Effect of Pictograms on Readability of Patient

Patient Education

Effect of Pictograms on Readability of Patient Information Materials Leila E Mansoor and Ros Dowse

OBJECTIVE: To design, develop, and evaluate a simple, understandable medicine label and patient information leaflet (PIL) for nystatin suspension, and to assess the effect of incorporating pictograms on understanding in low-literate participants. METHODS: Patient information materials were designed and pretested in a pilot study (n = 20), and were subjected to the Fry’s readability test. The final evaluation was conducted with 60 low-literate participants who had a maximum of 7 years of formal schooling and for whom English was their second language. Demographic data were collected. Participants were randomly allocated to a control (text-only information) or experimental (text + pictogram information) group, shown the medicine label and PIL, and asked to read them. A series of questions was asked about the instructions and an understanding level was calculated in each case. A second series of questions assessed patient acceptability of the materials. Differences in understanding were determined by χ2 tests. RESULTS:

Both sets of these simple written materials were generally well understood. However, the presence of pictograms was shown to improve the comprehension of more complex information, resulting in significantly more participants in the experimental group obtaining a score for understanding >80% for both the medicine label and PIL. A clear preference for the materials incorporating pictograms was expressed.

CONCLUSIONS: The presence of pictograms had a positive effect in the acquisition and comprehension of drug information. KEY WORDS: patient information, pictograms, readability.

Ann Pharmacother 2003;37:1003-9. Published Online, 21 May 2003, www.theannals.com, DOI 10.1345/aph.1C449

harmaceutical care is a philosophy that is being adoptP ed by many pharmacists worldwide and is described as a practice in which the pharmacist takes responsibility for a patient’s drug-related needs and is held accountable for this commitment.1 This entails accepting responsibility for patients’ pharmacotherapeutic outcomes and empowering the patient to practice responsible medicine-taking behavior. The pharmacist provides the necessary drug information2 and motivates the patient to take responsibility for his/her own health.3 The quality and form of the information provided must, however, be appropriate to the paAuthor information provided at the end of the text. This work was funded by Rhodes University and Roche Products.

www.theannals.com

tients’ level of education and must also take into account their culture, beliefs, attitudes, and expectations.4,5 The patient information leaflet (PIL) is the most widely used method for conveying health information6 and reinforces the information communicated during consultation with the healthcare practitioner.7 As patients retain only about 20% of what they hear,8 this combination of oral information from a healthcare practitioner plus written information in the form of a leaflet should improve patients’ knowledge and confidence, increase their active participation in healthcare decisions, and increase adherence to the treatment regimen.7,9 The number of people infected with HIV in South Africa is estimated at 5.3 million (11.7%) as of mid-2000.10 Drug therapy for HIV/AIDS and related opportunistic infections

The Annals of Pharmacotherapy

■

Downloaded from aop.sagepub.com at Chongqing Library on October 11, 2013

2003 July/August, Volume 37

■

1003

LE Mansoor and R Dowse

is often complicated and invariably involves polytherapy, a factor that has been shown to contribute to noncompliance.11 South Africa, in common with many developing countries, has significant literacy problems. Patients with low literacy and poor reading skills are more likely to experience difficulty accessing and understanding written information, which therefore places these patients at a high risk of being unintentionally noncompliant.8,12 One way of compensating for low literacy is to use visual aids such as pictograms that have been shown to enhance the comprehension and recall of information.13 If well designed, pictograms have the advantage of being understood faster, remembered longer, and being more compact than the written word.4 Pictograms on PILs and medicine labels have the potential to enhance understanding of information. Oral candidiasis is a common opportunistic infection in HIV/AIDS patients and is treated with nystatin suspension. Our research focused on drug information concerning nystatin suspension use. In South Africa, outpatients attending clinics in public hospitals and primary healthcare clinics receive their medicine from the pharmacist in the outpatient dispensary, where communication between patient and pharmacist frequently requires an interpreter. Apart from the written medicine label on the container, no additional information is normally provided. The objectives of this project were to design, develop, and evaluate a simple, understandable medicine label and PIL for the nystatin suspension and to assess the effect of incorporating pictograms on understanding of information in low-literate African IsiXhosa-speaking participants. Methods STUDY SITE AND STUDY POPULATION

