Purpose:To measure the impact of beliefs, expectations, side effects, and their combined effects on the risk for medication nonpersistence.Patients and methods:Using a cross-sectional design, individuals from Saskatchewan, Canada who started a new antihypertensive, cholesterol-lowering, or antihyperglycemic medication were surveyed about risk factors for nonpersistence including: (a) beliefs measured by a composite score of three questions asking about the threat of the condition, importance of the drug, and harm of the drug; (b) incident side effects attributed to treatment; and (c) expectations for side effects before starting treatment. Descriptive statistics and logistic regression models were used to quantify the influence of these risk factors on the outcome of nonpersistence. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.Results:Among 3,029 respondents, 5.8% (n=177) reported nonpersistence within four months after starting the new drug. After adjustment for numerous covariates representing sociodemographics, health-care providers, medication experiences and beliefs, both negative beliefs (OR: 7.26, 95%CI: 4.98-10.59) and incident side effects (OR: 8.00, 95%CI: 5.49-11.68) were associated with the highest odds of nonpersistence with no evidence of interaction. In contrast, expectations for side effects before starting treatment exhibited an important interaction with incident side effects following treatment initiation. Among respondents with incident side effects (n=741, 24.5%), the risk for early nonpersistence was 11.5% if they indicated an expectation for side effects before starting the medication compared to 23.6% if they did not (adjusted OR: 0.38, 95%CI: 0.25-0.60).Conclusion:Expectations for side effects may be a previously unrecognized but important marker of the probability to persist with treatment. A high percentage of new medication users appeared unprepared for the possibility of side effects from their new medication making them less resilient if side effects occur.

This manuscript offers a glimpse into the Canadian healthcare system, emphasizing the prevalence and management of minor ailments through self-care practices. The first section outlines the strengths and challenges of the healthcare system, including access issues and escalating costs. The second section explores self-care in Canada, outlines the Self-Care Readiness Index, and Canadians' proactive management of common conditions through self-care activities, including the use of over-the-counter (OTC) medicines. Consumer behaviors, preferences, and the thriving OTC market are discussed. It also discusses existing programs and initiatives encouraging self-care. While lacking a coordinated national strategy, various organizations, including Health Canada, have taken steps to regulate and promote self-care products. The role of pharmacies, industry groups, and public health campaigns in fostering self-care is explored, along with public access to OTC medicines, Rx-to-OTC switching, and consumer expectations related to such medicines. Factors influencing self-care and self-medication are explored, focusing on access to medical care, public perceptions of OTC medicines, and the public's ability to engage in appropriate actions. The crucial role of pharmacists in minor ailment care is examined. Insights are provided into Canada's healthcare landscape, emphasizing the significance of self-care in managing minor ailments. The public has access to many resources on how to engage in self-care and deal with minor ailments, but a formal system to promote them is lacking. The findings prompt considerations for future healthcare policies and public health campaigns, highlighting the evolving nature of healthcare practices in the nation.

The shift of proton pump inhibitors (PPIs) from prescription to nonprescription (nonRx) status in Canada has altered pharmacist treatment options for heartburn. This report examines pharmacist approaches to therapy based on case severity; pharmacist confidence and consult duration were also explored. A 2022 online survey gathered data from Ontario and Québec pharmacists regarding their therapeutic approaches for two hypothetical heartburn cases. A total of 715 pharmacists participated, with most having 1–10 years of experience. In Ontario, common choices for the milder case included a solo histamine-2 receptor antagonist (H2RA) (21.2%), combination H2RA + antacid (29.4%), and nonRx PPI (22.3%). For the more severe case, common choices for Québec were switches to nonRx H2RA (22.1%), combination H2RA + antacid (13.4%), a nonRx PPI (24.9%), or prescription PPI (22.5%). Pharmacists often recommended switching medications or referring patients with recurring symptoms after seven days. The approaches varied significantly between cases and provinces. The Ontario pharmacists favoured a combination H2RA + antacid for the milder case, while the Québec pharmacists preferred a solo H2RA. For the more severe case, both groups often chose nonRx H2RA followed by nonRx PPI. Despite the differences, the pharmacists demonstrated confidence in managing these situations. These findings highlight potential debates regarding optimal therapeutic approaches and the impact of drug scheduling on patient care.

