefore the foundation on which any translated label must be built.

Evidence: Translated Instructions That Were Understood

The strongest evidence on translated instructions comes from a randomized study of 202 adults with limited English proficiency who spoke Chinese, Korean, Russian, Spanish or Vietnamese, recruited from nine clinics and community organizations in San Francisco and Chicago (Bailey et al., 2012). Participants reviewed medicine bottles carrying either standard instructions in their language or standardized, plainly worded instructions in their language designed with health literacy principles. Understanding was assessed by demonstration. Participants given the standardized instructions showed significantly better understanding of the instructions and correct dosing, and they consolidated multi-drug regimens into fewer daily doses.

The study's comparison sets the limit of what it shows. Both groups read their own language. The result demonstrates that the quality of translated instructions affects understanding; it does not test translated labels against English-only labels. Combined with the evidence that limited English impairs understanding of English prescriptions (Masland et al., 2011), it supports the claim that well-made translated instructions help, while leaving the direct comparison untested.

Counterevidence: Translations That Mislead

Against this, a survey of pharmacies in the Bronx found that 73% of 286 participating pharmacies provided Spanish labels, mostly through computer programs, and that among 76 labels generated by 13 programs, 43% mixed English and Spanish and half contained some error (Sharif & Tse, 2010). A label that switches languages mid-instruction, or misspells a dose, could confuse more than it helps.

This evidence does not show that translation fails. It measured the accuracy of labels, not patients' understanding of them. What it shows is that the translations pharmacies routinely produce are often not the kind of translations the randomized study tested. The two findings are reconciled by a condition: translated labels help when they have been checked for accuracy and clarity, and routine software translation frequently lacks that check. The claim was revised during the term to include that condition, and the word verified in the introduction carries it.

Limitations

Three limits bound the claim. First, it concerns understanding, not adherence; label design has not been shown to change adherence or health outcomes (Shrank et al., 2007). Second, it is supported for the five languages tested in the randomized study and, for accuracy, Spanish; it cannot speak for others. Third, it assumes readers can read their first language well, and for adults with limited literacy in that language, a written label of any kind may fall short (Davis et al., 2006). The review itself has limits: it relied on a small number of studies, one search by one reviewer and no direct comparison of translated and English-only labels. No included study asked patients about their experience of receiving a translated label.

Implications for Pharmacy Practice and Health Education

For pharmacies, the review suggests that offering translated labels is not sufficient on its own; the value lies in verified, standardized instruction sets. Pharmacies might consider using a fixed library of plainly worded instructions translated and reviewed in advance, rather than generating new translations for each prescription. Because software errors were common in the one accuracy study found, periodic checks of printed labels by qualified bilingual staff or translators may be worth considering. For readers with limited literacy, spoken counseling with a professional interpreter remains important, and interpreters have been associated with better care for patients with limited English proficiency (Karliner et al., 2007).

For health educators, the review suggests that teaching about labels should include demonstration, since stating an instruction and carrying it out are different abilities. Educators working with communities whose languages were not studied could help pharmacies test whether verified labels in those languages are understood.

Conclusion

At community pharmacies, checked translations worded plainly and consistently help adults with limited English proficiency make sense of how to take each dose. The evidence for that claim is indirect but consistent: limited English impairs understanding, wording affects understanding within a language and standardized instructions in patients' own languages were understood better than standard ones. The claim depends on verification because routinely produced translations are often wrong. It does not reach adherence, untested languages or readers with limited literacy in their first language, and it leaves the direct comparison with English-only labels as the next question worth studying.

Appendix A: Source Inventory

Table A1 lists the sources by bin.

Table A1

Sources by Role in the Argument

Appendix B: Rubric Crosswalk

Table B1 maps each rubric criterion to the section of the paper that answers it.

Table B1

Rubric Criteria and Where Each Is Answered

References

Bailey, S. C., Sarkar, U., Chen, A. H., Schillinger, D., & Wolf, M. S. (2012). Evaluation of language concordant, patient-centered drug label instructions. Journal of General Internal Medicine, 27(12), 1707-1713. https://doi.org/10.1007/s11606-012-2035-3

Bradshaw, M., Tomany-Korman, S., & Flores, G. (2007). Language barriers to prescriptions for patients with limited English proficiency: A survey of pharmacies. Pediatrics, 120(2), e225-e235. https://doi.org/10.1542/peds.2006-3151

Davis, T. C., Wolf, M. S., Bass, P. F., Thompson, J. A., Tilson, H. H., Neuberger, M., & Parker, R. M. (2006). Literacy and misunderstanding prescription drug labels. Annals of Internal Medicine, 145(12), 887-894. https://doi.org/10.7326/0003-4819-145-12-200612190-00144

Institute of Medicine. (2004). Health literacy: A prescription to end confusion. National Academies Press. https://doi.org/10.17226/10883

Institute of Medicine. (2008). Standardizing medication labels: Confusing patients less: Workshop summary. National Academies Press. https://doi.org/10.17226/12077

Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2), 727-754. https://doi.org/10.1111/j.1475-6773.2006.00629.x

Masland, M. C., Kang, S. H., & Ma, Y. (2011). Association between limited English proficiency and understanding prescription labels among five ethnic groups in California. Ethnicity and Health, 16(2), 125-144. https://doi.org/10.1080/13557858.2010.543950

Nondiscrimination, 42 U.S.C. § 18116 (2023).

Sharif, I., & Tse, J. (2010). Accuracy of computer-generated, Spanish-language medicine labels. Pediatrics, 125(5), 960-965. https://doi.org/10.1542/peds.2009-2530

Shrank, W., Avorn, J., Rolon, C., & Shekelle, P. (2007). Effect of content and format of prescription drug labels on readability, understanding, and medication use: A systematic review. Annals of Pharmacotherapy, 41(5), 783-801. https://doi.org/10.1345/aph.1H582

Wolf, M. S., Davis, T. C., Shrank, W., Rapp, D. N., Bass, P. F., Connor, U. M., Clayman, M., & Parker, R. M. (2007). To err is human: Patient misinterpretations of prescription drug label instructions. Patient Education and Counseling, 67(3), 293-300. https://doi.org/10.1016/j.pec.2007.03.024