The study was conducted in Grahamstown, a small town in the largely rural Eastern Cape province. It is one of the poorest of the 9 South African provinces, with an extremely high unemployment rate.14 The majority of the local African population (84%) belongs to the Xhosa ethnic group and have IsiXhosa as their home language. Twenty percent of the province’s population aged ≥20 years have had no schooling, with only 5% holding a tertiary education. All study participants were drawn from the Xhosa group and had educational backgrounds ranging from 0 to 7 years of schooling. All were required to have at least basic literacy in English, which was their second language. Relevant permission was ob-

tained, and the interviews were conducted in local primary healthcare clinics in and around Grahamstown. Approval for the study was obtained from the Rhodes University Departmental Ethical Standards Committee. RESEARCH MATERIAL

Using the United States Pharmacopeia — Dispensing Information as a guideline, patient information materials were drafted for the nystatin suspension.15 Most pictograms used in these materials had been previously produced and evaluated in the target population.4 Preliminary drafts of the medicine label and PIL were designed in collaboration with focus groups from the target population and were refined using an iterative design-testing, modification, retesting process. The PILs were then subjected to the Fry’s readability test, which allows a quick estimation of readability levels between grade 1 and college,16 and were found to be suitable for grade 4 learners. Two sets of these materials were designed: one containing text only and the other containing text and pictograms, with both leaflets containing the same textual information. Figure 1 shows the nystatin suspension medicine labels, indicating the text only and text plus pictogram labels. Figure 2 shows the nystatin suspension PIL incorporating text plus pictograms. This leaflet (29.5 × 21 cm) was folded using the Z-fold technique, whereas the text-only leaflet was a flat double-sided page (21 × 14.9 cm). These materials were tested in a pilot study in a sample of 20 Xhosa participants. As a result of this pilot study, a variety of minor modifications was made. The final versions of the nystatin suspension test materials were evaluated using 60 participants. INTERVIEW PROCESS AND DATA COLLECTION

A questionnaire for data collection was designed. Participants were randomly allocated on an alternating basis to either the control group, who looked at materials containing text only, or the experimental group, who looked at materials containing text and pictograms. A standard approach was used for all interviews. The interpreter introduced himself and the researcher and explained the purpose of the interview. These were the only 2 people who interacted with the participants. Participants were assured that this was not a test for them, but rather a test of the information materials. Selected demographic data were collected (gender, race, age, home language, educational level); the ability to tell time from either a clock face, digital watch, or both, was also assessed, as selected pictograms incorporated clock faces. Participants were asked to read the nystatin suspension medicine label and answer a series of 6 questions. Their understanding of the label was rated according to the number of questions answered correctly. Data regarding their opinion of the medicine label were also collected. Participants were then asked to read the nystatin suspension PIL, and the reading time was recorded. The subsequent testing process described was based on that pioneered by the Communication Research Institute of Australia.17 A series of 11 questions was asked, with each question being broken down into 2 parts. The first part aimed to evaluate whether the participant could locate the appropriate information in the leaflet quickly and easily, such as, “Looking at the leaflet, does it tell you what to do if

Figure 1. Nystatin suspension medicine labels (actual size of labels used 4.70 × 7.85 cm).