Background:Over the past decade, Canada has witnessed a shift of several drugs from prescription-only to behind-the-counter (BTC) and over-the-counter (OTC) status. This work examined community pharmacists' agreement with the current scheduling of agents used in the management of allergic rhinitis, heartburn, and vulvovaginitis. Methods:From September to October 2022, an online survey was administered to pharmacists practicing in in Ontario and Québec. The survey aimed to gather insights into their preferred scheduling for 15 medicines commonly used to manage the three selected conditions. Pharmacists were asked whether they agreed with the current scheduling status of each and, if not, how they feel it should be scheduled. Results:715 pharmacists completed the survey, 462 from Ontario and 253 from Québec. Most were staff pharmacists working 30 or more hours per week, having been a pharmacist for 1-10 years. Ontario pharmacists expressed a preference for scheduling change for five drugs (four prescription [terconazole for intravaginal use, famotidine, rupatadine, mometasone nasal spray] and one unscheduled [ranitidine 75 mg]), while Québec pharmacists expressed preference for scheduling change for three prescription drugs (terconazole for intravaginal use, famotidine, rupatadine). Discussion:As pharmacy practice continues to evolve, pharmacists' comfort with initiating previously prescription-only therapy independently or assisting patients with self-selection may similarly evolve. Of the five drugs identified as having a discrepancy between current status and pharmacist preference, four are prescription and may be candidates to consider for prescription to OTC switch. Conclusion:Pharmacists in Ontario and Québec have expressed preference for most products used in the treatment of allergic rhinitis, heartburn, and vulvovaginitis to be categorised as Schedule II (BTC) or Schedule III (OTC) available only in pharmacies.

The public generally believes OTC medicines to be helpful for treating minor ailments. From a survey point of view, that position often originates from feedback obtained when these medicines are considered as one broad category. The objective of the study was to assess the properties of 15 categories of agents across three dimensions-effectiveness, safety, and familiarity. Data were gathered via an online non-random survey in one Canadian province, where residents were asked to consider 15 OTC medicine categories in terms of those dimensions. Five hundred and seventy-five completed surveys were obtained out of 3000 sent. On the 10-point effectiveness scale, values ranged from 5.1 (Athlete's foot cream) to 7.3 (headache medicine). For safety, the medicines were closely grouped (6.0 to 7.4). Cough syrups for children were perceived as less safe than those for adults. There was a trend in that, as product familiarity grew, so did impressions of safety and effectiveness. The results support other reports where OTC medicines are described as safe and effective, although safety ratings were not particularly high. Responders considered these medicines to generally be higher in safety than effectiveness.

BACKGROUND:Misconceptions about the health risks of cannabis remain prevalent, indicating the need to improve public health messaging and determine the effectiveness of educational programming. Our objective was to develop a standardized questionnaire to measure knowledge about cannabis in the context of cannabis legalization.METHODS:A Cannabis Knowledge Assessment Tool (CKAT) was created using the Delphi method. A purposive sample of healthcare professionals, policymakers, academics, patients, and students served as the content and development experts. Principal component analysis from the codes identified from open-ended feedback guided the item development. Upon completion, the CKAT was administered as a pre- and post-test in four schools (7th and 9th Grade) in Canada. The data were analysed to determine whether knowledge scores changed after participating in a cannabis education program.RESULTS:Twenty-four experts initially participated in the Delphi process and 18 (75% retention) continued throughout. Principal component analysis identified 3 domains: 1) effects of cannabis on the individual, 2) general information about cannabis, and 3) cannabis harm reduction. The final questionnaire consisted of 16 multiple-true-false questions (64 items) and received a Flesch-Kincaid Grade Level of 6.3, and a SMOG index score of 7.6. The CKAT was completed by 132 students; seventy-three 7th grade and fifty-nine 9th grade students. The baseline mean CKAT score was 46.2 (SD:5.5), which increased to 50.7 (SD:4.6) after the cannabis educational program (p<0.05).CONCLUSIONS:A novel tool to measure knowledge of cannabis was developed and piloted in 7th grade and 9th grade students. Future studies are required to test usability and validity of the CKAT in other contexts.

