An illustrated Bibliography: Pictograms in healthcare.

[January 20, 2025: This list is ‘work in progress’ and unlikely to be ever complete.]

The list includes first 23 references to systematic reviews. This is followed by a list of 222 studies that are mentioned in these systematic reviews.

Each reference contains a link to the source (DOI or website). It is briefly annotated, and shows the visuals. Hover your cursor over the bulleted items and the visual should pop-up.

Please inform waarde@glo.be if there are any omissions or mistakes.

Twenty-three systematic reviews (alphabetical):

Barros IMC, Alcantara TS, Mesquita AR, Santos, ACO, Paixao FP, Lyra DP. (2014) ‘The use of pictograms in the health care: A literature review.’. Research in Social and Administrative Pharmacy. 10, 704–719. [DOI]. 24 studies. Concludes: Pictograms can serve as communication tools to enhance visual attention, comprehension, recall and adherence of the instructions provided.

Beusekom MM van, Kerkhoven AH, Bos MJW, Guchelaar H-J, van den Broek JM. (2018) ‘The extent and effects of patient involvement in pictogram design for written drug information: a short systematic review’. Drug Discovery Today. 23(6), 1312-1318. [DOI]. 73 studies. Concludes: Designers of new pictograms are advised to clearly define the key characteristics of their intended target group, to involve (non-)patient participants with relevant characteristics early on and repeatedly in the design process and to involve relevant patients or medication users at least in the final evaluation of pictogram success.

Bianchini BV, Curvello K, Giugliani C, da Silva Dal Pizzol T. (2022) ‘Comprehension of Pictograms Demonstrating the Risk of Medication Use During Pregnancy: A Systematic Review’. Maternal and Child Health Journal. 26, 2318–2338. [DOI]. 12 studies. Concludes: The lack of a standard pictogram and uniform methods to evaluate the comprehension of the pregnancy pictogram made it challenging to reach a conclusion about the risk of medication use.

Brown SL, McRae D, Sheils , McDonnell BJ, Khan, I, James DH. (2022) ‘The effect of visual interventions on illness beliefs and medication adherence for chronic conditions: A scoping review of the literature and mapping to behaviour change techniques (BCTs)’. Research in Social and Administrative Pharmacy. 18, 3239-3262. [DOI]. 45 studies (12 about pictograms). Concludes: visual interventions can positively influence illness beliefs and medication adherence.

Chan HK, Hassali MA, Lim CJ, Saleem F, Tan WL. (2015) ‘Using pictograms to assist caregivers in liquid medication administration: a systematic review’. Journal of Clinical Pharmacy and Therapeutics. 40, 266–272. [DOI]. 5 studies. Concludes: pictographic interventions might be helpful in ameliorating communication of medication instructions.

Chen AT, Teng AK, Jillian Zhao J, Asirot MG, Turner AM. (2022) ‘The Use of Visual Methods to Support Communication with Older Adults with Cognitive Impairment: A Scoping Review’. Geriatric Nursing. 46, 52–60. [DOI]. 3 studies. Concludes: no study looked at the combination of understanding, communication, and decision making.

Choi J. (2011) ‘Literature review: using pictographs in discharge instructions for older adults with low-literacy skills’. Journal of Clinical Nursing. 20, 2984–2996. [DOI]. 44 studies: 12 included in table 1. Concludes: Healthcare education materials using pictographs provide effective strategies in improving discharge education for low-literate older adults in acute healthcare settings where nurses have primary responsibility as a first line of healthcare providers.

Del Re L, Vaillancourt R, Villareal G, Pouliot A. (2016) ‘Pictograms: Can they help patients recall medication safety instructions?’. Visible language. 50(1), 127-151. [DOI]. 19 studies. Concludes: Pictograms enhance patients’ recall of information.

Dermody S, Hughes M, Smith V. (2021) ‘The effectiveness of pictorial discharge advice versus standard advice following discharge from the emergency department: a systematic review and meta-analysis’. Journal of Emergency Nursing. 47(1), 66-75.E1. [DOI]. 4 studies. Concludes: Pictorial discharge advice improved comprehension, compliance, and patient satisfaction with the advice, but not satisfaction with the ED visit when compared with standard discharge advice.

