Pharmaceutical Indication Pictograms for Low Literacy Viewers: Health Literacy and Comprehension

Overview

Journal Health SA

Specialty Health Services

Date 2023 Nov 6

PMID 37927939

Authors

Ros Dowse

Sam Okeyo

Simise Sikhondze

Nosihle Khumalo

Affiliations

Soon will be listed here.

Abstract

Background: Poor comprehension of pharmaceutical pictograms used on medicine labels or leaflets can compromise understanding of medicine-taking information, potentially causing negative health outcomes.

Aim: The aim was to assess association of health literacy (HL) with comprehension of pictograms displaying indication and side effect information in a lower literacy, limited English proficiency (LEP) population.

Setting: Community centre, Makhanda, South Africa.

Methods: This was a quantitative cross-sectional study using simple random probability sampling. Ninety isiXhosa-speaking adults with a maximum of 12 years schooling, attending primary healthcare clinics were interviewed using structured interviews. Health literacy was assessed using the Health Literacy Test for Limited Literacy populations. Comprehension of 10 locally developed pictograms was evaluated.

Results: The mean pictogram comprehension score was 7.9/10, with 8/10 pictograms complying with the International Organization for Standardization criterion of 66.7% correct comprehension. Only 15.6% of participants had adequate HL. A significant association of HL with pictogram comprehension was established ( = 0.002). Pictogram misinterpretation was higher in those with lower HL; adequate HL was associated with superior comprehension. Pictogram comprehension was negatively associated with age ( < 0.006), and positively associated with education ( < 0.001) and English proficiency ( < 0.001).

Conclusion: Higher HL was associated with better pictogram comprehension. Low HL, LEP and low education levels are regarded as potential indicators for possible pictogram misinterpretation.

Contribution: This study observed the potential for misinterpretation of medication pictograms. Health professionals should be aware that low HL, limited schooling and limited English proficiency could signal difficulty in fully comprehending pictogram content.

References

Nouri S, Avila-Garcia P, Cemballi A, Sarkar U, Aguilera A, Lyles C . Assessing Mobile Phone Digital Literacy and Engagement in User-Centered Design in a Diverse, Safety-Net Population: Mixed Methods Study. JMIR Mhealth Uhealth. 2019; 7(8):e14250. PMC: 6740160. DOI: 10.2196/14250. View

Mbanda N, Dada S, Bastable K, Ingalill G, Ralf W S . A scoping review of the use of visual aids in health education materials for persons with low-literacy levels. Patient Educ Couns. 2020; 104(5):998-1017. DOI: 10.1016/j.pec.2020.11.034. View

Heyns J, van Huyssteen M, Bheekie A . The effectiveness of using text and pictograms on oral rehydration, dry-mixture sachet labels. Afr J Prim Health Care Fam Med. 2021; 13(1):e1-e11. PMC: 8111613. DOI: 10.4102/phcfm.v13i1.2646. View

Mansoor L, Dowse R . Effect of pictograms on readability of patient information materials. Ann Pharmacother. 2003; 37(7-8):1003-9. DOI: 10.1345/aph.1C449. View

Al Shamsi H, Almutairi A, Al Mashrafi S, Al Kalbani T . Implications of Language Barriers for Healthcare: A Systematic Review. Oman Med J. 2020; 35(2):e122. PMC: 7201401. DOI: 10.5001/omj.2020.40. View

van Beusekom M, Land-Zandstra A, Bos M, van den Broek J, Guchelaar H . Pharmaceutical pictograms for low-literate patients: Understanding, risk of false confidence, and evidence-based design strategies. Patient Educ Couns. 2017; 100(5):966-973. DOI: 10.1016/j.pec.2016.12.015. View

Luhnen J, Steckelberg A, Buhse S . Pictures in health information and their pitfalls: Focus group study and systematic review. Z Evid Fortbild Qual Gesundhwes. 2018; 137-138:77-89. DOI: 10.1016/j.zefq.2018.08.002. View

Jairoun A, Al-Hemyari S, Jairoun M, El-Dahiyat F . Readability, accuracy and comprehensibility of patient information leaflets: The missing pieces to the puzzle of problem-solving related to safety, efficacy and quality of medication use. Res Social Adm Pharm. 2021; 18(4):2557-2558. DOI: 10.1016/j.sapharm.2021.10.005. View

Pandey M, Maina R, Amoyaw J, Li Y, Kamrul R, Michaels C . Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study. BMC Health Serv Res. 2021; 21(1):741. PMC: 8314461. DOI: 10.1186/s12913-021-06750-4. View

10.

Dowse R, Ramela T, Barford K, Browne S . Developing visual images for communicating information aboutantiretroviral side effects to a low-literate population. Afr J AIDS Res. 2015; 9(3):213-24. DOI: 10.2989/16085906.2010.530172. View

11.

van Beusekom M, Grootens-Wiegers P, Bos M, Guchelaar H, van den Broek J . Low literacy and written drug information: information-seeking, leaflet evaluation and preferences, and roles for images. Int J Clin Pharm. 2016; 38(6):1372-1379. PMC: 5124048. DOI: 10.1007/s11096-016-0376-4. View

12.

Rice L, Sara R . Updating the determinants of health model in the Information Age. Health Promot Int. 2018; 34(6):1241-1249. DOI: 10.1093/heapro/day064. View

13.

Nutbeam D, Lloyd J . Understanding and Responding to Health Literacy as a Social Determinant of Health. Annu Rev Public Health. 2020; 42:159-173. DOI: 10.1146/annurev-publhealth-090419-102529. View

14.

Berthenet M, Vaillancourt R, Pouliot A . Evaluation, Modification, and Validation of Pictograms Depicting Medication Instructions in the Elderly. J Health Commun. 2016; 21 Suppl 1:27-33. DOI: 10.1080/10810730.2015.1133737. View

15.

Sletvold H, Sagmo L, Torheim E . Impact of pictograms on medication adherence: A systematic literature review. Patient Educ Couns. 2020; 103(6):1095-1103. DOI: 10.1016/j.pec.2019.12.018. View

16.

Kessels R . Patients' memory for medical information. J R Soc Med. 2003; 96(5):219-22. PMC: 539473. DOI: 10.1177/014107680309600504. View

17.

Mohammad A, Saini B, Badcock C, Chaar B . Comparing comprehensibility of standard and enhanced prescription medicine labels: a randomized simulation. Int J Pharm Pract. 2022; 30(4):332-341. DOI: 10.1093/ijpp/riac034. View

18.

Dowse R, Ehlers M . Medicine labels incorporating pictograms: do they influence understanding and adherence?. Patient Educ Couns. 2005; 58(1):63-70. DOI: 10.1016/j.pec.2004.06.012. View

19.

Cloutier M, Vaillancourt R, Pynn D, Wade J, Preston C, Turpin P . Design and development of culture-specific pictograms for type 2 diabetes mellitus education and counselling. Can J Diabetes. 2014; 38(6):379-92. DOI: 10.1016/j.jcjd.2014.03.010. View

20.

Fry-Bowers E, Maliski S, Lewis M, Macabasco-OConnell A, DiMatteo R . The association of health literacy, social support, self-efficacy and interpersonal interactions with health care providers in low-income Latina mothers. J Pediatr Nurs. 2014; 29(4):309-20. PMC: 4062609. DOI: 10.1016/j.pedn.2014.01.006. View