Survey on the Impact of Pill Color on Medication Adherence

ABSTRACT IMAGE

INTRODUCTION

Adhering to prescribed therapies is essential for successful treatment outcomes. However, non-adherence is a significant issue that negatively impacts not only the patient but also the overall healthcare system.^[1] Medication adherence is influenced by several factors, including socio-economic conditions, healthcare team and system dynamics, condition-specific aspects, therapy-related factors, and patient-related elements. Many of these factors, particularly those involving the healthcare team and system, are largely dependent on the patient’s individual characteristics and experiences.^[2]

Patients often rely on the appearance of their medications to ensure they are taking the correct one.^[3] The physical appearance of pills, including their color, not only affects perceptions of their effectiveness but also their intended medicinal impact.^[4] The color of a product plays a significant role in consumer experiences, particularly in pharmaceuticals, influencing patient expectations, behaviors, and adherence.^[5] Furthermore, color serves as a critical feature for identifying medications, particularly beneficial for patients with impaired memory and cognitive function.^[6,7]

The accurate identification of drug products by patients is crucial for safely and effectively managing medications.^[8] Therefore, the present study aimed to evaluate how pill color influences medication adherence.

MATERIALS AND METHODS

This questionnaire-based survey was conducted among Indian patients visiting cardiologists with cardiovascular diseases. Patients were asked to fill out a form that included 9 questions designed to assess the impact of pill color on drug adherence. In addition, demographic characteristics of the patients were collected. The ethics committee approval was obtained from the Kusum Independent Ethics Committee (PAPER_PUB/2025_02).

RESULTS

A total of 901 patients were included in the study. The majority of patients learned about the survey through personal interviews (94.9%), followed by WhatsApp (3.9%). Most patients were aged above 60 years (39.2%), and majority were male (53.8%). In the educational background of the patients, the majority had below high school education (42.5%), followed by high school graduates (25.1%). The higher proportion of patients was from the west region (42.0%), followed by the east region (38.1%). Approximately 91% of the 876 patients reported that they were taking medications that needed to be taken daily. Of the 894 patients, 89.7% reported that they managed their medications themselves, while 10.3% reported that a caregiver was responsible for managing their medications. About 44.9% of patients reported that they take 3–4 medications daily. The majority of patients (53.7%) knew which of their medications were specifically prescribed for heart conditions, while 46.3% did not know.

When taking multiple pills, 29.4% of patients remember the medication by the pill color, 28.4% remember by the strip color, and 28.0% remember by the brand name [Figure 1]. The majority of patients (59.3%) reported that similar-looking medications confused them when identifying their medications, while 31.9% of patients did not experience any confusion in identifying their medications. Out of 894 respondents, 77.4% believed that unique pill colors (such as golden/special colors) can aid in easy identification, reduce forgetfulness, and enhance medication adherence, while 14.5% disagreed, and 8.1% responded “Don’t know.” Approximately 44% of patients reported taking medications with a unique color. Among these patients, 9.3% mentioned red, followed by pink (7.3%), blue (6.0%), and yellow (6.0%). Among 334 patients, 35.9% found the unique color of their medicine helpful for easy identification, 25.1% found it helpful for easy remembrance, and 7.2% found it helpful for easy finding [Table 1].

Close

Figure 1:

Gender-wise comparison of medication identification by the patients.

Export to PPT

The proportion of patients who knew which of their medications were specifically prescribed for heart conditions was comparable between those aged ≤50 years and those aged >50 years. When managing multiple medications, patients aged >50 years predominantly relied on pill color (33.4% vs. 20.9%) and strip color (30.1% vs. 24.5%) for identification compared to those aged ≤50 years. However, a higher proportion of patients aged ≤50 years primarily used brand names for identifying medicines compared to those aged >50 years (44.8% vs. 20.4%). The proportion of patients aged >50 years who reported that similar-looking medications confused identifying their medication was significantly higher compared to those aged ≤50 years (63.2% vs. 50.5%; P < 0.001) [Table 2].

The proportion of male patients who knew which medications were specifically prescribed for heart conditions was significantly higher compared to female patients (58.8% vs. 47.8%; P < 0.001). When managing multiple medications, female patients primarily relied on pill color (33.1% vs. 26.6%) and strip color (30.7% vs. 26.4%) for identification compared to male patients. In contrast, a higher proportion of male patients identified their medications using brand names compared to female patients (32.2% vs. 22.9%). The proportion of male patients who believed that unique pill colors could help in easy identification, reduce forgetfulness, and enhance medication adherence was comparable to that of female patients [Figure 2]. The proportion of male patients who believed that unique pill colors could help with easy identification, reduce forgetfulness, and enhance medication adherence was comparable to that of female patients [Table 3].

Close

Figure 2:

Gender-wise comparison of patient-related factors for medication adherence.

Export to PPT

The proportion of patients with college graduates or above who knew which medications were specifically prescribed for heart conditions was significantly higher compared to high school graduates or below (73.5% vs. 44.3%; P < 0.001). When managing multiple medications, patients with a high school education or lower predominantly relied on pill color (36.9% vs. 13.9%) and strip color (34.4% vs. 15.7%) for identification compared to those with a college education or higher. Conversely, a higher proportion of college graduates and above identified their medications using brand names compared to those with a high school education or lower (62.0% vs. 11.9%). The proportion of patients with a high school education and below who reported that similar-looking medications confused identifying their medication was significantly higher compared to those with college graduates or above (67.1% vs. 42.9%; P < 0.001). The proportion of patients with a high school education who believed that unique pill colors could help in easy identification, reduce forgetfulness, and enhance medication adherence was significantly higher compared to those with a college education and above (82.4% vs. 66.9%; P < 0.001) [Table 4].