Faustino S, Oliveira-Martins S, Advinha AM. (2021) ‘Pictograms - A Useful (Digital and/or Physical) Tool to Assist Elderly Patients in Understanding Medication Instructions? – A Systematic Review’. 184-201 in: Garcia-Alonso J, Fonseca C. Gerontechnology III Contributions to the Third International Workshop on Gerontechnology, IWoG 2020. October 5–6, 2020, Évora, Portugal. [DOI]. 14 studies. Concludes: The studies were heterogeneous regarding the study design, population size and types of results. The interventions showed positive results promoting greater patient adherence to treatment and controlling problems related to the incorrect use of medication,

Ferreira-Alfaya FJ, Zarzuelo-Romero MJ, Cura Y. (2023) ‘Pharmaceutical pictograms to improve textual comprehension: A systematic review’. Research in Social and Administrative Pharmacy. [DOI]. 8 studies. Concludes: The heterogeneity prevented us from conclusively confirming the usefulness of pictograms complementary to instructional text in improving the comprehension of instructions for the rational use of medicines.

Lühnen J, Steckelberg A, Buhse S. (2018) ‘Pictures in health information and their pitfalls: Focus group study and systematic review’. Z. Evid. Fortbild. Qual. Gesundh. wesen (ZEFQ). 137, 77-89. [DOI]. 5 studies. Concludes: The overall effect of using pictures in health information remains unclear.

Mbanda N, Dada S, Bastable K, Gimbler-Berglund I, Schlosser RW. (2021) ‘A scoping review of the use of visual aids in health education materials for persons with low-literacy levels’. Patient Education and Counseling. 104, 998–1017. [DOI]. 47 studies: 12 included. Concludes: Large gaps in the research base are evident.

Menon DD, Joy JM, Paul A, Reddy SA, Raj EA, Krishnan JB, Vilakkathala R. (2021) ‘Effectiveness of pictograms in patients or caregivers in healthcare settings: a systematic review’. Journal of Pharmaceutical Health Services Research. 12, 607–614. [DOI]. 15 studies. Concludes: Pictograms are a useful tool for communication among patients speaking different languages and belonging to various literacy groups.

Merks P, Cameron J, Bilmin K, Świeczkowski D, Chmielewska-Ignatowicz T, Harężlak T, Białoszewska K, Sola KF, Jaguszewski MJ, Vaillancourt R. (2021) ‘Medication Adherence and the Role of Pictograms in Medication Counselling of Chronic Patients: a Review’. Frontiers in Pharmacology. 12. [DOI]. 18 studies. Concludes: Due to a paucity of research on pictograms and medication adherence in this population and due to the lack of best practice in much of the existing research, we could not conclude that these patients benefitted any more or less from pictogram interventions.

Nualdaisri P, Corlett SA, Krska J. (2021) ‘The Effectiveness and Value of Written Medicine Information Across Asia and Africa: Systematic Review’. Drug Safety. 44, 1283–1295. [DOI]. 43 studies (an earlier review contained 125 studies). In both reviews, 25 studies were about pictograms. Concludes: The studies suggest that written medicines information can improve both knowledge and adherence and is highly valued by people in many countries across Africa and Asia.

Park J, Zuniga J. (2016) ‘Effectiveness of using picture-based health education for people with low health literacy: An integrative review’. Cogent Medicine. 3, 1264679. [DOI]. 11 studies. Concludes: Use of picture-based health education for people with low health literacy was limited.

Saif S, Bui TTT, Srivastava G, Quintana Y. (2024) ‘Evaluation of the design and structure of electronic medication labels to improve patient health knowledge and safety: a systematic review’. Systematic Reviews. 13, 12. [DOI]. 14 studies, 10 about pictograms. The utilization of patientcentered language, pictograms/graphics, color/white space, or font optimization was seen to have the most impact on patient comprehension.

Schubbe D, Scalia P, Yen RW, Saunders CH, Cohen S, Elwyn G, Muijsenbergh M van den, Durand M-A. (2020) ‘Using pictures to convey health information: A systematic review and meta-analysis of the effects on patient and consumer health behaviors and outcomes’. Patient Education and Counseling. 103, 1935–1960. [DOI]. 53 studies. Concludes: Our results support including pictures in health communication to improve patient knowledge. Our results should be interpreted with caution considering the significant heterogeneity of the meta-analysis outcomes.

Sedeh FB, Henning MAS, Mortensen OS, Jemec GBE, Ibler KS. (2022) ‘Communicating with patients through pictograms and pictures – a scoping review’. Journal of Dermatological Treatment. 33(6), 2730-2737. [DOI]. 59 studies. Concludes: Pictograms are only poorly studied in a medical context. It nevertheless appears that they are most likely useful for improving communication between HCW and patients.