1004

■


■


www.theannals.com

Research Reports

you miss a dose of your medicine?” The second part of each question, “Can you tell me what it says in your own words?”, aimed to evaluate whether the participant understood the information correctly. The participants’ understanding of the instructions was calculated according to the number of answers located and understood correctly. All participants were shown both the text only and text plus pictogram PILs and were asked a series of open questions to assess patient acceptability of the PILs. These included questions that made reference to leaflet preference, leaflet size, ease of reading, and size of text. Opinions and comments were recorded. Participants were given a small honorarium at the end of the interview and thanked for their time. STATISTICAL ANALYSIS

An understanding score for the test materials was calculated based on the number of questions answered correctly. In assessing understandability of the PILs, the European Commission (EC) guideline was used.17 It sets a target that at least 80% of the participants should answer each question correctly, that is, they should locate the appropriate information and be able to explain it in their own words. Differences in understanding of the text only and text plus pictogram materials were determined using χ2 analysis; the level of significance was set at 5%.

Results

participants had attended school for 5–7 years; the remaining 20 (33%) had received schooling for 1– 4 years. No significant differences in demographic characteristics were found between the control and experimental groups. UNDERSTANDING OF MEDICINE LABEL

Four of the 6 questions asked about the nystatin suspension drug label (questions 1, 3, 5, 6) were answered correctly by most of the participants in both groups (Table 2). The presence of pictograms significantly enhanced comprehension of the information describing how to take the drug (question 2), and the times at which it should be taken (question 4). All but 2 participants in the experimental group achieved 100% understanding of the label incorporating pictograms, whereas this was achieved by less than half (40%) of the control group; this difference was significant (p = 0.001). All participants felt that the presence of pictograms on the medicine label helped them to understand the instructions better, whereas only 1 participant preferred the text-only label.

DEMOGRAPHIC CHARACTERISTICS

Sixty African IsiXhosa-speaking participants were interviewed. Demographic details are given in Table 1. Women constituted the majority (65%), and 68% of the participants were between 21 and 40 years of age. Forty (67%)

UNDERSTANDING OF THE PIL

A different pattern of responses for locating and understanding the information was noted for the leaflets. The information was located equally well in both PILs, but un-

Figure 2. Nystatin suspension patient information leaflet (text + pictograms).

www.theannals.com


■


■

1005


derstanding of the information was superior for the PILcontaining pictograms. Table 3 shows that the target set by the EC guideline was achieved for 8 of the 11 questions for the PIL containing text only, compared with 9 for the PIL containing text and pictograms. Twelve participants in the control group were able to answer all the questions correctly, compared with 18 in the experimental group. A further 4 participants in both groups correctly answered 10 of the 11 questions. In the PIL incorporating pictograms, the answers to questions 2, 3, 6, and 9 were illustrated with suitable pictograms, which resulted in 90–100% of the participants in the experimental group successfully locating the information and supplying the correct answers to these questions. However, of the 4 questions, the control group achieved satisfactory results only for question 6, where 97% of the participants located and understood the information. The other 3 questions failed to achieve the target as set by the EC guideline where 80% of the participants had to answer each question correctly. This illustrates the positive influence of pictograms on the understanding of this information. Significantly more participants in the experimental group (p = 0.005) displayed a high level of understanding (>80%) of the PIL incorporating pictograms when com-

pared with the control group (73% vs. 53%, respectively). The majority of the participants took between 2 and 4 minutes to read the PILs. PATIENT ACCEPTABILITY OF THE PIL

Table 4 illustrates that the majority of participants preferred the physical appearance of the text plus pictogram PIL and they believed that the presence of pictograms would enhance their understanding of the information. The readability of the PIL was found to be of average difficulty by the majority of subjects (63%), with the remaining 37% commenting that it was very easy to read. Although both leaflets contained the same textual information, 7% of the participants believed that the leaflet containing text plus pictograms had more words than the text-only leaflet. Discussion

