Medication nonadherence is a pervasive, multidimensional problem among elders. It is often caused by poor communication practices and age-related declines in cognitive abilities. We plan to improve communication through Expanded Medication Instructions, which should effectively complement labels because they are more complete and can be well-organized. The proposed research will expand our work on the organization of expanded instructions. Drawing on current theories of instruction processing, we will examine the influence of instruction organization on how well older and young readers understand and remember medication instructions (and their awareness of these benefits), and on how well they adhere to medication schedules. We will also examine if the effects of these instructional factors depend on medication (schedule complexity) and motivation factors. We will test if medication instructions that are compatible with readers' schemas for taking medication are more effective than less compatible instructions. The experiments measure the mental representation of medication information, comprehension and recall of instructions, self-assessment of comprehension and recall, and preferences for these instructions. We also test if compatible expanded instructions are more effective than labels in promoting adherence. Experiment 1 examines young and older subjects' schemas for taking medication. Experiment 2 examines if instructions with text formats that are compatible with the schema(s) are understood most easily and remembered most accurately. Experiments 3-4 examine if instructions with explicit formats are most effective. Experiment 5 examines the influence of visual-graphic as well as text formats on instruction comprehension and memory. The final two experiments directly compare prescription labels and expanded instructions. Experiment 6 examines how well these instructions convey multiple medication schedules. Experiment 7 tests if expanded instructions are more effective in promoting adherence to complex schedules. The experiments should converge to show that instructions are more easily processed when they explicitly signal the organization that matches the reader's task schema. They should lead to more effective medication instructions, which in turn should improve adherence, so that elders can lead independent lives for a longer time.