Sharko M, Sharma MM, Benda NC, Chan M, Wilsterman E, Grossman Liu L, Demetres M, Delgado D, Ancker JS. (2022) ‘Strategies to optimize comprehension of numerical medication instructions: A systematic review and concept map’. Patient Education and Counseling. 105, 1888–1903. [DOI]. 21 studies. Concludes: Visualized liquid medication doses and time period-based administration instructions improve comprehension of numerical medication instructions.

Sletvold H, Bjørnli Sagmo LA, Torheim EA. (2020) ‘Impact of pictograms on medication adherence: A systematic literature review’. Patient Education and Counseling. 103, 1095–1103. [DOI]. 17 studies. Concludes: Pictograms used in combination with written and/or oral information can have a positive impact on patient populations that are highly at risk for non-adherence when counselled on the proper use of medicines.

Wang T, Voss JG. (2020) ‘Effectiveness of pictographs in improving patient education outcomes: a systematic review’. Health Education Research. 36(1), 9-40. [DOI]. 52 studies. Concludes: Differences in patient population, pictograph designs and author developed outcome measurements made it difficult to compare the findings.

Articles included in these systematic reviews (chronological):

2022

Algabbani AM, Alzahrani KA, Sayed SK, Alrasheed M, Sorani D, Almohammed OA, Alqahtani AS. ‘The impact of using pictorial aids in caregivers’ understanding of patient information leaflets of pediatric pain medications: A quasi-experimental study.’. Saudi Pharmaceutical Journal. 30(5), 544–554. [DOI]. [N=130 , Saudi Arabia, Convenience sample, ibuprofen instructions with/without pictograms.] [Ferreira].

• Figure 2

• Figure 3

• Figure 4

• Appendix A

• Appendix B1

• Appendix B2

2021

Gruters AAA, Ramakers IHGB, Stiekema APM, Verhey FRJ, Kessels RPC, Vugt ME de. ‘An Exploratory Study of the Development and Pilot Testing of an Interactive Visual Tool of Neuropsychological Test Results in Memory Clinics’. Journal of Alzheimer’s Disease. 79, 1157–1170. [DOI]. [N= 18 neuropsychology experts + 14 patients and 13 family members, Netherlands, visual tool co-created with patients, family members, and neuropsychology experts.] [Chen 38].

• Figure 2

• Figure 3

Heyns J, Van Huyssteen M, Bheekie A. ‘The effectiveness of using text and pictograms on oral rehydration, dry-mixture sachet labels.’. African Journal of Primary Health Care & Family Medicine. 13(1), a2646. [DOI]. [N=132, South Africa, Convenience sample, Sachet with/without pictograms.] [Ferreira, Sedeh 77].

• Figure 1

• Figure 2

• Figure 3

• Figure 4

Merks P, Świeczkowski D, Balcerzak M, Religioni U, Drelich E, Krysiński J, Hering D, Jaguszewski M. ‘Patient counselling service with the use of pictograms as the example of pharmacist intervention to improving compliance and medicine safety’. Cardiology Journal. 28(6), 879–886. [DOI]. [N=221, Polish community pharmacies, pharmacy visitors, pictogram on packaging vs no pictograms.] [Sedeh 78].

• Figure 2

2020

Bogza L-M, Patry-Lebeau C, Farmanova E, Witteman HO, Elliott J, Stolee P, Hudon C, Giguere AMC. ‘User-Centered Design and Evaluation of a Web-Based Decision Aid for Older Adults Living With Mild Cognitive Impairment and Their Health Care Providers: Mixed Methods Study’. Journal of Medical Internet Research. 22(8), e17406. [DOI]. [N=7 clinicians and 12 older indivduals with mild cognitive impairment, Canada, web-based decision aid.] [Chen 37].

• Figure 7

2019

Browne SH, Barford K, Ramela T, Dowse R. ‘The impact of illustrated side effect information on understanding and sustained retention of antiretroviral side effect knowledge.’. Research in Social and Administrative Pharmacy. 15(4), 469-473. [DOI]. [N= 116, USA, Limited literacy HIV patients, standard vs standard+information leaflet.] [Ferreira, Menon, Merks, Nualdaisri 17]

• Figure 1

• Table 3

Fukuda Y, Ando S, Saito M. ‘Effect of a Japanese drug alert pictogram on medication-taking/driving behavior’. Traffic Injury Prevention. 21(1), 18–23. [DOI]. [N=600 men and 600 women aged 20–79, Japan, participants, pictogram for alerting patients about drugs that affect driving.] [Faustino 16].

