Research database

This Research Database has been developed by HCPC Europe to create an overview of the available research in the field of patient-friendly and adherence packaging. The database is for all members of HCPC Europe. Members can register as a user to get access to the database. Is your organisation not a member yet? Then please register your organisation as a member or contact our Executive Director Ger Standhardt for more information.


Food Packaging Design Accessibility Guidelines

The Food Packaging Design Accessibility Guidelines were originally developed by Arthritis Australia and Georgia Tech Research Institute’s Principal Research Scientist Dr Brad Fain for HealthShare NSW. The guidelines were part of a program designed to address issues patients had with opening portion controlled food packaging, which impacted their independence and nutrition. The guidelines were a world first and are now used to assist brand owners and manufacturers to develop packaging that is easy to understand, read and open by consumers. This is achieved by assisting the packaging industry to understand consumer’s abilities to complete tasks, such as the amount of force consumers can exert when removing a seal or cap.


The Relationship Between Hand Strength and the Forces Used To Access Containers by Well Elderly Persons

OBJECTIVE. This study extended previous work of Rice, Leonard, and Carter [AJOT, 52(8), 621–626] and examined the relationship between grip and pinch strengths and the forces produced while accessing common household containers in healthy, elderly persons.

METHOD. Forty-two women and 9 men 60 years of age and older were assigned randomly to one of four order groups in a counterbalanced, repeated-measures design. Grip strength was measured via a dynamometer and pinch strength via a pinch meter. The forces required to access six common household containers were measured with force sensing resistors applied to each container. Data analysis included Pearson product-moment correlations between the dependent variables of grip and pinch strength and force produced on the containers. Analyses of variance were used to determine differences by gender on the dependent measures and order of presentation of containers.

RESULTS. A fair relationship (r = .31 to .44) was found between grip and pinch strength and the ability to open three containers. Little or no relationship was found between grip and pinch strength and the ability to open the remaining three containers (r = −.03 to .25). Significant gender differences existed on overall strength and the force used to access two of the six containers. No order effects were found.

CONCLUSIONS. Strong relationships did not exist between the grip and pinch strength and the amount of force the elderly participants used to open the containers, which is similar to what Rice et al. found for younger persons. The participants appeared to use a greater proportion of their available strength when accessing the containers than did their younger counterparts previously studied. Further research is needed to determine at what level of weakness one would expect to see performance deficits in common daily occupations.


Applying Universal Design to Child-resistant Packaging

The United States’ Consumer Product Safety Commission (CPSC) administers the Poison Prevention Packaging Act of 1970 (PPPA) in order to protect children from the inadvertent ingestion of dangerous household products, including pharmaceuticals. The current test protocol for child-resistance (CR) and “senior friendliness” indicates that people with “overt or obvious disabilities” or people that cannot open a non-CR package be excluded from testing. Although people with disabilities are significant consumers of prescription drugs, the protocol excludes them. The exclusion of this group from government-directed testing unfairly punishes the elderly, who are more likely to be afflicted by disability than younger consumers. This is despite the fact that this portion of the test is meant to be a test of senior friendliness. Difficulties encountered when using packaging have also been documented to impact patient compliance, which is recognized as a significant problem of the healthcare system in the US. This research hypothesizes that by using an interdisciplinary team and applying the concepts of universal design to CR packaging, users with a wider range of abilities can be accommodated. Inclusionary designs will improve products and benefit all users, not just those with disabilities. Background and significance Drug packages protect and deliver prescription and over the counter drugs (OTC’s), as well as communicate necessary warnings and directions to people so that the pharmaceuticals held within can be used to enhance health. This project addresses two major issues of concern in public health that are related to packaging design: patient compliance and child safety.


Verpackungen von Tabletten – Eine für alle?

Eine Verpackung soll ein Produkt zunächst umhüllen, um es vor äußeren Einflüssen zu schützen. Des Weiteren transportiert sie Produktinformationen zum Endverbraucher und vermittelt Markenbotschaften sowie einen möglichen Zusatznutzen. Einige Verpackungen enthalten sogar Hilfsmittel zum Entnehmen oder Dosieren des Produkts.

Oft ist das Erscheinungsbild einer Verpackung im Regal entscheidend für Impulskäufe. Allerdings machen es manche Verpackungen dem Endverbraucher schwer, an das Produkt zu gelangen. Besonders bei empfind­lichen Anwendergruppen wie den »Silver Agern«, den Konsumenten in einem fortgeschrittenen Lebensabschnitt, kann dies zur Ablehnung des Produkts führen.