DISCUSSION

The influence of drug appearance on drug expectations has been a longstanding concern in managing medications and ensuring patient safety.^[6] The effectiveness of a treatment relies on both the medication’s efficacy and the patient’s adherence to the prescribed regimen. Patients, healthcare providers, and healthcare systems all play a part in enhancing medication adherence.^[1]

Patients who take five or more medications daily tend to place greater significance on the appearance of tablets to help differentiate between them compared to those taking fewer medications.^[9] In the present study, it was found that among patients taking multiple pills, 29.4% recall their medication based on the pill color, 28.4% based on the strip color, and 28.0% based on the brand name. Color significantly influences consumer perceptions, with studies suggesting that between 60% and 90% of product evaluations are primarily influenced by color. This underscores the critical role of color and its capacity to shape consumers’ perceptions of a product.^[5]

In the current study, approximately 59% of patients reported that similar-looking medications confused them when identifying their medication. This highlights the challenges patients face when medications appear alike. Color also aids in identifying small-sized medications that cannot be easily distinguished based on their shape, variations, or imprints. This visual cue plays a crucial role in ensuring patients take the correct medication as prescribed.^[6] In the present study, 77.4% of participants believed that unique pill colors can facilitate easy identification, reduce forgetfulness, and improve medication adherence. Patients who could not identify their medications either by name or appearance were more likely to report poorer adherence compared to those who could accurately identify their medications.^[3]

In the current study, around 44% of patients indicated using a medication that has a distinct color. Among these individuals, 9.3% specified red, followed by pink (7.3%), blue (6.0%), and yellow (6.0%). Similarly, a previous study showed that red and pink were the most preferred colors, and it seemed that the color of a medicine could influence the anticipated taste or flavor.^[5] Color plays a crucial role in identifying medications.^[7] In the current study, 35.9% of patients reported that the unique color of medicines helps in the easy identification of medication.

Age plays a significant role in how patients identify and adhere to their medications, particularly concerning pill color. Older adults often face practical challenges such as difficulty accessing their medications, distinguishing between different medicines, and understanding instructions on labels. These issues can lead to poor medication adherence, with up to 75% unable to differentiate between generic and brand names.^[10] In the present study, the majority of patients aged above 50 years reported that when taking multiple pills, the color of the pills helps them identify their medicines. Medication errors are a leading cause of patient harm globally, with look-alike medicines being a well-recognized contributor. These medications can be confused due to their similar appearance in packaging, shape, color, and size. This visual similarity often leads to patients mistakenly taking the wrong medication, resulting in potential harm.^[11] In the present study, it was observed that look-alike medications led to a higher degree of confusion among patients aged above 50 years compared to those aged 50 years or younger. Older people are also more likely to experience visual impairments, and as a result, they often identify oral medications by their size, shape, color, and embossing instead of reading the product label.^[12] In the current study, the proportion of patients aged >50 who believed that unique pill colors could help with easy identification, reduce forgetfulness, and enhance medication adherence was comparable to that of patients aged ≤50 years.

In the current study, when managing multiple medications, female patients predominantly used pill color (33.1% vs. 26.6%) for medication identification compared to male patients. In contrast, in a previous study, the majority of female patients identified the medication by its name, rather than relying on appearance or color.^[3]

Color and shape enhance brand recall and can impact treatment effectiveness by forming a visual association in consumers’ minds. Previous studies suggest that these factors aid in better brand recall and improve medication adherence. This is especially important in scenarios where taking medication is perceived as an unwilling task, and it becomes particularly crucial in populations with lower levels of education.^[13] In the present study, patients with a high school education or lower primarily used pill color and strip color to identify their medications when managing multiple prescriptions, compared to those with a college education or higher. The appearance of medications can be misleading, either because different medications may appear identical or because the same medication may have varying appearances.^[11] In the present study, the proportion of patients with a high school diploma or below who reported that similar-looking medications confused them when identifying their medication was significantly higher compared to those with college graduates or above.

CONCLUSION

This study emphasizes the crucial role of pill color in medication adherence, especially among patients managing multiple prescriptions. Our findings reveal that patients, particularly older adults, women, and those with lower educational attainment, rely heavily on pill color and strip color as primary cues for identifying and remembering their medications. The study also demonstrates that look-alike medications remain a significant source of confusion, with more than half of patients reporting difficulty in distinguishing between them. Importantly, the majority of participants expressed that unique pill colors enhance recognition, reduce forgetfulness, and ultimately support adherence.

From a clinical perspective, these results underscore the value of incorporating color differentiation into medication design and prescribing practices. By standardizing distinctive pill appearances, pharmaceutical manufacturers and healthcare providers can address a modifiable barrier to adherence, reduce medication errors, and improve treatment outcomes, especially in vulnerable populations. Hence, future policies and guidelines should consider pill appearance as more than just an aesthetic aspect; it should be recognized as a key patient-centered component in improving treatment adherence and ensuring safer cardiovascular therapy.