The success of using pictograms as a communication aid depends on a comprehensive design and testing process to produce clear, culturally acceptable pictograms, after which their value depends largely on their appropriate use by the healthcare practitioner who must provide verbal reinforcement in conjunction with the pictograms.2 Although some research on the effectiveness of pictograms has not supported the hypothesis that pictograms are beneficial for the acquisiTable 1. Demographic Characteristics of the Study Sample tion and comprehension of drug information,18,19 most studies have demonstrated that Participants, n (%) such information and/or instructions would be Demographic Text Only Text + Pictogram Total Data (n = 30) (n = 30) (n = 60) reinforced and patient recall would be better if Gender key points were illustrated.2,5,7,17,20,21 Our findmale 9 (30.0) 12 (40.0) 21 (35.0) ings concur with this as, generally, the inforfemale 21 (70.0) 18 (60.0) 39 (65.0) mation incorporating pictograms (both label Age (y) 65 0 0 0 Highest educational level hension and understanding of medicine innone 0 0 0 structions. grades 1–4 8 (26.7) 12 (40.0) 20 (33.3) In order to stimulate interest, drug informagrades 5 –7 22 (73.3) 18 (60.0) 40 (66.7) tion should be user-friendly, attractive, and easily accessible. Evaluating consumer or patient preference through open-ended questions best assesses these features. This forms a cruTable 2. Participants Correctly Understanding Instructions on the Nystatin Suspension Label cial part of the design process of patient information materials as it provides us with valuParticipants, n (%) able information on how to improve the physiText Only Text + Pictogram cal appearance and the readability of the Question (n = 30) (n = 30) p Value leaflets, thereby making the leaflets more com1. How much medicine do you need to 29 (96.7) 30 (100.0) 0.313 take? prehensible. Leaflets with the appropriate tone, 2. How must you take this medicine? 14 (46.7) 28 (93.3) 0.000 length, and design can do much to aid respon3. How many times a day must you take 30 (100.0) 30 (100.0) sible medicine taking.17 In this study, it was this medicine? clearly apparent that the Z-fold leaflet incorpo4. What are the actual times? 1 (3.3) 22 (73.3) 0.000 rating pictograms was the preferred format 5. Do you have to finish all the medicine? 27 (90.0) 30 (100.0) 0.076 and design. 6. Should you stop taking this medicine 27 (90.0) 30 (100.0) 0.076 Previous research has shown that drug inforas soon as you feel better? mation should be written in the simplest manner

1006

■


■


www.theannals.com

Research Reports STRENGTHS AND WEAKNESSES OF THE LEAFLET possible in order that it be understood,22 with even PILs hav23 ing a positive influence on patient knowledge of medicines. The following features successfully contributed to the One of the most frequently encountered problems with writlocation and understanding of the information: ten health information is the use of language at a level 1. short, easy-to-read and highlighted headings for navgreater than the reading skill level of the average patient.7 igating through the leaflet; The levels of understanding obtained in this study for both 2. bullet points and broken paragraphs as opposed to sets of test materials were higher than the values reported in 20,22 solid text for attracting attention; previous research. This could be due in part to the simplicity of the PILs, which were designed for a low-literacy target population. Particular attention was paid to both the Table 4. Patient Acceptability of PIL (n = 60) amount of information included and the diffiParticipants, n (%) culty of the words used. Linguistically transQuestion Text Only Text + Pictogram parent words and commonly used phrases that were familiar to the target population were in1. Which of the 2 leaflets do you prefer? 1 (1.7) 59 (98.3) corporated.24 “Don’t feel like eating” replaced 2. Which leaflet do you think is easier to read? 1 (1.7) 59 (98.3) 3. Which leaflet size do you prefer? 3 (5.0) 57 (95.0) the phrase “loss of appetite” and the word “di4. Do you prefer the 3 smaller columns (text arrhea,” which cannot be pronounced phoneti+ pictograms) or the 1 larger page (text only)? 2 (3.3) 58 (96.7) cally and which was therefore likely to be Yes No poorly understood, was replaced with “get a runny tummy.” Other words that presented 5. Do you think that 1 leaflet has more words/ problems included “nystatin,” “itchiness,” writing than the other? 4 (6.7) 56 (93.3) 6. Do you like having pictures in the leaflet? 59 (98.3) 1 (1.7) “oral thrush,” “blotches,” and “allergies,” and 7. Is the writing big enough? 59 (98.3) 1 (1.7) these were merely ignored. This contributed to 8. Should the leaflet be shorter? 4 (6.7) 56 (93.3) a lack of continuity in reading and a subse9. Do you think the pictures will help you quent lack of understanding of the entire understand the information better? 60 (100.0) 0 (0.0) meaning of the sentence.

