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Development and Evaluation of a Pictogram for Thai Patients with Low Literate Skills

Author(s): W. Phimarn*, L. Ritthiya, R. Rungsoongnoen, W. Pattaradulpithuk and K. Saramunee
Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham, Thailand, 44150

Correspondence Address:
Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantharawichai, Maha Sarakham 44150, Thailand, E-mail:

The patients with low literacy have difficulty in understanding instruction in medication labels. International pictograms would help resolve this problem. The purpose of the study is to develop a local pictogram for low literate Thai patients and to evaluate its effectiveness in improving patient’s understanding of prescription directions, medication adherence, and satisfaction. A four phase, mixed method study was designed. In phase I, a brainstorming discussion (n=21) was used to gather essential information to devise the first draft pictogram. An interview was used in phase II (n=20) and III (n=30) to adjust and finalize the pictogram. In phase IV, a randomized controlled trial was conducted. Low-literate and poor adherence patients were recruited from primary healthcare in North East Thailand. The experimental (n=67) and control (n=67) groups received medications with attached final pictogram and traditional labels, respectively. Participants were assessed understanding and adherence of medication use on day 0 and 14 with a reminder on day 7. Satisfaction of pictogram use was also evaluated on day 14. The experimental group had post intervention understanding scores that were significantly higher than the control group (100.00 vs 97.10±3.64; p<0.046). Moreover, the adherence score in the experimental group was statistically higher than the control group (97.41±3.62 vs 95.84±4.72; p<0.033). Most participants in the experimental group were satisfied with the final pictogram and also agreed that the local pictogram may improve their understanding and adherence. Pictograms improved both understanding and adherence among low literate participants.

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