Background: Universities are tasked with preparing students to assist the public in managing minor ailments. This study aimed to determine when pharmacy students would refer patients to medical care as an indicator of clinical skill. Methods: First- and final-year students from four schools were surveyed to determine referral timelines for 17 scenarios. Responders also quantified symptom severity and their confidence levels. Results: Students responding to at least three cases were kept for analysis (n = 117). First-year students considered nasal congestion to be low in severity, with painful urination and rectal bleeding deemed more serious, all while considering most cases more serious than upper-year students. Student confidence was generally lower in new students. Referral times showed similar patterns between years and universities. Red eye, painful urination, diarrhoea (child), and Gastro-Oesophageal Reflux Disease (GORD) (unhealthy patient) were referred quicker than nasal allergies and cough. Referrals typically stayed within a two-week window for most situations. Conclusion: Timelines for medical care were similar between years and institutions. As expected, new students assessed cases as more serious and had less confidence than their upper-year colleagues. A concern for the institutions might be the low rate of real-world case exposure within programmes.

There is concern as to whether the public use OTC (over-the-counter) medicines with due diligence. The objective was to quantify the likelihood and extent people would seek information on OTC medicines in relation to 10 non-medicine products as a surrogate of the importance consumers place on them. Citizens of one Canadian province estimated the likelihood and extent (scale of 1 to 10) they would search for information when considering a purchase. The survey had two lists—a MIXED products list (5 OTC medicine categories and 10 non-medicine products) and an OTC MEDICINES list (15 categories). Five hundred and seventy-five surveys were obtained (response rate 19.2 percent). The average age was 63.0 years and 61.6 percent were female. The mean search likelihood for the 15 products on the MIXED list ranged from 2.2 to 7.4. There was more intention to search for information involving OTC medicines (mean = 5.0) than non-medicine products (mean = 4.1). There was a weak positive correlation in search likelihood relative to OTC medicine familiarity. This study revealed that the likelihood of searching for information prior to purchase is not particularly robust. With a plethora of information currently available to consumers, motivation to access it is what may need attention.

A cross-sectional survey was conducted to determine the relative rankings of 17 key components in an undergraduate program. The degree of discrepancy between curricular content and that of student and pharmacist expectations was also of interest. An online questionnaire was emailed to both groups in one Canadian province. Respondents considered four questions related to the nature and adequacy of education they did receive (pharmacists) or should receive (students) and the relative importance of key topic areas (along 11-point scales). The response rate was 31.0 (students) and 10.8 percent (pharmacists). As expected, both students and pharmacists identified therapeutics and patient counselling as critical focal points for the program, while the importance of compounding was mixed. Most topics were deemed as best handled during the didactic program, with students seeing greater value in learning a larger portion of two skills (injection training and managerial duties) post-graduation. In conclusion, discrepancies were indeed found. For students, topics such as injection training and minor ailment prescribing were perceived as receiving too little attention, while communication, pharmaceutical sciences, and professionalism received too much attention. In a significant departure in perspective, pharmacists rated communication, ethical decision-making, and professionalism almost two points higher than did students.

Objective: To develop a valid and reliable scale to measure the public’s propensity to self-medicate with OTC medicines. Method: Propensity construct items were obtained from the literature and also created as new entities. Three experts reviewed the item pool for face validity. Internal consistency was assessed using Cronbach’s alpha. Test-retest reliability was estimated using Pearson correlation coefficients (r), Intraclass Correlation Coefficients (ICC) and paired sample t-tests. Further test-retest reliability assessed the degree of change in responses in a subset of subjects from time 1 to time 2 (one month apart) for each item on the scale. Results: From the pool, 16 items were assessed for applicability to the propensity construct. Factor Analysis identified four components and were labelled as purchase involvement, self-efficacy, awareness of care needed during self-medication, and the therapeutic usefulness of OTC medicines. The internal consistency of the 16-item scale was sufficient; overall alpha was 0.9 and each construct had an alpha of 0.7 to 0.8. Test-retest reliability coefficients (r) for the four components were reassuring, ranging from 0.4 to 0.5, while the ICC values ranged from 0.5 to 0.7. A paired sample t-test showed no statistically significant difference in the rating at the two iterations for each of the constructs, thereby suggesting good reliability of the data. Over 50% of respondents did not change their original response to the 7-point scales (strongly disagree (1) to strongly agree (7)) for 9 out of 16 items. Factor loading from Principal Component Analysis led to the reduction of the 16-items scale to a 15-item Propensity to Self-Medicate with OTC Medicines Scale. Conclusion: The developed tool for measuring the propensity to self-medicate with OTC medicines showed acceptable performance of internal consistency and reliability. The scale may have research potential in assessing the self-medication propensity of different cohorts of society.

