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 Sep;162(9):814-22. doi: 10.1001/archpedi.162.9.814.


Objective: To evaluate the efficacy of a pictogram-based health literacy intervention to decrease liquid medication administration errors by caregivers of young children.

Design: Randomized controlled trial.

Setting: Urban public hospital pediatric emergency department.

Participants: Parents and caregivers (N = 245) of children aged 30 days to 8 years who were prescribed liquid medications (daily dose or "as needed").

Intervention: Medication counseling using plain language, pictogram-based medication instruction sheets. Control subjects received standard medication counseling.

Outcome measures: Medication knowledge and practice, dosing accuracy, and adherence.

Results: Of 245 randomized caregivers, 227 underwent follow-up assessments (intervention group, 113; control group, 114). Of these, 99 were prescribed a daily dose medication, and 158 were prescribed medication taken as needed. Intervention caregivers had fewer errors in observed dosing accuracy (>20% deviation from prescribed dose) compared with caregivers who received routine counseling (daily dose: 5.4% vs 47.8%; absolute risk reduction [ARR], 42.4% [95% confidence interval, 24.0%-57.0%]; number needed to treat [NNT], 2 [2-4]; as needed: 15.6% vs 40.0%; ARR, 24.4% (8.7%-38.8%); NNT, 4 [3-12]). Of intervention caregivers, 9.3% were nonadherent (ie, did not give within 20% of the total prescribed doses) compared with 38.0% of controls (ARR, 28.7% [11.4%-43.7%]; NNT, 3 [2-9]). Improvements were also seen for knowledge of appropriate preparation for both medication types, as well as knowledge of frequency for those prescribed daily dose medications.

Conclusion: A plain language, pictogram-based intervention used as part of medication counseling resulted in decreased medication dosing errors and improved adherence among multiethnic, low socioeconomic status caregivers whose children were treated at an urban pediatric emergency department.

Trial registration: clinicaltrials.gov Identifier: NCT00537433.

Publication types

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

MeSH terms

  • Caregivers / education*
  • Child
  • Child, Preschool
  • Dosage Forms
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Medication Errors / prevention & control*
  • Multivariate Analysis
  • Outcome and Process Assessment, Health Care
  • Social Class
  • Teaching / methods*


  • Dosage Forms

Associated data

  • ClinicalTrials.gov/NCT00537433