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.

Verpackungstechnologische Einflussfaktoren auf leichtes Öffnen und sichere Handhabung von Verbraucherverpackungen

Die vorliegende Arbeit soll sich hauptsächlich mit den Einflüssen der Verpackungsgestaltung auf die erforderliche Öffnungskraft, möglichen weiteren Faktoren wie Motorik und Kognition und die daraus resultierende Verbraucherzufriedenheit beschäftigen. Daraus soll die Bedeutung dieser Einflussfaktoren erstmals in einer der Lebenswirklichkeit von Verbrauchern angelehnten Situation für das Verständnis der Verpackungskonzeption ermittelt werden. Die Kenntnis der Zusammenhänge im Vergleich mit instrumentellen Untersuchungsmethoden eröffnet die Möglichkeit, mit Hilfe der erhaltenen Daten leichtes Öffnen und sichere Handhabung gezielt hinsichtlich bestimmter Merkmale planbar vorherzusagen und zu optimieren.

From the English summary that starts on page 118:
The studies comprise examination of various commercial packages based on target group testing according to CEN/TS 15945. The choice of packages based on the priorities of the BAGSO studies and suspected barriers during opening. The results of the test steps effectiveness and efficiency of the opening procedure and the evaluation of consumers’ satisfaction with the opening procedure  were decisive for the assessment as easy-to-open package. The tests took place under standardized conditions, which were modelled on the situation at domestic kitchen tables. The target group  comprised random samples of people who represent a wide range of life experiences and life situations. With participant’s approval hand movements during opening procedures were documented using videotapes in order to understand and recognize patterns. Instrumental measurements of selected packaging types acted as reference to investigate the required opening force and to detect a possible correlation with the results of the target group testing. The comparison of both methods showed that the required opening force or the applicable force to the packages correlated not primarily with the results of target group tests, they had only minor importance for the consumers ́ satisfaction with the opening procedure. A study of blister packages led to a surprising result: the packages affording greater applied force when opened were evaluated significantly better in target group study than a n equivalent package, which needed less opening force. Similar packages, which required the same maximum force to open, have been rated significantly different in target group testing.

Adherence to long-term therapies: evidence for action

This report is based on an exhaustive review of the published literature on the definitions, measurements, epidemiology, economics and interventions applied to nine chronic conditions and risk factors. These are asthma, cancer (palliative care), depression, diabetes, epilepsy, HIV/AIDS, hypertension, tobacco smoking and tuberculosis.

Intended for policy-makers, health managers, and clinical practitioners, this report provides a concise summary of the consequences of poor adherence for health and economics. It also discusses the options available for improving adherence, and demonstrates the potential impact on desired health outcomes and health care budgets. It is hoped that this report will lead to new thinking on policy development and action on adherence to long-term therapies.

Interventions to Improve Adherence in Patients with Immune-Mediated Inflammatory Disorders: A Systematic Review


In patients with immune-mediated inflammatory disorders, poor adherence to medication is associated with increased healthcare costs, decreased patient satisfaction, reduced quality of life and unfavorable treatment outcomes.


To determine the impact of different interventions on medication adherence in patients with immune-mediated inflammatory disorder

The difficulties of old people taking drugs

There is considerable interest in the problems of the elderly taking drugs correctly and appropriately. A recent survey (Parkin et al. 1976) showed that these problems that have long been known in geriatric practice have now been noted by general physicians. This review was undertaken when an occupational therapist in a geriatric unit team noted that, although patients and their relatives were taught methods of dressing, toileting, shaving, bathing, eating, walking, transferring to a chair, wheelchair mobility and communication by the occupational therapist, physiotherapist and speech therapist, no advice or teaching was given concerning the accurate taking of the drugs prescribed. The results of a detailed investigation are reported elsewhere (Atkinson, Gibson & Andrews 1978). Repeatedly, patients ready for discharge were handed a batch of drugs by a nurse at the last possible moment, even while sitting by their luggage awaiting the ambulance. Following this, special attention was paid to problems such as intellectual impairment, loss of memory and confusion, poor sight, inability to handle containers, failure to take drugs and lack of patient-education. During ward rounds, particularly when a geriatric health visitor was present, attention was drawn to special topics such as the number of patients who inadvertently kill themselves and the numbers needing readmission due to failure to take drugs, overdosage or underdosage or mixing of drugs (Wade 1972). Ferguson Anderson’s comment (1974) that 7.15% of hospital admissions are due to drug reactions was also noted.

Child-resistant containers for the elderly?

With the introduction of child-resistant medication containers, the geriatric patient has suffered another setback in an already poor record of medication compliance. Most physicians, while applauding the remarkable decrease in child poisonings resulting from safety closure devices, are not aware of the burden that child-resistant medication containers has imposed on the elderly. Nor are they aware of methods to correct the problem. Elderly patients, however, are keenly aware of the problems of child-resistant medication containers but are ignorant about methods to overcome the difficulty in opening and closing them.

Adherence of elderly patients to treatment with pentoxifylline

A study of adherence to treatment was conducted by 179 general practitioners in elderly outpatients with geriatric cerebral symptomatology treated with pentoxifylline. The drug was provided in 2 different randomized packages, with or without memory‐aid stickers (also randomized). Compliance was assessed by pill count after 1 mo of treatment. Clinical evolution was assessed by a digit‐span test, and by filling in 9 “relative” visual analogue scales of aggravation—improvement. Side effects were recorded from patient complaints. Leftover drug was brought back by 83.1% of patients, and this proportion was influenced neither by packaging type nor memory‐aid stickers. Compliance was considered good (fewer than 30 tablets returned) in 62% of patients, and was not influenced by either packaging types or stickers. Peaks of pill count were evident at multiples of packaging units (10 or 40 according to type). Compliance was not related to age or sex, but was related to memory score. There was a correlation between compliance and clinical improvement, and a significant inverse correlation between the former and the frequency of side effects.