This manual which updates an earlier edition of PATHs (Program for Appropriate Technology in Health) guide to the development of health and family planning materials targeted to illiterate and low-literate audiences is introduced with a discussion of the prevalence and impact of illiteracy in the world. Each of the remaining sections describes a step in the development of materials to support educational efforts based on interpersonal communication techniques. Section 2 explains how to profile target audiences to determine their specific needs. The third section covers project planning in terms of the allocation of time and financial resources. Section 4 describes how to use KAP (knowledge attitude practice) surveys in-depth interviews and focus group discussions to derive information from target audiences for needs assessment. The manual continues with a section that details how to use data derived from audience research to develop messages and communicate them pictorially in a clear sequential manner. Section 6 presents guidelines for materials production that cover design/layout illustrations and text. The seventh section deals with pretesting and revision to ensure that intended messages are conveyed and materials are acceptable to the target audience. Section 8 identifies issues to consider during the printing stage and section 9 provides advice on the dissemination of the materials and on how to train health workers to use the materials effectively. The final section points out methods to use in evaluating the field use of the materials and their impact on the target audience. Appendices provide a 1) pretest background sheet 2) pretest data sheet 3) pretest summary of results sheet 4) monthly record form for distribution of educational materials by health educators and 5) discussion of special considerations on visual literacy.