• Figure 1

Gebreyohannes EA, Bhagavathula AS, Abegaz TM, Abebe TB, Belachew SA, Tegegn HG, Mansoor SM. ‘The effectiveness of pictogram intervention in the identification and reporting of adverse drug reactions in naïve HIV patients in Ethiopia: a cross-sectional study.’. HIV/AIDS Res Palliat Care. 11, 9–16. [DOI]. [N=207, Ethiopia, HIV positive patients, pictorial medication information and a pictogram-enhanced tool.] [Nualdaisri 34].

Malhotra R, Bautista MAC, Tan NC, Tang WE, Tay S, Tan ASL, Puillot A, Saffari SE, Vaillancourt R. ‘Bilingual text with or without pictograms improves elderly Singaporeans’ understanding of prescription medication labels.’. Gerontologist. 59(2), 378–90. [DOI]. [N=1414, Singapore, Elderly, English-text; English-text-and-pictograms; Bilingual-text; and Bilingual-text-and-pictogram.] [Beusekom 52, Ferreira, Nualdaisri 78, Saif 30].

McDonald J, Vaillancourt R, Mishra P, Puliot A. ‘HIV-TB treatment pictogram tool designed from semiotic analysis for community pharmacists in India.’. Ind J Pharm Sci.. 81(2), 373–9. [DOI]. [Design process, India, participants, pictogram-based counselling pamphlet.] [Nualdaisri 50].

• Figure 1

Merks P, Świeczkowski D, Balcerzak M, Drelich E, Białoszewska K, Cwalina N, Zdanowski S, Krysiński J, Gromadzka G, Jaguszewski M. ‘Patients’ Perspective And Usefulness Of Pictograms In Short-Term Antibiotic Therapy – Multicenter, Randomized Trial’. Patient Preference and Adherence. 13, 1667–1676. [DOI]. [N=64; N=199, Poland, Pharmacicsts; patients, pictograms placed on the external packaging.] [Sedeh 75].

• Figure 1

Wrench W, Dyk L van, Srinivas S, Dowse R. ‘Outcome of illustrated information leaflet on correct usage of asthma-metered dose inhaler’. African Journal of Primary Health Care & Family Medicine. 11(1), a2079. [DOI]. [N=55, South Africa, rural asthma patients, leaflet to instruct 12 steps of inhaler use.] [Merks, Nualdaisri 18, Sedeh 76].

• Figure 1

2018

Almomani BA, Mokhemer E, Al-Sawalha NA, Momanyb SM. ‘A novel approach of using educational pharmaceutical pictogram for improving inhaler techniques in patients with asthma’. Respiratory Medicine. 143, 103–108. [DOI]. [N=201, Jordan, asthma patients, inhaler instructions with/without pictograms.] [Merks, Sedeh 71].

• Figure 1

Cheng J. Widjajahakim R, Rajanala S, Maymone MBC, Secemsky E, Vashi NA. ‘Effect of Stimuli on Sun Protective Habits: A Randomized Double-Blind Controlled Study’. Photodermatology, Photoimmunology & Photomedicine. 35, 17–23. [DOI]. [N=145, USA, Hispanic population, images-text-none about skin cancer.] [Schubbe 74].

Kanji L, Xu S, Cavaco A. ‘Assessing the Understanding of Pharmaceutical Pictograms among Cultural Minorities: The Example of Hindu Individuals Communicating in European Portuguese’. Pharmacy. 6(1), 22. [DOI]. [N=50, Lisbon (Portugal), Hindu community, USP and FIP pictograms.] [Sedeh 72].

• Table 2a

• Table 2b

• Table 2c

• Table 2d

• Table 2e

Leiner M, Peinado J, Baylon A, Lopez I, Pathak I. ‘Divide and conquer: improving parental understanding of health-related instructions using sequential pictorial instructions. ’. Health Educ Res. 33 (2), 104–113. [DOI]. [N=359, USA, parents, sequential pictorial instructions vs written text instructions.] [Sharko 54, Wang 20].

