Pharmaceutical pictograms for low-literate patients: understanding, risk of false confidence, and evidence-based design strategies

Mara M. van Beusekom; Anne M. Land-Zandstra; Mark J.W. Bos; Jos M. van den Broek; Henk-Jan Guchelaar

doi:10.1016/j.pec.2016.12.015

Pharmaceutical pictograms for low-literate patients: understanding, risk of false confidence, and evidence-based design strategies

Mara M. van Beusekom, Anne M. Land-Zandstra, Mark J.W. Bos, Jos M. van den Broek, Henk-Jan Guchelaar

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: This study aims to (1) evaluate ten pharmaceutical pictograms for low-literate patients on understandability, (2) assess the risk of false confidence in understanding, and (3) identify how the design can be improved to increase understandability.

Methods: Interviews were conducted with n=197 pharmacy visitors in the Netherlands. Additional qualitative discussions were held with n=30 adequately and n=25 low-literate participants (assessed with REALM-D). Qualitative data were analysed using the Thematic Framework approach.

Results: Half of the pictograms reached 67% understanding (31.0%-98.5%); two did in the low-literate group. Three pictograms showed a risk for false confidence. Pictograms appeared to be most effective when people were familiar with their visual elements and messages.

Conclusion: Low-literate people have more difficulty understanding pictograms than people with adequate literacy. While the risk of false confidence is low, for critical safety information, 67% understanding might not be sufficient. Design strategies for pharmaceutical pictograms should focus on familiarity, simplicity, and showing the intake and effect of medicine.

Practice implications: Health professionals should go over the meaning of pictograms when providing drug information to patients to increase patients' familiarity with the message and to ensure that all pictograms are sufficiently understood.

Original language	English
Pages (from-to)	966-973
Number of pages	8
Journal	Patient Education and Counseling
Volume	100
Issue number	5
Early online date	19 Dec 2016
DOIs	https://doi.org/10.1016/j.pec.2016.12.015
Publication status	Published - May 2017

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Adult
Audiovisual aids
Comprehension
Drug labeling/methods
Female

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10.1016/j.pec.2016.12.015

van-Beusekom-2019-Pharmaceutical-pictograms-PEC-AAM
© 2016, Elsevier Ireland Ltd. This work has been made available online in accordance with the publisher's policies. This is the author created accepted version manuscript following peer review and as such may differ slightly from the final published version. The final published version of this work is available at https://doi.org/10.1016/j.pec.2016.12.015
Accepted author manuscript, 555 KBLicence: CC BY-NC-ND

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title = "Pharmaceutical pictograms for low-literate patients: understanding, risk of false confidence, and evidence-based design strategies",

abstract = "Objective: This study aims to (1) evaluate ten pharmaceutical pictograms for low-literate patients on understandability, (2) assess the risk of false confidence in understanding, and (3) identify how the design can be improved to increase understandability. Methods: Interviews were conducted with n=197 pharmacy visitors in the Netherlands. Additional qualitative discussions were held with n=30 adequately and n=25 low-literate participants (assessed with REALM-D). Qualitative data were analysed using the Thematic Framework approach. Results: Half of the pictograms reached 67\% understanding (31.0\%-98.5\%); two did in the low-literate group. Three pictograms showed a risk for false confidence. Pictograms appeared to be most effective when people were familiar with their visual elements and messages. Conclusion: Low-literate people have more difficulty understanding pictograms than people with adequate literacy. While the risk of false confidence is low, for critical safety information, 67\% understanding might not be sufficient. Design strategies for pharmaceutical pictograms should focus on familiarity, simplicity, and showing the intake and effect of medicine. Practice implications: Health professionals should go over the meaning of pictograms when providing drug information to patients to increase patients' familiarity with the message and to ensure that all pictograms are sufficiently understood.",

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author = "\{van Beusekom\}, \{Mara M.\} and Land-Zandstra, \{Anne M.\} and Bos, \{Mark J.W.\} and \{van den Broek\}, \{Jos M.\} and Henk-Jan Guchelaar",

year = "2017",

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doi = "10.1016/j.pec.2016.12.015",

language = "English",

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journal = "Patient Education and Counseling",

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publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - Pharmaceutical pictograms for low-literate patients

T2 - understanding, risk of false confidence, and evidence-based design strategies

AU - van Beusekom, Mara M.

AU - Land-Zandstra, Anne M.

AU - Bos, Mark J.W.

AU - van den Broek, Jos M.

AU - Guchelaar, Henk-Jan

PY - 2017/5

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N2 - Objective: This study aims to (1) evaluate ten pharmaceutical pictograms for low-literate patients on understandability, (2) assess the risk of false confidence in understanding, and (3) identify how the design can be improved to increase understandability. Methods: Interviews were conducted with n=197 pharmacy visitors in the Netherlands. Additional qualitative discussions were held with n=30 adequately and n=25 low-literate participants (assessed with REALM-D). Qualitative data were analysed using the Thematic Framework approach. Results: Half of the pictograms reached 67% understanding (31.0%-98.5%); two did in the low-literate group. Three pictograms showed a risk for false confidence. Pictograms appeared to be most effective when people were familiar with their visual elements and messages. Conclusion: Low-literate people have more difficulty understanding pictograms than people with adequate literacy. While the risk of false confidence is low, for critical safety information, 67% understanding might not be sufficient. Design strategies for pharmaceutical pictograms should focus on familiarity, simplicity, and showing the intake and effect of medicine. Practice implications: Health professionals should go over the meaning of pictograms when providing drug information to patients to increase patients' familiarity with the message and to ensure that all pictograms are sufficiently understood.

AB - Objective: This study aims to (1) evaluate ten pharmaceutical pictograms for low-literate patients on understandability, (2) assess the risk of false confidence in understanding, and (3) identify how the design can be improved to increase understandability. Methods: Interviews were conducted with n=197 pharmacy visitors in the Netherlands. Additional qualitative discussions were held with n=30 adequately and n=25 low-literate participants (assessed with REALM-D). Qualitative data were analysed using the Thematic Framework approach. Results: Half of the pictograms reached 67% understanding (31.0%-98.5%); two did in the low-literate group. Three pictograms showed a risk for false confidence. Pictograms appeared to be most effective when people were familiar with their visual elements and messages. Conclusion: Low-literate people have more difficulty understanding pictograms than people with adequate literacy. While the risk of false confidence is low, for critical safety information, 67% understanding might not be sufficient. Design strategies for pharmaceutical pictograms should focus on familiarity, simplicity, and showing the intake and effect of medicine. Practice implications: Health professionals should go over the meaning of pictograms when providing drug information to patients to increase patients' familiarity with the message and to ensure that all pictograms are sufficiently understood.

KW - Adult

KW - Audiovisual aids

KW - Comprehension

KW - Drug labeling/methods

KW - Female

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Pharmaceutical pictograms for low-literate patients: understanding, risk of false confidence, and evidence-based design strategies

Abstract

UN SDGs

Keywords

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