Development and Evaluation of Pictograms of Auxiliary Labels on Instructions on Drug Use for Illiterate Muslim Patients

Abstract

Objective: To develop and evaluate the communicability of pictorial auxiliary labels for instruction of drug use in illiterate Thai Muslim patients. Method: The researcher surveyed the instructions of drug use specified on auxiliary labels from 52,929 prescriptions in Yala Hospital in 1 year (January-December 2014). Subsequently, pictograms were developed with 4 rounds of focus group discussions (6 persons/round) among illiterate Thai Muslims patients to identify appropriate pictures for pictograms. This research tested communicability of pictograms developed in the study and those of Bowonrat Angsuwattanakul in 109 illiterate Thai Muslims subjects. Results: Ten most commonly used auxiliary labels covered 87.9% of the drugs needed auxiliary labels. Nonetheless, 4 pictograms of them had already been developed by Bowonrat Angsuwattanakul in 2013. Among 6 remaining labels, the researchers combined the instructions "Do not chew or grind medicine" and "Do not chew/ grind the medicine/ split the medication" into the same pictogram. Therefore, there were 5 pictograms to be developed. Test of communicability was conducted in 5 rounds. The first round of testing in 30 subjects showed that 4 of the pictograms were understood by less than 70% of subjects. For the pictograms “Do not take this drug more than 8 tablets per day”, no subjects could understand the meaning. Therefore, it was not further developed and removed from the study because the results of the study showed great barrier in communicating the meaning of this pictogram. The researcher revised the pictograms on “Do not chew/ crush medicine/ split the medication”, “Expire in 1 month after opening”, and “Taking this drug continuously as indicated every day until the drug finish”. Then, all 3 pictograms were tested in 30, 10 and 10 patients, respectively and revised accordingly for 2, 3 and 3 times, respectively. The test of all 8 pictograms in 109 subjects (61-74 subjects per pictogram) found that 85.1-100.0% of the subjects correctly understood the pictograms. All labels passed the American National Standards Institute (ANSI) criteria specifying that the symbol must communicate the meaning to at least 85% of the subjects. Conclusion: The pictorial labels developed in this research can convey meaning in illiterate Thai Muslim patients. Hence, these pictograms can be used in pharmacy service along with verbal and text descriptions on the drug label in patients with cultural context similar to the subjects in this study.