• Figure 2

Merks P, Świeczkowski D, Balcerzak M, Drelich E, Białoszewska K, Cwalina N, Krysinki J, Gabuszewski M, Pouliot A, Vaillancourt R. ‘The evaluation of pharmaceutical pictograms among elderly patients in community pharmacy settings - a multicenter pilot study.’. Patient Preference and Adherence. 12, 257-66. [DOI]. [Supplementary materials are here.] [N=68, Poland, over 65, first 50 pictograms, 15 discarded.] [Beusekom 41, Sedeh 73]

• Table 2a

• Table 2b

Monroe AK, Pena JS, Moore RD, Riekert KA, Eakin MN, Kripalani S, Chander G. ‘Randomized Controlled Trial of a Pictorial Aid Intervention for Medication Adherence Among HIV-positive Patients with Comorbid Diabetes or Hypertension’. AIDS Care. 30(2), 199–206. [DOI]. [N=46, USA, HIV and common chronic conditions, PictureRx card.] [Brown, Merks, Sedeh 74, Sletvold 39, Wang 55].

Phimarn W, Ritthiya L, Rungsoongnoen R, Pattaradulpithuk W, Saramunee K. ‘Development and Evaluation of a Pictogram for Thai Patients with Low Literate Skills’. Indian J Pharm Sci. 81(1), 89-98. [Website]. [N=21, N=20, N=30, N=134, Thailand, low literacy, local pictograms.] [Menon, Sharko 58].

• Figure 1

• Figure 3

2017

Beusekom MM van, Land-Zandstra AM, Bos MJW, van den Broek JM, Guchelaar H. ‘Pharmaceutical pictograms for low-literate patients: Understanding, risk of false confidence, and evidence-based design strategies.’. Patient Education and Counseling. 100(5), 966–973. [DOI]. [N=197, Netherlands, pharmacy clients, 10 pictograms.] [Beusekom 78, Sedeh 69, Vendruscolo].

• Table 2

• Table 4

Buljan I, Malicki M, Wager E, Puljak L, Hren D, Kellie F, West H, Alfirevic Z, Marusic A. ‘No difference in knowledge obtained from infographic or plain language summary of a Cochrane systematic review: three randomized controlled trials’. Journal of Clinical Epidemiology. 97, 86-94. [DOI]. [N=171 university student, N= 99 consumers, N=64 doctors, Croatia, Infographic.] [Schubbe 69].

Chan H-K, Aswad E, Ho Y-E. ‘Influences of pictogram-based instructions in paediatric drug labelling on dosing accuracy among caregivers: a pilot study from Malaysia’. Journal of Pharmaceutical Health Services Research. 8(2), 131–134. [DOI]. [N=63, Malaysia, Children’s caregivers, text only or text+pictogram label.] [Beusekom 69, Sharko 53, Wang 72].

• Figure 1

Choi J, Jacelon CS, Kalmakis KA. ‘Web-based, pictographformatted discharge instructions for low-literacy older adults after hip replacement surgery: findings of end-user evaluation of the website.’. Rehabilitation Nursing. 42(5), 254–61. [DOI]. [N=15, USA, low-literate older adults following hip-replacement surgery, pictograph formatted discharge instructions on website.] [Wang 37] [PDF is dated 2016].

• Figure 1b

• Figure 1c

Hussin SN, Razak MRA. ‘Evaluating Pictogram-based Patient Information Leaflet among Children Attending Kindergarten.’. Pertanika Journal of Social Science and Humanities. 25, 29-37. [Website]. [N=60, Malaysia, Kindergarten students, 10 modified USP Pictograms.] [Beusekom 89].

• Figure 2

Kasper J, Roemer A van de, Pöttgen J, Rahn A, Backhus I, Bay Y, Köpke S, Heesen C. ‘A new graphical format to communicate treatment effects to patients-A web-based randomized controlled trial.’. Health Expect. 20, 797–804. [DOI]. [N=682, Germany, People with MS, clarifying risk figures.] [Wang 60].

• Figure 1

• Figure 3

Kayyali R, Hesso I, Ejiko E. ‘A qualitative study of Telehealth patient information leaflets (TILs): are we giving patients enough information?’. BMC Health Services Research. 17, 362. [DOI]. [N=14, UK, patients, telehealth leaflets.] [Wang 45].

Lakshminarayana R, Wang D, Burn D, Chaudhuri KR, Galtrey C, Valle Guzman N, Hellman B, James B, Pal S, Stamford J, Steiger M, Stott RW, Teo J, Barker RA, Wang E, Bloem BR, Eijk M van der, Rochester L, Williams A.‘Using a smartphone-based self-management platform to support medication adherence and clinical consultation in Parkinson’s disease’. npj Parkinson’s Disease. 3, article 2. [DOI]. [N=158, England and Scotland, Parkinson’s disease, phone app.] [Brown].

