Evaluation of the readability of the package inserts of hormone replacement therapy, combined oral contraceptives, and progestin-only pills: Analytical Research: Cross-Sectional Study

ABSTRACT
Aim: The comprehension of a written text is directly related to its readability. There are specific formulas to objectively measure readability. The readability of package leaflets is also important for public health. This study aimed to determine the readability level of the package inserts of hormone replacement therapy (HRT), combined oral contraceptives (COCP), and progestin-only pills (POP).
Material and Method: The official website of the Turkish Medicines and Medical Devices Agency created a list of all over-the-counter and prescription hormone preparations that are sold in pharmacies and can be used by women. Hormone preparations sold with or without a prescription in Turkey are divided into three groups according to their content: HRT, COCP, and POP. Ateşman, Bezirci-Yılmaz, and Çetinkaya-Uzun readability formulas, which are valid for Turkish texts, were used to evaluate these texts. The research was conducted with a two-sided 5% significance level and a 95% confidence level.
Results: The mean values of the Ateşman readability index for the three drug groups were quite similar, between 70.5 and 71.3 (p = 0.690). The mean values of the Çetinkaya-Uzun readability index were quite similar, between 49.9 and 50.7 (p = 0.627). Bezirci-Yılmaz shows that the readability index for the three drug groups is divided into two categories: 7-8 grade and 9-10 grade. The majority of the package inserts for each drug group fall into the 7-8 grade category, indicating that the package inserts are quite easy to read and understand. There is no significant difference between the Bezirci-Yılmaz readability index for three different drug groups (p = 0.534).
Conclusion: Considering the average level of education in Turkey, the readability level of the package inserts for these preparations is high. Adjusting the language and structure of package inserts to align with the average education level will increase the readability and, therefore, the comprehensibility. Future studies could incorporate factors such as visual presentation and user feedback to enhance the comprehensibility of package inserts.
Keywords: Hormone replacement therapy, combined oral contraceptives, readability, package insert, progestin-only pills