Effect of pictograms on readability of patient information materials

Ann Pharmacother. Jul-Aug 2003;37(7-8):1003-9. doi: 10.1345/aph.1C449.


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 chi(2) 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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / adverse effects
  • Antifungal Agents / therapeutic use
  • Communication*
  • Data Collection
  • Drug Labeling*
  • Educational Status
  • Female
  • Health Education / methods*
  • Humans
  • Male
  • Nystatin / administration & dosage
  • Nystatin / adverse effects
  • Nystatin / therapeutic use
  • Patient Acceptance of Health Care
  • South Africa
  • Suspensions


  • Antifungal Agents
  • Suspensions
  • Nystatin