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Lecturer, School of Healthcare, University of Leeds, Leeds, England
Professor of Pharmacy Practice, School of Healthcare, University of Leeds
Medical Student, School of Medicine, University of Leeds
Medical Student, School of Medicine, University of Leeds
Reprints: Dr. Knapp, School of Healthcare, University of Leeds, Leeds LS2 9JT, England, fax 113 343 1461, p.r.knapp{at}leeds.ac.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.
Key Words: patient information, pictograms, readability
Published Online, May 16, 2005. www.theannals.com, DOI 10.1345/aph.1E483
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