Pharmaceutical indication pictograms for low literacy viewers: Health literacy and comprehension.

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.

Methodology of an approach for modifying pictograms showing medication side effects or indication.

Background: Pictograms may improve user-friendliness and comprehension of written or verbal health information. This paper describes a method to modify pictograms to improve their visual clarity, appeal and overall interpretive complexity in order to reduce the cognitive load on the viewer during comprehension.

Methodology: Nine pictograms previously tested for comprehension were selected for modification.

Pharmacy students' opinion of the routine use of pharmaceutical pictograms on a health care train serving rural limited literacy patients.

Objectives: To assess pharmacy student opinion of the routine use of pictograms for counselling and communicating medicine-related information.

Methods: A Google Forms survey was sent to co-ordinators at five Pharmacy Schools who distributed the link to 152 students following their 5-day work placement. The survey included Likert Scale and open questions on prior pictogram exposure, their usefulness in practice and their design.

Pharmacists, are words enough? The case for pictograms as a valuable communication tool.

Despite living in a visually saturated world, with visual content permeating seemingly every aspect of our lives, an area in which visuals are still under-represented is health communication. Written health information, including medicines information, has generally been reported as being reader-unfriendly, offering challenges and barriers to even the most literate of readers with its often lengthy, detailed documents, use of medical jargon, and densely packed small text. The inclusion of visual content in the form of pictograms offers the potential to enhance the attractiveness and reader-friendliness of the information as well as improving comprehension and recall of medicines and general health information.

Designing and reporting pictogram research: Problems, pitfalls and lessons learnt.

Research describing the design, evaluation or use of pictograms for various health-related applications is receiving increasing attention in the literature. However, recent reviews of this body of literature have commented adversely on the overall quality of the research, highlighting problems with the pictogram design process, as well as calling for improvement in both the methodology and reporting of all aspects of designing, developing, modifying, evaluating and applying pictograms in practice. The heterogeneity in study design, as well as in the interventions and outcomes measured, prevents overall conclusions being drawn about the effectiveness of pictograms on comprehension and medicine-taking behaviour such as adherence and self-care.

Acceptance of ambulatory blood pressure monitoring in a semi-rural population in South Africa.

Background: Ambulatory blood pressure monitoring is a valuable tool that helps in providing an insight into the diagnosis and management of hypertension; however, no evidence exists of its acceptance in the diverse South African population.

Aim: We assessed the acceptance of an ambulatory blood pressure monitor in patients attending public sector primary health care (PHC) clinics.

Setting: Five PHC clinics in the Makana subdistrict in the Eastern Cape.

Outcome of illustrated information leaflet on correct usage of asthma-metered dose inhaler.

Background: Research globally has shown that metered dose inhaler (MDI) technique is poor, with patient education and regular demonstration critical in maintaining correct use of inhalers. Patient information containing pictorial aids improves understanding of medicine usage; however, manufacturer leaflets illustrating MDI use may not be easily understood by low-literacy asthma patients.

Aim: To develop and evaluate the outcome of a tailored, simplified leaflet on correct MDI technique in asthma patients with limited literacy skills.

Preferences of Resettled Refugees on Pictograms Describing Common Symptoms of Illness.

Illustrated health resources are useful for people who have limited English linguistic ability. The aim was to compare the preferences of resettled refugees from Africa and non-African countries, on pictograms describing common symptoms of illness. Data were collected in two cities in Queensland, Australia.

'Yummy or crummy?' The multisensory components of medicines-taking among HIV-positive youth.

The global rollout of Antiretroviral Treatment (ART) has revealed an urgent need to understand the medicines-taking practices of HIV-positive adolescents. In the last decade, the literature on the social determinants of health has broadened the evidence-base on ART adherence. Interdisciplinary studies have expanded conceptions of medicines-taking beyond clinical or health systems frameworks, recognising the importance of socio-structural conditions and of patients' beliefs and experiences.

An illustrated booklet for reinforcing community health worker knowledge of tuberculosis and facilitating patient counselling.

Background: Community health workers (CHWs) have facilitated the move to decentralise tuberculosis (TB) management, but lack access to information appropriate both for personal use and in patient interaction and education.

Aim: To explore the impact of a pictorial-based TB booklet on reinforcing CHW knowledge and facilitating patient counselling.

Setting: This study was conducted in local primary health care clinics and the Hospice in Grahamstown, Eastern Cape Province in South Africa.

The impact of illustrated side effect information on understanding and sustained retention of antiretroviral side effect knowledge.

Background: Prompt management of side effects is critical to supporting adherence to antiretroviral (ARV) medication.

Objective: This study examines the impact of presenting side effect information using simple text combined with pictograms on sustained knowledge of ARV side effects over three months.

Method: Previously designed side effect pictograms, combined with simple text, were incorporated into a side effects panel within an ARV information leaflet.

Knowledge and practice of healthcare professionals relating to oral medicine use in swallowing-impaired patients: a scoping review.

