Hi All

Thanks for the original link to the pill card - it stimulated some great
research ideas for our pharmacy students. It's been good to see the level of
interest in using visuals, as their practical application and use is a
highly contentious issue because of their potential for misinterpretation.

We have been investigating images and pictograms communicating medicine
instructions for a few years and our first exercise in our research program
was to test the USP pictograms and develop our own modifications for a low
literate South African population. The results have been (and continue to
be) incredibly interesting, surprising, in some cases unbelievable, but what
has always heartened us is the reaction of the people with whom we have
worked. Almost 100% of our 100s of participants/patients over the years have
welcomed this form of communication, and the preference for text with
pictograms has always far exceeded preference for text alone. As we have
serious literacy problems in South Africa, many of our participants had
extremely low visual literacy skills and many had only very basic schooling.


I include some of our publications below:

Dowse, R. and Ehlers, M. (2001) The evaluation of pharmaceutical pictograms
in a low-literate South African population. Patient Education and
Counseling, 45 (2). pp. 87-99. ISSN 0738-3991 
http://dx.doi.org/10.1016/S0738-3991(00)00197-X

Dowse, R. and Ehlers, M. (2004) Pictograms for conveying medicine
instructions: comprehension in various South African language groups. South
African Journal of Science, 100 (11 & 12). pp. 687-693. ISSN 0038-2353 
http://eprints.ru.ac.za/137/

Mansoor, L.E. and Dowse, R. (2004) Design and evaluation of a new
pharmaceutical pictogram sequence to convey medicine usage. Ergonomics SA,
16 (2). pp. 29-41. ISSN 1 http://eprints.ru.ac.za/647/010-2728

Dowse, R. and Ehlers, M. (2005) Medicine labels incorporating pictograms: do
they influence understanding and adherence? Patient Education and
Counseling, 58 (1). pp. 63-70. ISSN 0738-3991 
http://dx.doi.org/10.1016/j.pec.2004.06.012

Mansoor, L.E. and Dowse, R. (2006) Medicines information and adherence in
HIV/AIDS patients. Journal of Clinical Pharmacy and Therapeutics, 31 (1).
pp. 7-15. ISSN 0269-4727 http://dx.doi.org/10.1111/j.1365-2710.2006.00696.x

Regards
Ros

Ros Dowse
Associate Professor
Faculty of Pharmacy
Rhodes University
Grahamstown, South Africa
+27 (0)46 603 8070(w)
+27 (0)83 556 9796 (mobile)

-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Helen Osborne
Sent: 28 February 2008 11:31 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 1808] Re: pill card

Hi all,

An excellent article about the use of visuals is in the African Journal of 
AIDs Research, "Understanding visuals in HIV/AIDS education in South Africa:

difference between literate and non-literate audiences" by Carstens A, Maes 
A, and Gangla-Birir L. 2006, 5(3): 221-232.

The authors researched how people understand human images as well as 
abstract symbols (such as speech and thought balloons and purely 
mathematical symbols). Here is a statement from their results: "First, for 
literate and low-literate respondents, the recognition level decreased as 
the elements became less familiar and less related to their own embodied 
experiences: humans were more easily recognized that non-human objects and 
abstracts objects, respectively.  Second, the difference between literate 
and low-literate participants increased as the elements became more 
abstract, and less embodied."

Here's a link to that issue of the Journal. I followed their directions to 
order the article and it arrived a few days later by email, 
http://www.ajol.info/viewissue.php?jid=46&id=4216&ab=0

Health literacy solutions are truly international!
~Helen

Helen Osborne, M.Ed., OTR/L
Health Literacy Consulting & Health Literacy Month
www.healthliteracy.com & www.healthliteracymonth.org
helen at healthliteracy.com & 508-653-1199
Speaker, Author, Plain Language Writer & Editor 

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