• Figure 3

• Figure 4

• Figure 5

• Figure 6

Leong M, Tam V, Xu T, Peters M. ‘Understanding Medication Schedules: Do Pictograms Help?’. Journal of Patient Safety. 14(2), e19-e24. [DOI]. [N=30, Baltimore (USA), participants, text and pictogram instructions] [Faustino 20].

• Figure 2

Ng AWY, Chan AHS, Ho VWS. ‘Comprehension by older people of medication information with or without supplementary pharmaceutical pictograms.’. Applied Ergonomics. (58) 167-175. [DOI]. [N=50, Hong Kong, Older Chinese, 9 USP pictograms on packaging.] [Ferreira, Nualdaisri 98, Schubbe 101, Sharko 57]

• Figure 2

• Figure 3

• Figure 4

• Figure 5

• Figure 6

Yin HS, Gupta RS, Mendelsohn AL, Dreyer B, Schaick L van, Brown CR, Encalada K, Sanchez DC, Warren CM, Tomopoulos S. ‘Use of a low-literacy written action plan to improve parent understanding of pediatric asthma management: a randomized controlled study’. J. Asthma. 54, 919–929. [DOI]. [N=217, USA, Parents, pictogram- and photograph-based written asthma action plan.] [Schubbe 115].

• Figure 1

Yin HS, Parker RM, Sanders LM, Mendelsohn A, Dreyer BP, Bailey SC, Patel DA, Jimenez JJ, Kim K-YA, Jacobson K, Smith MCJ, Hedlund L, Meyers N, McFadden T, Wolf MS. ‘Pictograms, Units and Dosing Tools, and Parent Medication Errors: A Randomized Study. ’. Pediatrics. 140(1). [DOI]. [N=491, USA, English and Spanish speaking parents, medication label with or without pictograms.] [Beusekom 68, Menon, Saif 28, Schubbe 116, Sharko 43]

• Figure 1

Zargarzadeh AH, Ahmadi S. ‘Comprehensibility of selected United States Pharmacopeia pictograms by illiterate and literate Farsi speakers: The first experience in Iran—Part II.’. Journal of Research in Medical Sciences. 22, 1–6. [DOI]. [N= 358, Iran, students-low literate-illiterate, 3 USP pictograms.] [Beusekom 81, Vendruscolo, Wang 47].

• Figure 1

2016

Anglada-Martínez H, Martin-Conde M, Rovira-Illamola M, Sotoca-Momblona JM, Sequeira E, Aragunde V, Angels Moreno M, Catalan M, Codina-Jané C. ‘Feasibility and Preliminary Outcomes of a Web and Smartphone–Based Medication Self-Management Platform for Chronically Ill Patients’. J Med Syst. 40, article 99. [DOI]. [N=42, Spain, patients, Medplan app and website (defunct?).] [Brown].

• Figure 3

• Figure 4

• Figure 5

• Figure 6

• Figure 7

• Figure 8

Berthenet M, Vaillancourt R, Pouliot A. ‘Evaluation, Modification, and Validation of Pictograms Depicting Medication Instructions in the Elderly’. Journal of Health Communication. 21, sup1, 27-33. [DOI]. [N=135, Canada, Elderly, 76 FIP pictograms.] [Beusekom 42, Faustino 14, Mbanda 58].

• Appendix A1

• Appendix A2

• Appendix A3

• Appendix B

• Appendix C

Beusekom MM van, Grootens-Wiegers P, Bos MJW, Guchelaar HJ, Broek JM van den. ‘Low literacy and written drug information: information-seeking, leaflet evaluation and preferences, and roles for images’. Int J Clin Pharm. 38(6), 1372-9. [DOI]. [N=45, Netherlands, Package inserts and visuals.] [Beusekom 5].

Choi J. ‘Effect of Pictograph-Based Discharge Instructions on Older Adults' Comprehension and Recall: A Pilot Study’. Research in Gerontological Nursing. 9(2), 66–71. [Website]. [N=42, USA, Older adults, discharge instructions.] [Mbanda 81, Park, Sedeh 70, Wang 56].

