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Effectiveness of Pictograms in Patients or Caregivers in Healthcare Settings: a Systemic Review
Corresponding Author(s) : P. Nikitha Reddy
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 12 No. 3 (2024): 2024 Volume -12 - Issue 3
Abstract
Background: Pictograms are a graphical symbol that covey’s concept through its pictorial resemblance to a physical object, pictorial representation has shown to have a potential in enhancing patient knowledge.
Aim: To study the effectiveness of pictorial health information on the patients or their caregivers.
Methodolgy: The systematic review was conducted according to PRISMA guidelines. Randomized controlled trials including participants over 18 years older were included in the review.
RCTs were included as it reduces certain type of bias by randomly allocating the participants.
The risk of bias was assessed using Cochrane risk of bias tool, which assessed 5 different domains and scores were given to their indication of low, high and unclear risk.
The interventions include in these articles were pictograms with text or pictograms with verbal instructions and low literacy plan pictograms.
Results: A total of 965 articles were retrieved through electronic searching, which went through first and second pass screening. Among which articles were included for the system review. All the included studies show similar outcomes which said that pictograms had a positive impact on improving patient adherence to their respective medication and helped in decreasing dosing error. Factors such as age, gender, literacy level have a negative impact on adherence. Pictogram intervention improved adherence especially in patients with low health literacy levels than the written/oral interventions.
Conclusion: The current review provided a brief literature on the effectiveness of pictogram in healthcare setting in patients or their caregivers of various age groups.
Future studies should be aimed to identify the knowledge gaps and barriers impacting the effectiveness of pictogram for better patient education and safety
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- Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. The lancet. 1997; 349(9061):1269-76
- Garrett L. Existential challenges to global health. New York: Center on International Cooperation, New York University. 2013.
- Klein RE, Weller SC, Zeissing R, Richards FO, Ruebush TK. Knowledge, belief and practices in relation to malaria transmission and vector control in Guatemala. Am J TropMed. Hyg. 1995; 52(5):383–8.
- Parker RM, Ratzan SC, Lurie N. Health literacy: a policy challenge for advancing high-quality health care. Health Aff. 2003; 22(4):147-53.
- Hewitt M. Roundtable on Health Literacy; Board on Population Health and Public Health Practice; Institute of Medicine. Facilitating State Health Exchange Communication Through the Use of Health Literate Practices: Workshop Summary. National Academies Press. p. 1; 2012
- McQueen DV, Kickbusch I, Potvin L, Pelikan JM, Balbo L, Abel T. Health and modernity: the role of theory in health promotion. Springer Science & Business Media; 2007.
- Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K. et al., Health Literacy Interventions and Outcomes: An Updated Systematic Review. Evid Rep Technol Assess. 2011; 199:1-941.
- Health Literacy and Patient Education Guide: Pictograms. Strauss Health Science Library. Last update 2020.
- Schroyens W, Schaeken W, Handley S. In search of counter-examples: Deductive rationality in human reasoning. Q J Exp Psychol A. 2003 1; 56(7):112945.
- van Beuskom M, Kerkhoven AH, Bos MJW, Guchelaar HJ, van den Broek JM. The extent and effects of patient involvement in pictogram design for written drug information: a short systematic review. Drug Discov Today. 2018; 23(6):1312-1318.
- Chan HK, Hassali MA, Lim CJ, Saleem F, Tan WL. Using Pictogram to assist caregivers in liquid medication administration: Systematic review. J Clin Pharm Ther. 2015; 40(3):266-72.
- Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W264.
- Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD et al. The Cochrane Collaboration's tool for assessing risk of bias in Randomised trials. BMJ. 2011; 343:d5928.
- Braich PS,Almeida DR, Hollands S, Coleman MT. Effects of pictograms in educating 3 distinct low-literacy populations on the use of postoperative cataract medication, Can JOphthalmol. 2011; 46(3):276-81.
- Browne SH, Barford K, Ramela T, Dowse R. The impact of illustrated side effect information on understanding and sustained retention of antiretroviral side effect knowledge. Res Social Adm Pharm. 2019; 15(4):469-73.
- Chan HK, Hassali MA. Modified labels for long-term medications: influences on adherence, comprehension and preferences in Malaysia. Int J Clin Pharm. 2014; 36(5):904-13.
- Dowse R, Ehlers M. Medicine labels incorporating pictograms: do they influence understanding and adherence? Patient Educ Couns. 2005; 58(1):63-70.
- Dowse R, Barford K, Browne SH. Simple, illustrated medicines information improves ARV knowledge and patient self-efficacy in limited literacy South African HIV patients. AIDS Care. 2014; 26(11):1400-06.
- Kalichman SC, Cherry C, Kalichman MO, Amaral C, White D, Grebler T, et al. Randomized clinical trial of HIV treatment adherence counselling interventions for people living with HIV and limited health literacy. J Acquir Immune Defic Syndr, 2013; 63(1):42-50.