It has been suggested that the COVID-19 pandemic led to an increase in self-medication practices across the world. Yet, there is no up-to-date synthesized evidence on the prevalence of self-medication that is attributable to the pandemic. This study aimed to conduct a systematic literature review on the prevalence and correlates of self-medication for the prevention and treatment of COVID-19 globally. The review was registered with the PROSPERO database. Searches were conducted following PRISMA guidelines, and relevant articles published between 1 April 2020 and 31 March 2022 were included. Pooled prevalence rate was conducted using the Meta package in R. A total of 14 studies from 14 countries, which represented 15,154 participants, were included. The prevalence of COVID-19-related self-medication ranged from 3.4–96%. The pooled prevalence of self-medication for this purpose was 44.9% (95% CI: 23.8%, 68.1%). Medications reported by studies for self-medication were antibiotics (79%), vitamins (64%), antimalarials (50%), herbal and natural products (50%), analgesics and antipyretics (43%), minerals and supplements (43%), cold and allergy preparations (29%), corticosteroids (14%), and antivirals (7%). The prevalence of self-medication with antibiotics is concerning. More public health education about responsible self-medication amidst the COVID-19 pandemic and future pandemics is required to mitigate the rising threat of antimicrobial resistance.

Background: Drug discontinuation (i.e., nonpersistence) is often attributed to the emergence of adverse effects. However, it is not known whether other factors increase the risk of nonpersistence when adverse effects occur. Objectives: To identify factors associated with early nonpersistence among patients experiencing adverse effects from newly prescribed medications. Methods: A questionnaire was mailed to new users of antihypertensive, antihyperglycemic, and lipid-lowering medications in Saskatchewan, Canada, between 2019 and 2020. Only respondents experiencing adverse effects were included. Responses were compared between the nonpersistent group (i.e., people who had discontinued their medication) and the persistent group (i.e., those who were taking their medication at the time of the survey). Statistically significant factors were tested in multivariable logistic regression models. Odds ratios (ORs) and 95% CIs were reported. Results: Of the 3973 returned questionnaires, 813 respondents experienced adverse -effects from their new medication and were included in the study. Of these, 143 respondents (17.5%) had stopped their medication at the time of survey completion; most discontinuations (72.1%) occurred within 1 month of the first dose. Nonpersistent patients were older, had lower income, and were less likely to be taking an antihyperglycemic medication. After covariate adjustment, 6 factors were independently associated with nonpersistence: age less than 65 years (OR 1.56 [95% CI 1.01-2.41]), female sex (1.67 [1.08 -2.59]), health condition not considered dangerous (2.09 [1.25-3.51]), medication not considered important for health (6.90 [4.40-10.84]), failure to expect adverse effects before starting medication (2.67 [1.74-4.10]), and taking 2 or more medications (0.45 [0.27-0.73]). Conclusion: Despite the strong link between the emergence of adverse effects and early nonpersistence, our findings confirm that this association is highly influenced by several factors external to the physical experiences caused by the new medication. (C) 2022 American Pharmacists Association (R), Published by Elsevier Inc.

Experiential education is a critical component of any pharmacy undergraduate curriculum. Establishing new, high-quality practice sites can be challenging. We designed a new advanced pharmacy practice experiential rotation suitable for implementation in most community pharmacy settings. The aim of this article is to describe the design of this rotation entitled the Targeted Pharmacy Intervention in Inflammatory Bowel Disease (TPI-IBD) and to determine its impact on student knowledge and confidence using a before-after survey design. The TPI-IBD utilizes a student-delivered intervention as a platform for experiential learning in community pharmacy practice. The TPI was focused on patients with IBD, and implementation was guided by a co-preceptor from the university in collaboration with onsite-preceptors at each pharmacy. The TPI-IBD rotation was delivered from 6 community pharmacies during 5 weeks in 2018. Students conducted standardized monitoring on patients with IBD and met weekly with the university preceptor for case presentations and therapeutic discussions. Electronic charts were maintained by students who were responsible for ensuring detailed documentation on each patient. Knowledge, confidence, and overall satisfaction were assessed by a survey given to students before and after the rotation. Students were highly satisfied with the learning experience and improvements in knowledge and confidence were clearly demonstrated. The TPI strategy was an effective way to expand rotation options in community pharmacy sites with minimal burden on local preceptors.