Coylewright M, Dick S, Zmolek B, Askelin J, Haskins E, Branda M, Inselman JW, Zeballos-Palacios C, Shah ND, Hess EP, LeBlanc A, Montori VM, Ting HH. ‘Percutaneous Coronary Intervention Choice Decision Aid for Stable Coronary Artery Disease. A Randomized Trial’. Circulation: Cardiovascular Quality and Outcomes. 9, 767–76. [DOI]. [N=124, USA, percutaneous coronary intervention patients, a decision aid.] [Wang 79].

• Figure 2A

• Figure 2B

Hill B, Perri-Moore S, Kuang J, Bray BE, Ngo L, Doig A, Zeng-Treitler Q. ‘Automated pictographic illustration of discharge instructions with Glyph: impact on patient recall and satisfaction.’. J Am Med Inform Assoc. 23(6), 1136-42. [DOI]. [N=144, USA, Patients in a cardiovascular medical unit, Pictograph-enhanced discharge instructions.] [Beusekom 50, Mbanda 84, Schubbe 48, Wang 63].

• Table 1

Jiang R, Chen M, Li Y. ‘Effectiveness of picture description education on compliance behaviors of diabetics in western Sichuan district’. Int. J. Nurs. Sci.. 3, 229–234. [DOI]. [N=182, China, Diabetic patients, picture description education vs control group.] [Schubbe 85].

Kim J, Fnu V, Bell E, Kim H. ‘Feasibility of the rulebased approach to creating complex pictograms.’. Nursing Informatics. 225, 397–401. [DOI]. [N= 42, USA, senior center users, USP pictograms.] [Beusekom 33, Faustino 19, Vendruscolo].

• Table 2

Kuo H-C, Pan H-H, Creedy DK, Tsao Y. ‘Distraction-based interventions for children undergoing venipuncture procedures: a randomized controlled study’. Clin. Nurs. Res. 27, 467–482. [DOI]. [N=276, Taiwan, children 3-7, picture book-animated cartoon-routine oral instructions.] [Schubbe 92].

Occa A, Suggs LS. ‘Communicating breast cancer screening with young women: an experimental test of didactic and narrative messages using video and infographics’. J. Health Commun. 21, 1–11. [DOI]. [N=194, Italy, through university and snowball, video or infographic.] [Schubbe 102].

• Figure 1

• Figure 2

• Figure 3

Wolf MS, Davis TC, Curtis LM, Bailey SC, Knox JP, Bergeron A, Abbett M, Shrank WH, Parker RM, Wood AJJ. ‘A patient-centered prescription drug label to promote appropriate medication use and adherence.’. J Gen Intern Med. 31(12), 1482–1489 [DOI]. [N=845, USA, type 2 diabetes and/or hypertension, Universal Medication Schedule (UMS).] [Saif 29, Sharko 50].

• Figure 1

Wolpin SE, Nguyen JK, Parks JJ, Lam AY, Morisky DE, Fernando L, Chu A, Berry DL. ‘Redesigning pictographs for patients with low health literacy and establishing preliminary steps for delivery via smart phones.’. Pharm Pract (Granada) . 14(2), 686. [DOI]. [N=29, USA, low literacy adults, 91 pictographs on smart phone.] [Beusekom 85, Wang 30]

• Figure 2

• Table 4

2015

Barajas MR, Formea CM, McCormick JB, Abdalrhim AD, Han LC, McBaneRD, Fiksdal AS, Kullo IJ. ‘A patientcentered approach to the development and pilot of a warfarin pharmacogenomics patient education tool for health professionals.’. Curr Pharm Teach Learn. 7, 249–55. [DOI]. [N=three focus groups of 5-7 people, location, Warfarin patients, Patient education prototype.] [Wang 38].

• Figure 1

• Figure 2

• Figure 3

Beusekom MM van, Bos M, Wolterbeek R, Guchelaar H-J, Broek J van den. ‘Patients’ preferences for visuals: Differences in the preferred level of detail, type of background and type of frame of icons depicting organs between literate and low-literate people’. Patient Education and Counseling. 98(2), 226–233. [DOI]. [N=191, Netherlands, pharmacy visitors, icons of organs.] [Beusekom 45].

• Figure 1

• Table 2

• Table 3

• Table 4

Cabassa LJ, Oh H, Humensky JL, Unger JB, Molina GB, Baron M. ‘Comparing the impact on Latinos of a depression brochure and an entertainment-education depression fotonovela’. Psychiatric Services . 66(3), 313–316. [DOI]. [N=132, USA, Latinos from adult school, fotonovela.] [Schubbe 70].