- Kheir N, Awaisu A, Radoui A, El Badawi A, Jean L, Dowse R. Development and evaluation of pictograms on medication labels for patients with limited literacy skills in a culturally diverse multiethnic population. Res Social Adm Pharm, 2014; 10(5):720-30.
- Kripalani S, Schmotzer B, Jacobson TA. Improving medication adherence through graphically enhanced interventions in coronary heart disease (IMAGE-CHD): a randomized controlled trial. J Gen Intern Med, 2012; 27(12):1609-17.
- Mansoor LE, Dowse R. Medicines information and adherence in HIV/AIDS patients. J ClinPharm Ther, 2006; 31(1):7-15.
- Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, et al., Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med, 2007; 146(10):714–25.
- Negarandeh R, Mahmoodi H, Noktehdan H, Heshmat R, Shakibazadeh E. Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes, Prim Care Diabetes,2013;7(2):111–18.
- Phimarn W, Ritthiya L, Rungsoongnoen R, Pattaradulpithuk W, Saramunee K. Development and Evaluation of a Pictogram for Thai Patients with Low Literate Skills. Indian J Pharm Sci 2019; 81(1):89-98
- Yin HS, Dreyer BP, van Schaick L, Foltin GL, Dinglas C, and Mendelsohn AL. Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Arch Pediatr Adolesc Med, 2008; 162(9):814–22.
- Shonna Yin H. Health Literacy and Child Health Outcomes: Parental Health Literacy and Medication Errors. Health Literacy and Child Health Outcomes. 1938
- Zerafa N, Adami MA, Galea J. Impact of drugs counselling by an undergraduate pharmacist on cardiac surgical patient’s compliance to medicines. Pharm Pract, 2011; 9(3):156–61.
- Montagne M. Pharmaceutical pictograms: a model for development and testing for comprehension and utility. Res Social Adm Pharm, 2013, 9(5), 609–20.
- Knapp P, Raynor DK, Jebar AH, Price SJ. Interpretation of medication pictograms by adults in the UK. Ann Pharmacother, 2005; 39(7-8):1227-33.
- Morrell RW, Park DC, Poon LW. Effects of labelling techniques on memory and comprehension of prescription information in young and old adults. J Gerontol, 1990, 45(4): 166-72.
- van Beusekom MM, Kerkhoven AH, Bos MJW, Henk-JanGuchelaar, van den Broek JM. The extent and effects of patient involvement in pictogram design for written drug information: a short systematic review. Drug Discov Today, 2018; 23(6):1312-18.
- Sletvold H, Bjornli Sagmo LA, Torheim EA. Impact of pictograms of mediation adherence: A systematic literature review. Patient Educ Couns, 2019, S0738-3991(19)30562-2.
- Magnay JL, O’Brien S, Gerlinger C, Seitz C. A systematic review of methods to measure menstrual blood loss. BMC Women’s Health, 2018; 18:142.
- Chan HK, Hassali MA, Lim CJ, Saleem F, Tan WL. Using pictograms to assist caregivers in liquid medication administration: a systematic review. J Clin Pharm Ther, 2015; 40(3):266-72
References
Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. The lancet. 1997; 349(9061):1269-76
Garrett L. Existential challenges to global health. New York: Center on International Cooperation, New York University. 2013.
Klein RE, Weller SC, Zeissing R, Richards FO, Ruebush TK. Knowledge, belief and practices in relation to malaria transmission and vector control in Guatemala. Am J TropMed. Hyg. 1995; 52(5):383–8.
Parker RM, Ratzan SC, Lurie N. Health literacy: a policy challenge for advancing high-quality health care. Health Aff. 2003; 22(4):147-53.
Hewitt M. Roundtable on Health Literacy; Board on Population Health and Public Health Practice; Institute of Medicine. Facilitating State Health Exchange Communication Through the Use of Health Literate Practices: Workshop Summary. National Academies Press. p. 1; 2012
McQueen DV, Kickbusch I, Potvin L, Pelikan JM, Balbo L, Abel T. Health and modernity: the role of theory in health promotion. Springer Science & Business Media; 2007.
Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Viera A, Crotty K. et al., Health Literacy Interventions and Outcomes: An Updated Systematic Review. Evid Rep Technol Assess. 2011; 199:1-941.
Health Literacy and Patient Education Guide: Pictograms. Strauss Health Science Library. Last update 2020.
Schroyens W, Schaeken W, Handley S. In search of counter-examples: Deductive rationality in human reasoning. Q J Exp Psychol A. 2003 1; 56(7):112945.
van Beuskom M, Kerkhoven AH, Bos MJW, Guchelaar HJ, van den Broek JM. The extent and effects of patient involvement in pictogram design for written drug information: a short systematic review. Drug Discov Today. 2018; 23(6):1312-1318.
