Pictograms can help older patients avoid medication mishaps

Simple pictures can help seniors understand their prescriptions and avoid potentially fatal errors, researchers find

These pharmaceutical pictograms could help older people better understand their prescriptions. (Source: Ng, Annie et al: Applied Ergonomics, January 2017)

A simple picture can help people understand their prescriptions and avoid potentially deadly drug misadventures. That’s what we’ve found in a new study on how images are helping seniors understand how to take prescription medication.

Seniors are taking an increasing range of drugs to treat a variety of diseases and relieve debilitating symptoms. But it can be confusing: different medicines have different instructions. Physicians explain how to take medication, but when faced with an array of pills, older patients only remember about 20 to 60 percent of the instructions they’ve heard.

This means they often have to rely on the written instructions that accompany medication. But couple the complexity of multiple prescriptions with sight problems, poor language skills or even a degenerative disease like dementia, and a patient could be at real risk of taking the wrong – potential damaging – doses.

They could misread, or miss, important medical instructions, precautions and warnings on text labels or boxes. Such errors do not only have catastrophic results for the patient; the Centers for Disease Control and Prevention (CDC) estimates that the cost of non-adherence to prescriptions by taking the medicine at the wrong dose, time or frequency is $100 billion to $289 billion every year.

Better-presented instructions could help reduce or even prevent the negative health and economic impacts of seniors not adhering to their prescriptions. In a new paper in Applied Ergonomics, we examine the benefits of using simple images called pictograms to help improve seniors’ comprehension of medication information.

Building a better picture

Older people form the largest group of medication users. In Hong Kong, where we carried out the study, 70 percent of people aged 60 and over have one of more chronic diseases, such as hypertension, diabetes, arthritis or heart disease.

We asked a group of 50 people aged 65 to 84 to complete a medical information comprehension task. They were educated to varying levels, from primary to university level, and all had normal or corrected-to-normal vision. They each took one of five drugs commonly used by older people.

The participants were given drugs in their usual container boxes, but each box was in a plastic bag with a label. Participants in the experimental group were presented with text labels and pictograms explaining the instructions in illustration form. Those in the control group were shown only the text labels.

An example of the drug labelling for the control group – only text instructions are given on the label. (Source: Ng, Annie et al: <em>Applied Ergonomics,</em> January 2017)

We used nine pictograms to convey the medical instructions on the prescription (see image at the top of the story):

  1. Take by mouth.
  2. Read the label.
  3. Take three times a day with meals.
  4. Take with meals.
  5. Do not store medicine where children can get it.
  6. Do not drink alcohol while taking this medicine.
  7. Take in the morning.
  8. Do not store near heat or in sunlight.
  9. Poison.

We presented the pictograms to the participants in different ways to investigate how they affect comprehension of instructions. Some pictograms appeared on the box, others the external label on the plastic bag.

Medication label on a plastic bag and corresponding pictograms on the box. (Source: Ng, Annie et al: <em>Applied Ergonomics,</em> January 2017)

Medication label and corresponding pictograms on the plastic bag. (Source: Ng, Annie et al: <em>Applied Ergonomics,</em> January 2017)

We asked the participants to report their understanding of the medication instructions and information conveyed on each drug label. We then assessed their comprehension responses for the medication information about each drug, examining the ease of reading the label information, how useful they found the pictograms and their preferences for pictograms.

A clear diagnosis for pictograms

The results were clear: including pictograms improves the comprehension of medical information and instructions for older people. The majority of seniors in the experimental group found pictograms useful for conveying medical information when the pictograms supplemented the written text.

Education level was a critical factor in determining people’s understanding of the information: a lower education level was associated with poorer understanding. So if we do apply a tool like these pictograms to enhance comprehension, we will need to give extra consideration to seniors with lower levels of education and determine the most effective ways of using pictograms for them.

Regardless of education level, we believe that pictograms would help people of every educational level to understand drug information. We hope this would reduce the prevalence of drug misadventure and improve medicine adherence, especially for older people.

Our study conveys a clear message to healthcare professionals: the effective use of pictograms to convey medical instructions, information and warnings can help seniors understand how to take their medicines and ultimately save lives.

Read the study

Elsevier has made the following article freely available until January 18, 2017:

Applied Ergonomics is aimed at ergonomists and all those interested in applying ergonomics/human factors in the design, planning and management of technical and social systems at work or leisure. Readership is truly international with subscribers in over 50 countries. Professionals for whom Applied Ergonomics is of interest include ergonomists, designers, industrial engineers, health and safety specialists, systems engineers, design engineers, organizational psychologists, occupational health specialists and human-computer interaction specialists.



Written by

Annie Ng, PhD

Written by

Annie Ng, PhD

Dr. Annie Ng is a PhD graduate in ergonomics at the Department of Systems Engineering and Engineering Management, City University of Hong Kong. Her research interests include information design, usability evaluation, participatory design and active ageing.

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