Interpretation of Medication Pictograms by Adults in the UK

BACKGROUND Patients' ability to understand information about medication is crucial for safety and effectiveness. Rates of illiteracy worldwide indicate that written information alone cannot meet many patients' needs. Medication pictograms are an alternative, but may be culturally sensitive. Previous testing has used large pictograms, which are impractical for conventional drug information formats. OBJECTIVE To compare 2 sets of pictograms for instructions or warnings (from the US and South Africa) for understandability by adults in the UK and examine the effects of pictogram size and repeat presentation on understandability among older adults. METHODS In the first part of the study, 160 adults (aged 17–83 y) reviewed and interpreted 10 pictograms. In the second, 67 older adults (aged 65–96 y) were randomly assigned to review 10 small or large pictograms. After giving their interpretation, they were informed of the correct meaning. One week later, they were shown the same pictograms and gave their interpretation. RESULTS The pictograms for the 10 different instructions and warnings showed great variation in interpretation rates (7.5–90%), with few significant differences between the US and South African versions. Only 3 were understood by ≥85% of the population. Pictograms performed significantly better if they were larger and at the second presentation. CONCLUSIONS Pictograms have the potential to help patients understand information on drug therapy. This study shows that some existing pictograms are not easily interpreted and that testing is needed before their implementation. A reduction in their size to allow incorporation into conventional written formats may cause additional problems for patients.

[1]  Ros Dowse,et al.  Effect of Pictograms on Readability of Patient Information Materials , 2003, The Annals of pharmacotherapy.

[2]  D. Schillinger,et al.  Association of health literacy with diabetes outcomes. , 2002, JAMA.

[3]  D. Dickinson,et al.  What information do patients need about medicines? Ask the patients--they may want to know more than you think. , 2003, BMJ.

[4]  B. Svarstad,et al.  Evaluation of written prescription information provided in community pharmacies: a study in eight states. , 2003, Journal of the American Pharmacists Association : JAPhA.

[5]  Ros Dowse,et al.  The influence of education on the interpretation of pharmaceutical pictograms for communicating medicine instructions , 2003 .

[6]  P Jaconello,et al.  Communicating with patients. , 1977, Canadian Medical Association journal.

[7]  H. Egeth,et al.  Using pictographs to enhance recall of spoken medical instructions II. , 1998, Patient education and counseling.

[8]  A. L. Dal-Fabbro,et al.  Adherence to long term therapies: evidence for action , 2005 .

[9]  M. Marinker,et al.  Not to be taken as directed , 2003, BMJ : British Medical Journal.

[10]  D. K. Raynor,et al.  Ask the patients—they may want to know more than you think , 2003, BMJ : British Medical Journal.

[11]  J Bennett,et al.  Communicating with patients. , 1992, BMJ.

[12]  Khan Mk,et al.  Health literacy: report of the Council on Scientific Affairs. Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. , 1999, JAMA.

[13]  P. Aslani,et al.  Factors influencing consumer use of written drug information. , 2003, The Annals of pharmacotherapy.

[14]  J A Bucher,et al.  Using pictographs to enhance recall of spoken medical instructions. , 1998, Patient education and counseling.

[15]  L. de Jong-van den Berg,et al.  Accessing medication information by ethnic minorities: barriers and possible solutions , 2003, Pharmacy World and Science.

[16]  M Duman,et al.  Patient information leaflets for medicines: using consumer testing to determine the most effective design. , 2001, Patient education and counseling.

[17]  Mark V. Williams,et al.  Health literacy and knowledge of chronic disease. , 2003, Patient education and counseling.

[18]  R. Dowse,et al.  The evaluation of pharmaceutical pictograms in a low-literate South African population. , 2001, Patient education and counseling.

[19]  M D Shepherd,et al.  Design, development, and evaluation of visual aids for communicating prescription drug instructions to nonliterate patients in rural Cameroon. , 1997, Patient education and counseling.

[20]  Peter Knapp,et al.  We are the experts: people with asthma talk about their medicine information needs. , 2004, Patient education and counseling.

[21]  N. Gray Health literacy: Implications for concordance and compliance , 2003 .

[22]  D W Baker,et al.  Health literacy among Medicare enrollees in a managed care organization. , 1999, JAMA.

[23]  D. Schillinger,et al.  Functional Health Literacy and Medication Use: The Pharmacist's Role , 2003, The Annals of pharmacotherapy.

[24]  R. Dowse,et al.  Pictograms in pharmacy , 1998 .