Table 3. Participants Correctly Locating and Understanding Instructions in the Nystatin Suspension PIL Participants, n (%) Text Only (n = 30)

Question

Text + Pictogram (n = 30) p Value

1. Using the leaflet, can you tell me what this medicine is used for?

located understood

29 (96.7) 29 (96.7)

30 (100.0) 30 (100.0)

0.313 0.313

2. Looking at the leaflet, what should you use to measure the correct amount of medicine to take each time?b

located understood

22 (73.3)a 21 (70.0)a

29 (96.7) 29 (96.7)

0.011 0.006

3. Does the leaflet tell you what you should do once the medicine is in your mouth?b

located understood

25 (83.3) 22 (73.3)a

30 (100.0) 30 (100.0)

0.020 0.002

4. Looking at the leaflet, does it tell you what to do if you forget to take your medicine?

located understood

29 (96.7) 29 (96.7)

29 (96.7) 26 (86.7)

1.000 0.161

5. Suppose you start feeling sick and vomit while taking this medicine. Does the leaflet tell you what to do?

located understood

29 (96.7) 24 (80.0)

25 (83.3) 21 (70.0)a

0.085 0.371

6. According to the leaflet, how many times a day must you take this medicine?b

located understood

29 (96.7) 29 (96.7)

30 (100.0) 30 (100.0)

0.313 0.313

7. Suppose you start getting a runny tummy while taking this medicine. Does the leaflet tell you what to do?

located understood

29 (96.7) 24 (80.0)

25 (83.3) 23 (76.7)a

0.085 0.754

8. Does the leaflet tell you how much of this medicine to take each time?

located understood

30 (100.0) 30 (100.0)

30 (100.0) 30 (100.0)

9. Suppose you’ve been taking this medicine for a week and you start feeling better. Does the leaflet tell you what to do?b

located understood

21 (70.0)a 21 (70.0)a

27 (90.0) 27 (90.0)

0.053 0.053

10. According to the leaflet, if you have any allergies, what should you do before taking this medicine?

located understood

27 (90.0) 24 (80.0)

26 (86.7) 26 (86.7)

0.688 0.488

11. Is there any information in the leaflet regarding whom to talk to if you have any other questions?

located understood

24 (80.0) 24 (80.0)

26 (86.7) 26 (86.7)

0.488 0.488

PIL = patient information leaflet. a Questions that did not achieve the target of 80% of participants who correctly located and understood the information. b Questions influenced by the presence of pictograms.

www.theannals.com


■


■

1007


3. large spaces between paragraphs and important points rendering the leaflet less intimidating; and 4. large print size that improved legibility. Features that detracted from complete understanding of the information included: 1. the shaded box was ineffective in attracting attention and was often ignored; and 2. the length of the leaflet was a deterrent that sometimes hindered attention span. Appropriately designed and tested drug information can improve compliance rates, satisfy patient information needs, and educate patients on the correct use of their medication.25 It also plays an important role in empowering patients to become more active participants in their health care.20 A more informed patient enables greater participation in the decision-making process, resulting in a positive impact on medicine-taking behavior and health outcomes. It is, therefore, essential that information provided on medicine labels and PILs should be patient oriented, relatively brief, concise, and comprehensive.25 Summary This project demonstrates the benefits of consumer testing in the design of patient information and can result in the production of improved materials. The presence of pictograms was found to significantly improve the understanding of instructions in both the nystatin suspension test materials. Participants also expressed an overwhelming positive desire for pictograms in their drug information. These factors lead to the conclusion that serious consideration should be given to including pictograms on labels and PILs for selected medicines. Leila E Mansoor BPharm, PhD Candidate, Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa Ros Dowse BPharm PhD, Senior Lecturer, Pharmaceutics, Faculty of Pharmacy, Rhodes University Reprints: Ros Dowse BPharm PhD, Faculty of Pharmacy, Rhodes University, Grahamstown, PO Box 94, 6140, South Africa, FAX 27 46 636 1205, E-mail [email protected]

