Redesigning pictographs for patients with low health literacy and establishing preliminary steps for delivery via smart phones

Abstract

Background:Pictographs (or pictograms) have been widely utilized to convey medication related messages and to address nonadherence among patients with low health literacy. Yet, patients do not always interpret the intended messages on commonly used pictographs correctly and there are questions how they may be delivered on mobile devices.Objective:Our objectives are to refine a set of pictographs to use as medication reminders and to establish preliminary steps for delivery via smart phones.Methods:Card sorting was used to identify existing pictographs that focus group members found “not easy” to understand. Participants then explored improvements to these pictographs while iterations were sketched in real-time by a graphic artist. Feedback was also solicited on how selected pictographs might be delivered via smart phones in a sequential reminder message. The study was conducted at a community learning center that provides literacy services to underserved populations in Seattle, WA. Participants aged 18 years and older who met the criteria for low health literacy using S-TOFHLA were recruited.Results:Among the 45 participants screened for health literacy, 29 were eligible and consented to participate. Across four focus group sessions, participants examined 91 commonly used pictographs, 20 of these were ultimately refined to improve comprehensibility using participatory design approaches. All participants in the fifth focus group owned and used cell phones and provided feedback on preferred sequencing of pictographs to represent medication messages.Conclusion:Low literacy adults found a substantial number of common medication label pictographs difficult to understand. Participative design processes helped generate new pictographs, as well as feedback on the sequencing of messages on cell phones, that may be evaluated in future research.

The evaluation of pharmaceutical pictograms among elderly patients in community pharmacy settings – a multicenter pilot study

“…A unique support throughout the process was the use of new technologies and devices such as smartphones to aid in information gathering, as seen in the Wolpin et al’s research. 15 …”

“… 23 Moreover, in our study, modification or redesigning of certain pictograms contributed to an improvement in the transparency of the pictograms, which has also been observed in the study conducted by Mok et al 24 The search for ways to improve the designed pictograms within the semiotic analysis is currently taking place, but only further validations performed with the Polish patient population will enable us to determine image elements that can raise the pictograms’ transparency/translucency in the future. 15 , 25 …”

Evaluation of the Omaha System Prototype Icons for Global Health Literacy

“…Several focus group participants noted that comprehension of the icon differed before and after the intended concept was revealed, and that once the user knows what the icon stands for, comprehension is less of an issue. This is the case for symbols used in traffic and navigation as well as health care symbols and icons for mobile devices in general [1][2][3][4][5][6]. Thus, the challenges of representing abstract concepts may need to be overcome through education of users as well as continued efforts to refine and improve the icons.…”

“…The use of symbols to represent knowledge in digital platforms is continually expanding in the digital world through growing use of technology in computers and handheld devices [1][2][3][4][5][6]. User-friendly health information in visual icons can be an effective method for improving understanding of health information and supporting successful health-related communication [1][2][3][4][5][6][7][8][9][10][11].…”

“…User-friendly health information in visual icons can be an effective method for improving understanding of health information and supporting successful health-related communication [1][2][3][4][5][6][7][8][9][10][11]. This is especially important for disadvantaged groups that may face digital disparities due to low literacy or other barriers [12][13][14].…”