Development of Pictographs Depicting Medication Use Instructions for Low-Literacy Medical Clinic Ambulatory Patients

Abstract

• 40 million Americans cannot read general consumer health information, and 90 million have difficulty understanding and acting upon this information.• Patients with poor literacy skills are often older adults, people with limited education, and those with limited native language proficiency.• Low-literacy patients are often embarrassed to ask health care professionals for help with understanding instructions, and without help they are likely to misunderstand written medication use instructions, contributing to medical errors and noncompliance.• Early work with pictographs found that patients recalled about 14% of verbal medical instructions, but correct recall improved to 85% when verbal instructions were enhanced with pictographs. What is already known about this subject Development of Pictographs Depicting Medication Use Instructions for Low-Literacy Medical Clinic Ambulatory PatientsMei-Hua Chuang, PharmD; Chin-Lon Lin, MD; Yuh-Feng Wang, MD, MS; and Thau-Ming Cham, PhD ABSTRACT BACKGROUND: One approach to help elderly and low-literacy patients understand instructions for medication use is to use pictographs or pictorial diagrams. However, most of these pictographs are designed by medical professionals and may not be optimal for such patients.

Exploring the perspectives of potential consumers and healthcare professionals on the readability of a package insert: a case study of an over-the-counter medicine

“…Medication errors have been associated with inadequate interpretation of the labelling or PIs of medicinal products [19][20][21][22][23][24]. In this context, healthcare professionals are responsible for assuring the transmission of information fundamental to the adequate use of medicines, despite what materials might exist, in particular dosage instructions, side effects and strategies for patients' adherence [25][26][27].…”

Development of a standardized knowledge base to generate individualized medication plans automatically with drug administration recommendations

“…However, in ambulatory care, drug application is mostly accomplished by the patient himself [6]. Accordingly, patients' lack of knowledge may impair the safety of drug therapy [6][7][8][9][10][11][12] and information deficits are indeed associated with adverse health outcomes including ADEs, increased morbidity, mortality and additional health care costs [5,7,8,[10][11][12][13][14][15][16].…”

“…Moreover, the way of information exchange should be tailored to the patients' needs to be effective [24][25][26]. Hence, any verbal education should be accompanied by written instructions [21,25,27,28] to enhance recall [29,30], which is particularly effective when written in an easy and comprehensible language [4,6,7,9,12,23,25,[31][32][33]. Adding pictograms to written instructions or a pictorial supplement to verbal information may additionally facilitate understanding [8-12, 15, 31, 33, 34] and recall [29,35] of medication instructions.…”

Patient communication tools to enhance ART adherence counseling in low and high resource settings

“…[17] Concrete tools such as pictographs have been used to simplify complex medical concepts in the context of health education, [18-20] and are frequently used to communicate instructions for medication use (e.g., time of day, with or without food) among elderly and low literacy patients. [21] Pictographs have been the best method for communicating risk and benefit information regarding treatment options for patients with both low and high numeric literacy. [21] Patients report trusting information that is conveyed in pictographs.…”

“…[21] Pictographs have been the best method for communicating risk and benefit information regarding treatment options for patients with both low and high numeric literacy. [21] Patients report trusting information that is conveyed in pictographs. [22] Such pictorial tools are particularly important for use among populations with minimal education, challenged cognitive skills, or in settings where providers are not fluent in the varied languages or dialects of their patients.…”