Pictograms for Conveying Medicine Instructions: Comprehension in Various South African Language Groups

From the abstract:

"The comprehension of medicine instructions is essential for the safe and effective use of medicines. In cases where low literacy constitutes a possible barrier to understanding written medicine information fully, the inclusion of pictograms may facilitate comprehension. Twenty-three internationally available pictograms and 23 corresponding locally developed images were evaluated in 304 low-literate respondents from eight different South African language groups. Demographic data were collected and an English literacy test was administered to those respondents who had stated that they could read English. Interviewees were shown the 46 pictograms in random order and were asked for their interpretation.

Preference for either the international or local version was assessed. Correct interpretation of individual pictogrammes ranged from 14% to 97%. Images which had been developed locally were more successful in eliciting correct interpretations than those obtained from an international source (USP [United States Pharmacopeia] pictograms). Only 2 of the 23 USP pictograms achieved the 85% criterion of the American National Standards Institute compared with 12 of 23 locally developed counterparts.

Local pictograms were preferred over the American ones in all cases. Standard of education had a significant influence on interpretation, whereas no significant differences in interpretation could be attributed to cultural diversity between the African language groups. Almost all respondents (98%) reacted positively to the idea of having pictograms on their medicine labels.

The success of the local pictograms highlighted the value of a rigorous and consultative design and test process. Results from one African language group can reliably be extrapolated to other groups in South Africa."