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

Abstract

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. Visual images or pictograms used as a counselling tool or included in patient information leaflets have been shown to improve patients' knowledge, particularly in low-literate groups. The objective of this study was to design visuals or pictograms illustrating various ARV side effects and to evaluate them in a low-literate South African Xhosa population. Core images were generated either from a design workshop or from posed photos or images from textbooks. The research team worked closely with a graphic artist. Initial versions of the images were discussed and assessed in group discussions, and then modified and eventually evaluated quantitatively in individual interviews with 40 participants who each had a maximum of 10 years of schooling. The familiarity of the human body, its facial expressions, postures and actions contextualised the information and contributed to the participants' understanding. Visuals that were simple, had a clear central focus and reflected familiar body experiences (e.g. vomiting) were highly successful. The introduction of abstract elements (e.g. fever) and metaphorical images (e.g. nightmares) presented problems for interpretation, particularly to those with the lowest educational levels. We recommend that such visual images should be designed in collaboration with the target population and a graphic artist, taking cognisance of the audience's literacy skills and culture, and should employ a multistage iterative process of modification and evaluation.

Evaluating the Impact of Educational Interventions on Use of Highly Active Antiretroviral Therapy and Adherence Behavior in Indian Human Immunodeficiency Virus Positive Patients: Prospective Randomized Controlled Study

“…Awareness of adverse effects to ART among these patients impacts greatly with its association to manage early adverse effects of ART treatment, improved self-efficacy skills and HAART adherence behavior. These are in agreement with Dowse et al and Wolf et al studies demonstrating that awareness of ART side effects using pictograms, PIL and visual images have been shown to improve patients' knowledge, particularly in low-literate groups [38,39]. Our recent study showed an association between medication adherence outcomes and ADRs to HAART in Indian HIV positive patients demonstrating the need for EI, to promote awareness for adverse effects of ART for the early identification of sign and symptoms of ADRs [40].…”

Processus d’une recherche-développement réalisée avec des parties prenantes pour favoriser l’accès à l’information sur les services qu’ils reçoivent

“…La création d'illustrations signifiantes, qui tiennent compte de la culture des parties prenantes, est ainsi à privilégier (Peregrin, 2010). Lorsque les éléments visuels, ajoutés aux contenus écrits, ont été choisis, validés ou générés avec les personnes du public cible, ils augmentent l'acquisition de connaissances chez ces personnes (Dowse, Ramela, Barford & Browne, 2010). Dans ces situations, ces auteurs ont noté que les illustrations diminuent la quantité requise de lecture et elles clarifient les informations.…”

Lost in Translation: Language, Terminology, and Understanding of Penile–Anal Intercourse in an HIV Prevention Trial in South Africa, Uganda, and Zimbabwe

“…For socially sensitive topics, a visual aid can reduce participant discomfort; using the body-map template enabled VOICE-D participants to indicate anatomical areas without having to verbalize the words. Two-dimensional pictures alongside text have successfully been used to improve comprehension of health messages in health education campaigns (Dowse, Ramela, Barford, & Browne, 2010). However, visual aids may also be interpreted differently depending on the literacy levels of the audience and the cultural context.…”