An illustrated leaflet containing antiretroviral information targeted for low-literate readers: development and evaluation

Patient Educ Couns. 2011 Dec;85(3):508-15. doi: 10.1016/j.pec.2011.01.013. Epub 2011 Feb 8.


Objective: To apply a dual visual/textual modal approach in developing and evaluating a medicine information leaflet with pictograms suitable for low-literate HIV/AIDS patients. To identify and recommend best practices in this type of information design.

Methods: A simple leaflet incorporating pictograms was designed for an antiretroviral regimen. Cognitive testing for understanding was conducted in 39 low-literate, South African, antiretroviral-naïve adults. Participants were required to locate and explain the information, and were questioned on their opinion of leaflet layout and contents.

Results: Average understanding of the leaflet was 60%. Basic medication information was the best understood. An overall lack of knowledge of HIV/AIDS and its core concepts was found. Only half the participants considered this simple leaflet "easy" to read. All endorsed the inclusion of pictograms.

Conclusion: This testing method used in ARV-naïve individuals was invaluable in identifying areas needing modification before its use in patients. Text associated with pictograms was more noticeable and better understood, but only if they were closely juxtaposed.

Practice implications: Leaflet design should consider culture and literacy skills, be informed by learning theory and design principles, include visuals to enhance appeal and improve understanding, and involve end-users. Verbal counseling should accompany written information.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Retroviral Agents / therapeutic use
  • Audiovisual Aids
  • Communication*
  • Comprehension*
  • Dyslexia
  • Educational Status*
  • Female
  • Focus Groups
  • HIV Infections / drug therapy
  • Humans
  • Male
  • Middle Aged
  • Pamphlets*
  • Patient Education as Topic / methods*
  • Program Evaluation
  • Reading
  • South Africa
  • Young Adult


  • Anti-Retroviral Agents