Objectives: Swallowing impairment is a growing problem that affects 16% of the overall population and can significantly affect medicine-taking. However, little is known about the knowledge and practice of healthcare professionals (HCPs) relating to swallowing-impaired (SI) patients. The aim of this scoping review was to investigate the knowledge and practice of HCPs in supporting SI patients with their medicine-taking, to identify their reference sources, and to describe their training and information needs.

Reflecting on patient-centred care in pharmacy through an illness narrative.

Patient-centred care (PCC) is rapidly adopting a central position in discussions on the quality of healthcare, with patient-centredness deemed essential to transforming the healthcare system. PCC speaks to the quality of patient-provider relationships and has been defined as an approach to providing care that is respectful of and responsive to individual patient preferences, needs, and values, while ensuring that patient values guide all clinical decisions. However its place within pharmacy practice is unclear and is as yet undefined, particularly in relation to pharmaceutical care.

Development and evaluation of pictograms on medication labels for patients with limited literacy skills in a culturally diverse multiethnic population.

Background: Much of the migrant workforce in Qatar is of low literacy level and does not understand Arabic or English, presenting a significant challenge to health care professionals. Medicine labels are typically in Arabic and English and are therefore poorly understood by these migrant workers.

Objective: To develop pictograms illustrating selected medicine label instructions and to evaluate comprehension of the pictograms or conventional text supported with verbal instructions in foreign workers with low literacy skills.

Understanding the medicines information-seeking behaviour and information needs of South African long-term patients with limited literacy skills.

Background: Although much health information-seeking behaviour (HISB) research has been reported in patients with good literacy skills, little is known about HISB in patients with limited literacy skills served by under-resourced health-care systems.

Objective: To investigate medicine information-seeking behaviour and information needs in patients with limited literacy.

Methods: Using a question guide, four focus group discussions (FGDs) were conducted to explore themes related to information needs, information-seeking practices and awareness of and ability to utilize information sources.

An illustrated leaflet containing antiretroviral information targeted for low-literate readers: development and evaluation.

Objective: To apply a dual visual/textual modal approach in developing and evaluating a medicine information leaflet with pictograms suitable for low-literate HIV/AIDS patients. To identify and recommend best practices in this type of information design.

Methods: A simple leaflet incorporating pictograms was designed for an antiretroviral regimen.

Developing visual images for communicating information aboutantiretroviral side effects to a low-literate population.

The side effects of antiretroviral (ARV) therapy are linked to altered quality of life and adherence. Poor adherence has also been associated with low health-literacy skills, with an uninformed patient more likely to make ARV-related decisions that compromise the efficacy of the treatment. Low literacy skills disempower patients in interactions with healthcare providers and preclude the use of existing written patient information materials, which are generally written at a high reading level.

Applicability of the REALM health literacy test to an English second-language South African population.

Objective And Setting: To investigate health literacy in an English second language population using the REALM test, to evaluate its appropriateness and to compare health literacy between four different education categories.

Setting: Primary healthcare clinics and participant homes in Grahamstown, South Africa.

Method: The REALM test, a US-developed test, was administered via an interpreter to 125 Xhosa-speaking, English second language participants from a range of educational backgrounds.

Development of written information for antiretroviral therapy: comprehension in a Tanzanian population.

Objective: To design and develop a simple, easily readable patient information leaflet (PIL) for a commonly used antiretroviral (ARV) regimen and to evaluate its readability and acceptability in a Tanzanian population.

Method: A PIL incorporating simple text and pictograms was designed for the antiretroviral regimen of stavudine, lamivudine and efavirenz. The PIL was designed according to established good design guidelines, modified during a multi-stage iterative testing process and piloted in a South African Xhosa population.

Written medicines information for South African HIV/AIDS patients: does it enhance understanding of co-trimoxazole therapy?

Written information to promote patient education is being increasingly recognized as an integral part of quality health care. The main objective of this study was to evaluate the effect of distributing a patient information leaflet (PIL) on knowledge acquisition and recall. Two different PILs were designed for co-trimoxazole tablets: a simple, shorter PIL that incorporated pictograms and text and a text-only PIL that was longer and more complex.

Medicine labels incorporating pictograms: do they influence understanding and adherence?

The objective was to determine the influence of medicine labels incorporating pictograms on the understanding of instructions and on adherence. Eighty-seven Xhosa participants attending an outpatient clinic who had been prescribed a short course of antibiotics were randomly allocated to either a control group (41 participants given text-only labels), or an experimental group (46 participants given text + pictogram labels). All participants had a maximum of 10 years of formal schooling.

Effect of pictograms on readability of patient information materials.

Objective: To design, develop, and evaluate a simple, understandable medicine label and patient information leaflet (PIL) for nystatin suspension, and to assess the effect of incorporating pictograms on understanding in low-literate participants.

Methods: Patient information materials were designed and pretested in a pilot study (n = 20), and were subjected to the Fry's readability test. The final evaluation was conducted with 60 low-literate participants who had a maximum of 7 years of formal schooling and for whom English was their second language.