References 1. Hepler CD, Strand L. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990;47:533-43. 2. Dowse R, Ehlers MS. Pictograms in pharmacy. Int J Pharm Pract 1998; 6:109-18. 3. Ormrod J, Robinson M. How readable are health education leaflets? Health Visit 1994;67:424-5. 4. Dowse R, Ehlers MS. Evaluation of pharmaceutical pictograms in a lowliterate South African population. Elsevier: Patient Education Counsel 2000;45:87-99. 5. Doak CC, Doak LG, Root JH. Teaching patients with low-literacy skills. Philadelphia: JB Lippincott, 1996. 6. Kenny T, Wilson RG, Purves IN, Clark J, Newton LD, Newton DP, et al. A PIL for every ill? Patient information leaflets (PILs): a review of past, present and future use. Fam Pract 1998;15:471-9. 7. Buck ML. Providing patients with written medication information. Ann Pharmacother 1998;32:962-9. 8. Report of the National Work Group on Literacy and Health. Communicating with patients who have limited literacy skills. J Fam Pract 1998; 46:168-76.

1008

■


■

9. Kitching JB. Patient information leaflets — the state of the art. J Soc Med 1990;3:298-300. 10. Dorrington RE. How many people are currently infected with HIV in South Africa? S Afr Med J 2002;92:196-7. 11. Gao X, Nau DP, Rosenbluth SA, Scott V, Woodward C. The relationship of disease severity, health beliefs and medication adherence among HIV patients. AIDS Care 2000;12:387-98. 12. Weiss BD. Identifying and communicating with patients who have poor literacy skills. Fam Med 1993;25:369-70. 13. Dowse R, Ehlers MS. The influence of education on the interpretation of pharmaceutical pictograms for communicating medicine instructions. Int J Pharm Pract 2003;11:11-8. 14. Population census (1999). Census overview ’96. www.statssa.gov.za/ census96/HTML/press/Part009.htm (accessed 2002 Oct 30). 15. United States Pharmacopeia dispensing information 2000. Advice for the patient. Drug information in lay language. 20th ed. Denver: Micromedex Inc, 2000: 117-22. 16. Spadaro DC, Robinson LA, Smith LT. Assessing readability of patient information materials. Am J Hosp Pharm 1980;37:215-21. 17. Dickinson D, Raynor DK, Duman M. Patient information leaflets for medicines: using consumer testing to determine the most effective design. Elsevier: Patient Education Counseling 2001;43:147-59. 18. Wolff JS, Wogalter MS. Test and development of pharmaceutical pictorials. Interface 1993;187-92. 19. Hanson EC, Hartzema A. Evaluating pictograms as an aid for counselling elderly and low-literate patients. J Pharm Mark Manage 1995;9 (3):41-54. 20. Bernardini C, Ambrogi V, Perioli L, Tiralti MC, Fardella G. Comprehensibility of the package leaflets of all medicinal products for human use: a questionnaire survey about the use of symbols and pictograms. Pharmacol Res 2000;41:679-88. 21. Report issued by: United States Pharmacopeia. Optimizing patient comprehension through medicine information leaflets. Final report. University of North Carolina at Chapel Hill (contractor) and Duke University (subcontractor), 1999. 22. Eaton M, Holloway RL. Patient comprehension of written drug information. Am J Hosp Pharm 1980;37:240-3. 23. Winfield AJ, Owen CW. Information leaflets: a means of improving compliance. Br J Pharm Pract 1990; June:206-9. 24. Lecoko MLE. Applicability of a health literacy test from the U.S. in a South African population. Unpublished MSc (pharmacy) thesis. Grahamstown, South Africa: Rhodes University, 2000. 25. Bradley B, Singleton M, Li Wan Po A. Readability of patient information leaflets on over-the-counter (OTC) medicines. J Clin Pharm Ther 1994;19:7-15.