Chan HK, Hassali MA, Lim CJ, Saleem F, Tan WL. Using Pictogram to assist caregivers in liquid medication administration: Systematic review. J Clin Pharm Ther. 2015; 40(3):266-72.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W264.
Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD et al. The Cochrane Collaboration's tool for assessing risk of bias in Randomised trials. BMJ. 2011; 343:d5928.
Braich PS,Almeida DR, Hollands S, Coleman MT. Effects of pictograms in educating 3 distinct low-literacy populations on the use of postoperative cataract medication, Can JOphthalmol. 2011; 46(3):276-81.
Browne SH, Barford K, Ramela T, Dowse R. The impact of illustrated side effect information on understanding and sustained retention of antiretroviral side effect knowledge. Res Social Adm Pharm. 2019; 15(4):469-73.
Chan HK, Hassali MA. Modified labels for long-term medications: influences on adherence, comprehension and preferences in Malaysia. Int J Clin Pharm. 2014; 36(5):904-13.
Dowse R, Ehlers M. Medicine labels incorporating pictograms: do they influence understanding and adherence? Patient Educ Couns. 2005; 58(1):63-70.
Dowse R, Barford K, Browne SH. Simple, illustrated medicines information improves ARV knowledge and patient self-efficacy in limited literacy South African HIV patients. AIDS Care. 2014; 26(11):1400-06.
Kalichman SC, Cherry C, Kalichman MO, Amaral C, White D, Grebler T, et al. Randomized clinical trial of HIV treatment adherence counselling interventions for people living with HIV and limited health literacy. J Acquir Immune Defic Syndr, 2013; 63(1):42-50.
Kheir N, Awaisu A, Radoui A, El Badawi A, Jean L, Dowse R. Development and evaluation of pictograms on medication labels for patients with limited literacy skills in a culturally diverse multiethnic population. Res Social Adm Pharm, 2014; 10(5):720-30.
Kripalani S, Schmotzer B, Jacobson TA. Improving medication adherence through graphically enhanced interventions in coronary heart disease (IMAGE-CHD): a randomized controlled trial. J Gen Intern Med, 2012; 27(12):1609-17.
Mansoor LE, Dowse R. Medicines information and adherence in HIV/AIDS patients. J ClinPharm Ther, 2006; 31(1):7-15.
Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, et al., Pharmacist intervention to improve medication adherence in heart failure: a randomized trial. Ann Intern Med, 2007; 146(10):714–25.
Negarandeh R, Mahmoodi H, Noktehdan H, Heshmat R, Shakibazadeh E. Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes, Prim Care Diabetes,2013;7(2):111–18.
Phimarn W, Ritthiya L, Rungsoongnoen R, Pattaradulpithuk W, Saramunee K. Development and Evaluation of a Pictogram for Thai Patients with Low Literate Skills. Indian J Pharm Sci 2019; 81(1):89-98
Yin HS, Dreyer BP, van Schaick L, Foltin GL, Dinglas C, and Mendelsohn AL. Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children. Arch Pediatr Adolesc Med, 2008; 162(9):814–22.
Shonna Yin H. Health Literacy and Child Health Outcomes: Parental Health Literacy and Medication Errors. Health Literacy and Child Health Outcomes. 1938
Zerafa N, Adami MA, Galea J. Impact of drugs counselling by an undergraduate pharmacist on cardiac surgical patient’s compliance to medicines. Pharm Pract, 2011; 9(3):156–61.
Montagne M. Pharmaceutical pictograms: a model for development and testing for comprehension and utility. Res Social Adm Pharm, 2013, 9(5), 609–20.
Knapp P, Raynor DK, Jebar AH, Price SJ. Interpretation of medication pictograms by adults in the UK. Ann Pharmacother, 2005; 39(7-8):1227-33.
Morrell RW, Park DC, Poon LW. Effects of labelling techniques on memory and comprehension of prescription information in young and old adults. J Gerontol, 1990, 45(4): 166-72.
van Beusekom MM, Kerkhoven AH, Bos MJW, Henk-JanGuchelaar, van den Broek JM. The extent and effects of patient involvement in pictogram design for written drug information: a short systematic review. Drug Discov Today, 2018; 23(6):1312-18.
Sletvold H, Bjornli Sagmo LA, Torheim EA. Impact of pictograms of mediation adherence: A systematic literature review. Patient Educ Couns, 2019, S0738-3991(19)30562-2.
Magnay JL, O’Brien S, Gerlinger C, Seitz C. A systematic review of methods to measure menstrual blood loss. BMC Women’s Health, 2018; 18:142.
Chan HK, Hassali MA, Lim CJ, Saleem F, Tan WL. Using pictograms to assist caregivers in liquid medication administration: a systematic review. J Clin Pharm Ther, 2015; 40(3):266-72