How effective is safety packaging

Of 96 ingestions involving safety packaging, 82% involved misuse. The package in some way was unacceptable to the consumer–it was too difficult to open or too difficult to close. Nonacceptance by the elderly was not a significant factor. In only 18% of the safety packaged ingestions, did the child upen the package. The child was more likely to be able to open the screw-cap and the strip-pack. The pop-off and press-lift were not opened by any child but were types misused only by parents. The older child with a record of prior poisoning was most likely to open a safety package. These children would appear to represent a hard core of risk subjects refractory even to safety packaging. Safety packaging has had a dramatic effect on the morbidity and mortality of accidental poisoning. There are two remaining problems that require further study: 1. The analysis of technical factors impeding consumer acceptance and child proofing. The ideal package is so easily handled by the adult that misuse does not occur, but is too difficult for the child to open. 2. The personality characteristics of the safety-package-resistant child. Safety packaging, as implemented by the Consumer Product Safety Commission, has had remarkable success. Education did not reduce accidental poisoning; safety packaging does. Pediatricians, pharmacists, and toxicologists must work with industry and the Consumer Product Safety Commission to complete the goal of elimination of accidental poisoning.



Assessment of a new calendar pack—the ‘C-Pak’

Seventy-eight elderly patients in hospital were studied for up to four weeks to assess drug compliance. Forty patients received medication from individualized calendar packs (‘C-Pak’) and 38 received medication from standard bottles. There was no difference in compliance between the two groups, the percentage error for each group being 26%. This result suggests that C-Pak is unlikely to improve drug compliance in unselected elderly patients.


Testing child resistant packaging for access by infants and the elderly

Accidental poisoning of young children by household products and medicines remains a serious problem in many countries. Child resistant packaging, i.e. packages of which the opening and closing mechanisme requires manipulation and/or forces beyond the limits of children’s exertions, has been developed to counter this problem. It is important to standardise field trials of such packaging to ensure adequate protection for the population at risk (the inquisitive and ingenious youngsters), while permitting access by adults. Testing variables which were studied were the age boundaries of the child panel and of the adult panel. Tests were conducted on four types of child resistant reclosable containers; two of the push-and-turn type, two of the squeeze-and-turn type. Inclusion of children between 24 and 41 months old in the test panel did not significantly affect the proportion of subjects who were able to gain access to the containers. However, the inclusion of adults, in the age-range 60–75 yr, in the test was found to provide the best safeguard against overcomplex and difficult packaging coming on to the market. Any standardised tests need to take into account the finding that in a testing situation most of the children between 42 and 51 months do not use their teeth. In normal situations nevertheless, children of one-two years old, the age group in which most of the poisoning accidents happen, frequently resort to using their teeth when they are unable to open containers by hand.


Evaluation of a novel medication aid, the calendar blister-pak, and its effect on drug compliance in a geriatric outpatient clinic

A prospective, controlled, crossover study on drug compliance was initiated in 22 elderly patients from a geriatric clinic. Half of the patients received their pills from a commercially prepared calendar mealtime blister‐pak; the remaining patients received their medication from standard pill bottles. At the end of three months the two groups were crossed over. Pill count and issuance of a new drug supply were done monthly to assess compliance. It was found that the average noncompliance index was significantly decreased (9.17 to 2.04) with the blister‐pak packaging system. The relationship of age, Folstein mini‐mental status, over compliance, frequency of dosing interval, and living situation were also explored.


Quantifying the ease or difficulty older persons experience in opening medication containers

To compare the difficulty experienced by older persons in using various medication containers, 50 noninstitutionalized women and men over 60 years of age were timed while opening 15 containers. Pill and liquid medication bottles with and without child‐resistant closure mechanisms were tested. In addition, other types of medication packaging were evaluated, such as nitroglycerin patches.

All subjects could open each of the non‐child‐resistant containers, though none of the child‐resistant containers could be opened by all participants. For child‐resistant containers, dramatic differences were observed in the proportion of subjects who could open the various designs and in the amount of time required. Subjects’ comments and observations of subjects’ efforts provided possible reasons for some of these differences.

The results suggest that when child‐resistant containers are used, consideration of the type of medication container can significantly reduce inconvenience to older persons. Containers without child‐resistant mechanisms provide the best option for elderly people when access by small children is not an issue.