INTRODUCTION:Adverse symptoms experienced by solid organ transplant recipients remain largely unexplored despite their purported frequency.OBJECTIVE:To characterize patient perspectives on adverse symptoms, identifying the most problematic symptoms and the perceived cause and treatability, and to evaluate their impact on quality of life (QoL) and medication adherence.METHODS:An electronic survey was distributed to members of the Canadian Transplant Association, to characterize perceptions on symptom experience (Modified Transplant Symptom Occurrence and Distress Scale), and QoL (Short Form-12), medication adherence (Basel Assessment of Adherence to Immunosuppressive Medications Scale), demographics, and clinical situation.RESULTS:The questionnaire was distributed to 249 solid organ transplant recipients and achieved a 51% response rate (N = 127). Respondents reported a mean of 25 (standard deviation 10) adverse symptoms each. In women, the most prevalent and distressing symptoms were tiredness, lack of energy, sleep difficulties, difficulty concentrating or memory problems, diarrhea, joint pain, and depression. In men, they were tiredness, flatulence, lack of energy, sleep difficulties, and erectile problems. With the exception of flatulence, these symptoms were more often perceived to be caused by medical conditions rather than by immunosuppressants or other medications. Quality of life was similar to the general public, with mean physical and mental component scores of 47.4 (9.9) and 52.1 (8.2), respectively (relative to a US average of 50 [10]). However, QoL scores inversely correlated to the number of symptoms reported and were higher in patients who perceived all symptoms to be treatable.CONCLUSION:Adverse symptoms may impact patient well-being. Perceived cause and treatability should be further explored.

Background: Self-care instruction in pharmacy curricula is essential given the impact pharmacists have in caring for patients in the community and their evolving role in this area. The primary objective of this study was to strengthen our current understanding of self-care education across undergraduate Canadian pharmacy programs. Methods: A national curriculum survey and follow-up phone interview was conducted in 2019 to assess the quantity and quality of self-care instruction across Canadian pharmacy schools. Representatives were selected based on theirparticipation in the Association of Faculties of Pharmacy of Canada Self-Care Therapeutics and Minor Ailments special interest group. Results: Responses were received from all 10 pharmacy schools in Canada. Self-care education varies across Canadian pharmacy curricula, reflecting differences in scopes of practice across provinces, topics of interest and availability of space within curricula by the various faculties. Specifically, there was considerable variability in the number of hours devoted to self-care education, course content and methods for integration and teaching. Conclusions: Results of this study may help inform and evolve self-care curricula across the country. We argue that strategies for enhancing current programs may include establishing a minimum number of core hours and topics, expanding natural health product content and curricular content oversight by a lead faculty member. Can Pharm J (Ott) 2021;154:xx-xx.

Objective: To determine the impact of the SIMPL-SYNC refill synchronization (SSRS) service compared with that of usual care (UC) on medication adherence when applied as an opt-out strategy among patients receiving chronic medications. Design: This was a pragmatic randomized controlled trial. Setting and participants: The study was conducted in 2 community pharmacies located in Saskatchewan, Canada. Eligible patients were chronic medication users visiting the study pharmacies. Outcome measures: The primary outcome was the percentage of individuals achieving optimal adherence to all eligible study medications. Eligible study medications included 22 commonly used medication classes used to treat diverse conditions. Adherence was assessed for each medication class after 300 days using the proportion of days covered (PDC). Optimal adherence was defined as PDC >= 80%. Results: A total of 488 patients were screened for eligibility, and 190 patients were included in the intention-to-treat analysis (95 in SSRS, 95 in UC). The mean age of participants was 59 years, and 34% (65/190) were older than 65 years. A total of 574 individual adherence observations representing the 22 eligible study medication classes were generated from the 190 study participants. The percentage of individuals achieving optimal adherence to all their eligible study medications was 50.5% (48/95) in the SSRS group versus 44.2% (42/95) in the UC group (P = 0.383). Similarly, no statistically significant difference was observed in a per-protocol analysis assessing people who participated fully in the service; the percentage of individuals achieving optimal adherence to all their eligible study medications was 55.1% (38/69) in SSRS versus 40.7% (33/81) in UC (P = 0.080). Patient refusal of the refill synchronization services was common among randomized patients. Conclusion: SSRS service failed to detect a robust improvement in medication adherence when delivered using an opt-out strategy. However, small improvements in adherence or benefits to specific subgroups of patients could not be ruled out. (C) 2020 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.