EXTRACTO

Diseñar, desarrollar, y evaluar una etiqueta que sea sencilla y entendible y una hojuela informativa para el paciente (PIL, por sus siglas en inglés) para nistatina en suspensión, y determinar si el incorporar pictogramas tiene algún efecto en el nivel de comprensión de participantes con poca capacidad de leer y escribir. MÉTODOS: Se diseñaron materiales de información al paciente y se realizó un estudio piloto como pre-prueba (n = 20). Se utilizó la escala de Fry para determinar el nivel de lectura. La evaluación final se realizó utilizando 60 participantes con poca capacidad de leer y escribir que tenían un máximo de 7 años de educación formal y para los cuales el inglés es su segundo idioma. Se recolectaron datos demográficos de los participantes. Los participantes fueron asignados aleatoriamente a un grupo control (el cual recibió sólo información escrita) y un grupo experimental (el cual recibió información escrita e información pictográfica). A cada participante, se le mostró la etiqueta del medicamento y el PIL y se le pidió que lo leyera. Se hicieron una serie de preguntas acerca de las instrucciones para usar el producto y el nivel de comprensión fue calculado para cada caso. Otra serie de preguntas evaluó el grado de aceptación de los pacientes de los materiales. Se utilizaron pruebas de ji-cuadrado para determinar si existían diferencias en el nivel de comprensión. RESULTADOS: Ambos grupos de materiales escritos fueron bien comprendidos. Sin embargo, el uso de pictogramas mejoró el grado de OBJETIVOS:


www.theannals.com

comprensión de información más compleja, lo cual resultó en que un número significativamente mayor de participantes en el grupo experimental obtuviera una puntuación en comprensión sobre 80%, tanto para la etiqueta como para el PIL. Los participantes expresaron una preferencia por los materiales que incluían pictogramas. CONCLUSIONES: El uso de pictogramas tuvo un efecto positivo en la adquisición y nivel de comprensión de la información sobre un medicamento. Homero A Monsanto RÉSUMÉ

Créer, développer, et évaluer une étiquette claire et un feuillet d’information destiné aux patients (FIP) pour la nystatine en suspension. De plus, l’étude a pour but d’évaluer l’effet de pictogrammes sur la compréhension de la posologie chez des sujets faiblement éduqués. MÉTHODES: Le matériel destiné aux patients a été pré-testé à l’intérieur d’une étude pilote (n = 20) et évalué à l’aide de la grille de clarté de Fry. OBJECTIF:

www.theannals.com

L’évaluation finale est faite chez 60 sujets de langue seconde anglaise et de 7 années ou moins de scolarité. Les patients sont randomisés dans 2 groupes (texte ou texte et pictogramme). Une série de questions portant sur l’utilisation de la nystatine leur est soumise et leur niveau de compréhension est calculé dans chaque cas. De plus, des questions portant sur l’acceptabilité du matériel éducatif sont soumises. Le test du chi-carré a été utilisé pour évaluer les différences entre les groupes. RÉSULTATS: La matériel écrit est généralement bien compris. Toutefois, l’ajout de pictogrammes améliore la compréhension des directives plus complexes. Ainsi, un nombre significativement plus élevé de sujets du groupe expérimental ont compris plus de 80% des directives évaluées. Finalement, les sujets ont exprimé une claire préférence pour le matériel contenant les pictogrammes. CONCLUSIONS: La présence de pictogrammes a un effet positif sur l’acquisition et la compréhension de l’information sur le médicament.


Jean Longtin

■


■

1009