Development and Evaluation of a Pictogram for Thai Patients with Low Literate Skills

Abstract

Low literacy is an important and widespread problem. Deficiencies in basic reading, communicating, and comprehension skills significantly affect the ability to function in daily life, particularly effective use of medicines, as patients cannot perform necessary functions in health care environment such as understanding the directions on the label on medication packages [1]. In 1990, the UNESCO reported 26.6 % of adults in the world were illiterate and of those 34.9 % were in developing countries [2]. Illiteracy rate was found quite high (30 %) in Asia, whereas it was as low as 1 % in developed countries [3]. In Thailand, the report of literacy survey illustrated that Thai people were approximately 95 % literate [4]. The Thai National Statistical Institute reported more than 7.5 % of Thai people over the age of 50 were illiterate [5]. Level of literacy has an impact on health literacy, which means the cognitive and social skills of individuals to gain access to understand and use promoted health information for maintaining good health [6]. Inadequate health literacy may therefore decrease abilities of people to understand health information. In addition, people with low literacy are likely to have difficulties in understanding language/instruction in medication labels [6,7]. This problem results in poor health outcomes and high healthcare costs [8-10]. Previous studies reported that abilities to read [11,12] and understand medication [13] labels are important to medication adherence. One way to facilitate communication of medication information with patients, who literacy skills are limited, is to incorporate visual aids; such as graphic symbols or pictograms, on medication labels and leaflets [14] .

Medication Adherence and the Role of Pictograms in Medication Counselling of Chronic Patients: a Review

“…• Self-reported adherence was 0.5 points higher in ARMS score n the intervention group, though not statistically significant (95% CI, -0.1-1.1) • Patients in the intervention group had a higher mean percentage compliance score (88%) than the controls (66%) (p < 0.05) interventions employing pictograms (Machtinger et al, 2007;Negarandeh et al, 2013;Mohan et al, 2014;Phimarn et al, 2019), whereas, individuals with high health literacy do not seem to benefit to the same degree (Kripalani et al, 2012). Table 1 summarizes the results of studies on the use of pictograms among chronically ill patients in distinction for the following diseases: asthma (n 2), diabetes (n 4), AIDS (n 7), chronic kidney disease (n 1), and cardiac disorders (n 4).…”

“…In patients living with chronic illness, data suggests that individuals with low health literacy can benefit more from interventions employing pictograms ( Machtinger et al, 2007 ; Negarandeh et al, 2013 ; Mohan et al, 2014 ; Phimarn et al, 2019 ), whereas, individuals with high health literacy do not seem to benefit to the same degree ( Kripalani et al, 2012 ). Table 1 summarizes the results of studies on the use of pictograms among chronically ill patients in distinction for the following diseases: asthma ( n = 2), diabetes ( n = 4), AIDS ( n = 7), chronic kidney disease ( n = 1), and cardiac disorders ( n = 4).…”

Exploring the Use of Pictograms in Privacy Agreements to Facilitate Communication Between Users and Data Collecting Entities: Randomized Controlled Trial

“…Most studies about pictograms used as communication tools focus on pictograms that depict pharmaceutical-and health-related information [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] or hazardous substances and their safe handling [7,[20][21][22][23][24][25][26][27][28][29][30][31].…”

“…Pictograms are useful when communicating certain types of information for which language, literacy, and reaction times can be barriers [ 32 ]. For example, some studies have shown that pictograms are beneficial for facilitating danger recognition and the understanding of precautionary measures [ 5 , 7 , 8 , 12 , 13 , 18 , 22 , 31 , 33 ]. Some of the advantages of using pictograms instead of written words are that they can facilitate faster recognition and remembrance during a second encounter and can improve the understanding of communicated messages for people with visual deficiencies or low literacy levels and people who are unfamiliar with the language used.…”

“…Some of the advantages of using pictograms instead of written words are that they can facilitate faster recognition and remembrance during a second encounter and can improve the understanding of communicated messages for people with visual deficiencies or low literacy levels and people who are unfamiliar with the language used. Chief among these advantages is that pictograms can be more easily understood than their written counterparts [ 8 , 9 , 18 , 20 , 26 , 28 , 30 , 31 ]. When it comes to health care, pictograms have been shown to be better at informing patients about examination preparation [ 34 ].…”