Pictographic instructions for medications: do different cultures interpret them accurately?

Abstract

Objective (1) To determine whether a range of linguistically diverse individuals of non‐European descent could understand the meaning of predeveloped pictograms without any additional aids such as verbal explanations; (2) to identify appropriate modifications to the pictograms to diminish errors of interpretation; and (3) to test the notion that central pictogram elements have the same meaning irrespective of language or culture. Setting The study was conducted in Vancouver, Canada. Method This study tested a set of 16 predeveloped pictograms to determine whether they accurately communicated the intended medication administration directions to participants who neither speak nor read English, French or Spanish. Both qualitative and quantitative methods evaluated the pictograms' interpretability among 39 participants from three language groups, Cantonese, Somali and Punjabi. Standard analysis of variance tested for differences due to language groups and other demographics. Key findings Only four of the 16 initial pictograms tested were interpreted correctly by 70% of participants. Relaxing the criterion from 70% to 50% included seven more. Modifications of problem elements within the pictograms further improved interpretation accuracy levels by 22%, to a final accuracy of 67.15%. Quantity errors were twice as common as timing, administration route or auxiliary instruction errors. Conclusions Participants could identify particular pictographic symbols they found confusing or ambiguous. Basic education and time since immigration predicted interpretation accuracy better than first language or any other demographic characteristic.

The Influence of Symbols on the Short-Term Recall of Pharmacy-Generated Prescription Medication Information in a Low Health Literate Sample

“…The sample for this investigation consisted primarily of African Americans, and published evidence suggests that cultural background may influence the interpretation of symbols (Kassam, Vaillancourt, and Collins, 2004). However, inadequate health literacy encompasses society (Kirsch et al, 1993), and this investigation provides evidence that functional health literacy of patients is an important element of the medicationuse process.…”

Development of an illustrated medication schedule as a low-literacy patient education tool

“…However, when applying pictorial images cross-culturally, it is important to pilot test the images to ensure that they are easily interpreted and culturally appropriate. Groups may misinterpret pictorial materials which do not coincide with culturally specific patterns of medication use [32,38,[52][53][54], or which are not accompanied by an explanation [36,55].…”

A Case Report on Neonatal Bartter Syndrome and It’s Effective Management-Clinical Pharmacist Perspective

“…The use of pictograms can help reduce the risks related to poor patient understanding of health care information and improve comprehension among patients across all literacy levels and cultures. [17][18][19] The use of pictograms to communicate health information to people with language barriers or limited health literacy may improve patient understanding and increase the efficiency of treatment of such individuals. Pictograms are descriptive symbols that help to convey information regarding medication and health, and can be incorporated to emphasize key counselling points.…”