Evaluation and validation of pictographic medication instructions in a tertiary hospital in Southwest Nigeria

Background: Written medication instructions are often complex for individuals with low literacy level to comprehend. There is a need to improve communication between providers and patients. Pictograms have the ability to simplify medication instructions to improve medication safety, compliance, and overall health outcomes.

Objectives: The study aimed to validate and evaluate a set of pictograms from the International Pharmaceutical Federation (FIP) intended to depict medication information.

Methods: Pictogram comprehension was assessed using a “guessability” test. Translucency test was also administered to numerically assess the degree to which participants associated an image to its intended meaning. Participants were made to undergo a “REALM” (Rapid Estimate of Adult Literacy in Medicine) test to identify their level of health literacy. Guessability was then re-assessed. Data analysis was carried out using averages, percentages, Chi Square test, correlational and regression statistics.

Results: Forty ( 40) volunteers participated in the study. Mean guessability score was 84.5 ± 13.7% initially which rose to 96.3 ± 5.4% on recall of pictographic instructions. The mean translucency score was 6.12 ± 0.72. Males and adults had a non-significant higher odd ratios compared to females and teens respectively as regards guessability scores {1.09 (0.28-4.26, P = 0.89); 2.14 (0.38-12.03, P = 0.39)}respectively. Pictograms were better recognized and interpreted correctly by volunteers on verbal supplementation of the instructions, P = 0.000.

Conclusion: The guessability score, though below the set threshold (≥85%) initially however rose beyond it on recall test. This presupposes that the pictograms will be potentially an ideal, valid and easily understood tool to be used for explaining medication instructions if only those instructions were verbalized.