BACKGROUND AND PURPOSE:Pharmacy schools would benefit from new models of experiential education. The University of Saskatchewan (Canada) recently opened a patient care clinic called the Medication Assessment Centre (MAC) as new experiential education model. The purpose of this paper is to describe the structure and function of the MAC and to report program evaluation data.EDUCATIONAL ACTIVITY AND SETTING:The MAC is a unique application of an existing experiential education model in that it is an pharmacist-run ambulatory clinic (which is common) that is physically located on campus amongst the classrooms and supervised by pharmacy faculty (which is unique). Students are all required to participate in the clinic on a regular basis, in between lectures, throughout the four years of the pharmacy program.FINDINGS:Students were invited to participate in one of five focus groups to assess the value of the experience. Transcripts were analyzed using thematic analysis, and the results identified strong satisfaction amongst students. The overall themes fell into three categories: (1) aspects that students liked, (2) aspects that students found challenging, and (3) positive impact on student learning. Previously published studies have found strong support for the MAC amongst patients and physicians.SUMMARY:Students felt that a faculty supervised experiential education clinic that is physically located within their pharmacy school was a valuable learning experience. This paper provides a description of how the MAC has been integrated into an existing pharmacy curriculum, which may be valuable to schools contemplating a similar addition to existing experiential learning.

Background: Pharmacists have been given authority in many Canadian provinces to go beyond simply recommending over-the-counter medicines to patients with minor ailments. In Saskatchewan, they can prescribe medicines normally under the sole control of physicians for 17 conditions. An evaluation program is underway to assess the value of the program. Methods: Adults were recruited over a one-year period and were eligible for inclusion if prescribed an agent for an applicable condition. Pharmacists from 40 pharmacies participated in identifying people who received the service. Of patients agreeing to participate, a link to an online survey was provided. The survey included items on clinical improvement, care options, and patient confidence in knowing when to seek a physician for a minor ailment. Results: Forty-eight people were involved in prescribing encounters, with the majority seeking help for themselves. All but one saw their symptoms improve subsequent to pharmacist assistance, most often to a significant extent. Satisfaction with the service was high. Convenience and trust in pharmacists were primary reasons for choosing the service over medical care (rather than an issue potentially more worrisome such as not having a family physician). Had this service not been in place, 30.6% of those asking for help would have gone to a medical clinic or emergency room. Seventy-five percent were (at least) very confident in knowing when to seek a physician (rather than a pharmacist) for such conditions. Conclusion: Information on the clinical outcomes of pharmacist-led minor ailment care is starting to accrue in Saskatchewan. While the numbers are extremely low to date, what has become available suggests the service is of value to the citizens of the province, it is chosen for appropriate reasons, and is of an acceptable standard of care. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties. However, the authors are pharmacists licensed within the province and bring this perspective to this evaluation of a pharmacy-based program. Type: Original Research

Background Several educational interventions have been designed to improve patient knowledge before and after kidney transplantation. However, evaluation of such interventions has been difficult because validated instruments to measure knowledge-based outcomes in this population have not been developed. Objective To create a tool to measure patient knowledge of kidney transplantation and to evaluate its validity. Methods The Kidney Transplant Understanding Tool (K-TUT) was created using a stepwise iterative process. Experts in the field and transplant recipients were consulted to establish content validity. The K-TUT consists of 9 true/false and 13 multiple-choice questions, and scores are based on the number correct answers [YES/NO format] of 69 items. The questionnaire was piloted in a study that also measured health literacy (via the Short Test of Functional Health Literacy) in transplant candidates, whereas the main survey was mailed to transplant recipients. Test-retest was performed, and completed surveys were analyzed for internal consistency, construct validity, floor and ceiling effects, and reproducibility. Results Surveys were offered to 106 pretransplant patients and 235 in the posttransplant period, and response rates were 38.7% (41/106) and 63.4% (149/235), respectively. The mean corrected scores were 53.1 ± 8.5 (77%) and 56.2 ± 6.3 (81%), respectively. Test-retest was performed over 20% of both cohorts and percent agreement ranged between 70% and 100% in the pretransplant group and 66% and 100% in the posttransplant group. Cronbach α ranged from 0.794 to 0.875 in all cohorts indicating favorable internal consistency. Increased health literacy in the pretransplant group was significantly associated with increased knowledge ( r = 0.52; P < 0.001), suggestive of construct validity, and the absence of floor and ceiling effects was positive. The majority of transplant recipients (98/148, 67%) believed the questionnaire adequately assessed transplant knowledge, about a quarter (36/148, 24.3%) were “unsure,” and 85% (126/148) agreed that no questions should be removed. Conclusions Although more study is warranted to further assess psychometric properties, the K-TUT appears to be a promising tool to measure transplant knowledge.

Following publication of the original article [1], these errors were flagged: