Objective: We developed a pharmacist-based patient education intervention to improve older adults' adherence to chronic heart failure (CHF) medications, which included written patient-centered instructions. The study evaluated these instructions by examining whether patients preferred them to standard pharmacy instructions. Method: Elders diagnosed with CHF participated in the randomized controlled trial (83 in the intervention; 153 in usual care control group). Instruction preferences were collected after 6 months of participation. Results: Patient-centered instructions were preferred for learning about adherence information (e.g., schedule) and standard instructions for learning about drug interactions. Preference for the patient-centered instructions was greater for intervention versus control participants and for participants with lower health literacy. Literacy no longer predicted preferences with patients' cognitive abilities controlled, suggesting literacy reflected more fundamental cognitive mechanisms. Discussion: The finding that preferences varied with patients' experience using the instructions and cognitive abilities suggests instructions should accommodate diverse patient needs and abilities.
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