Original Research

Outcome of illustrated information leaflet on correct usage of asthma-metered dose inhaler

Wendy Wrench, Lynette van Dyk, Sunitha Srinivas, Ros Dowse
African Journal of Primary Health Care & Family Medicine | Vol 11, No 1 | a2079 | DOI: https://doi.org/10.4102/phcfm.v11i1.2079 | © 2019 Wendy Wrench, Lynette van Dyk, Sunitha Srinivas, Ros Dowse | This work is licensed under CC Attribution 4.0
Submitted: 11 March 2019 | Published: 21 August 2019

About the author(s)

Wendy Wrench, Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
Lynette van Dyk, Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
Sunitha Srinivas, Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa
Ros Dowse, Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa

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Background: Research globally has shown that metered dose inhaler (MDI) technique is poor, with patient education and regular demonstration critical in maintaining correct use of inhalers. Patient information containing pictorial aids improves understanding of medicine usage; however, manufacturer leaflets illustrating MDI use may not be easily understood by low-literacy asthma patients.

Aim: To develop and evaluate the outcome of a tailored, simplified leaflet on correct MDI technique in asthma patients with limited literacy skills.

Setting: A rural primary health care clinic in the Eastern Cape, South Africa.

Methods: Pictograms illustrating MDI steps were designed to ensure cultural relevance. The design process of the leaflet was iterative and consultative involving a range of health care professionals as well as patients. Fifty-five rural asthma patients were recruited for the pre-post design educational intervention study. Metered dose inhaler technique was assessed using a checklist, and patients were then educated using the study leaflet. The principal researcher then demonstrated correct MDI technique. This process was repeated at follow-up 4 weeks later.

Results: The number of correct steps increased significantly post intervention from 4.6 ± 2.2 at baseline to 7.9 ± 2.7 at follow-up (p < 0.05). Statistically significant improvement of correct technique was established for 10 of the 12 steps. Patients liked the pictograms and preferred the study leaflet over the manufacturer leaflet.

Conclusion: The tailored, simple, illustrated study leaflet accompanied by a demonstration of MDI technique significantly increased correct MDI technique in low-literacy patients. Patients approved of the illustrated, simple text leaflet, and noted its usefulness in helping them improve their MDI technique.


primary health care; asthma; metered dose inhaler use; patient education; illustrated leaflet; pictograms; limited literacy patients.


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