Gallagher-Thompson D, Tzuang M, Hinton L, Alvarez P, Rengifo J, Valverde I, Chen N, Emrani T, Thompson LW. ‘Effectiveness of a fotonovela for reducing depression and stress in Latino dementia family caregivers.’. Alzheimer Dis Assoc Disord. 29, 146–53. [DOI]. [N=147, USA, Latino dementia caregivers, fotonovela.] [Schubbe 80, Wang 66].

Hamstra DA, Johnson SB, Daignault S, Zikmund-Fisher BJ, Taylor JMG, Larkin K, Wood A, Fagerlin A. ‘The impact of numeracy on verbatim knowledge of the longitudinal risk for prostate cancer recurrence following radiation therapy.’. Med Decis Making. 35, 27–36. [DOI]. [N=420, USA, prostate cancer patients, 4 different diagrams: pie (1), pictograph (2), line (3), Bar (4).] [Wang 52].

• Appendix 1 a

• Appendix 1 b

• Appendix 2 a

• Appendix 2 b

• Appendix 3 a

• Appendix 3 b

• Appendix 4 a

• Appendix 4 b

Kara S, Ntsiea MV. ‘The effect of a written and pictorial home exercise prescription on adherence for people with stroke.’. Hong Kong J Occup Ther. 26, 33–41. [DOI]. [N=42, South Africa, stroke survivors, written and pictorial home exercise prescription.] [Schubbe 86, Wang 57].

• Appendix 1 a

• Appendix 1 b

Ma XJ. ‘Developing Design Guidelines for a Visual Vocabulary of Electronic Medical Information to Improve Health Literacy’. Interacting with Computers. 28(2), 151-69. [DOI]. [N=20, Hong Kong, 10 English + 10 Chinese speakers + 156 USA mTurk workers + 8 elderly and 8 people from a different language and cultural background, medical graphics.] [Beusekom 51].

• Figure 2

• Figure 4

• Figure 5

• Figure 6

• Figure 8

• Figure 9

• Figure 10

• Figure 11

Mateti UV, Nagappa AN, Attur RP, Bairy M, Nagaraju SP, Mallayasamy S, Vilakkathala R, Guddattu V, Balkrishnan R. ‘Preparation, validation and user-testing of pictogram-based patient information leaflets for hemodialysis patients.’. Saudi Pharmaceutical Journal. 23(6), 621-5. [DOI]. [N=24 + 81, India, 12 English + 12 Kannada, pictogram-based patient information leaflets.] [Beusekom 59, Merks, Nualdaisri 149, Sedeh 68].

Meppelink CS, Bol N. ‘Exploring the role of health literacy on attention to and recall of text-illustrated health information: An eye-tracking study’. Computers in Human Behavior. 48, 87–93. [DOI]. [N=61, The Netherlands, Healthy adults, Health webpage with text and without text.] [Mbanda 61].

• Figure 1

• Figure 2

Odedra KM. ‘Self-management plans for people with deteriorating asthma.’. Prim Health Care. 25, 24–30.[DOI]. [N=53, UK, asthma, Self-management plans.] [Wang 48].

Perri S, Argo L, Kuang J, Bui D, Hill B, Bray B, Treitler-Zeng Q. ‘A picture’s meaning: the design and evaluation of pictographs illustrating patient discharge instructions. ’. J Commun Healthc. 8, 335–49. [DOI]. [N=150, USA, diverse, cardiovascular discharge instructions.] [Wang 41].

• Figure 1

• Figure 2

• Figure 3

• Figure 4

• Figure 5

• Figure 6

• Figure 7

• Figure 8

• Figure 9

• Table 11

• Table 1

• Table 2a

• Table 2b

• Table 6

• Table 8

Veldwijk J, Lambooij MS, van Til JA. ‘Words or graphics to present a Discrete Choice Experiment: does it matter?’. Patient Education and Counseling. 98, 1376–1384. [DOI]. [N=959, Netherlands, parents, words or graphics.] [Wang 68].

• Figure 1

2014

Barros IMC, Alcântara TS, Mesquita AR, Bispo ML, Rocha CE, Moreira VP, Lyra Junior DP. ‘Understanding of pictograms from the United States Pharmacopeia Dispensing Information (USP-DI) among elderly Brazilians’. Patient Preference and Adherence. 8, 1493–1501. [DOI]. [N=116, Brazil, elderly 60-90, USP Pictograms.] [Beusekom 86].

• Figure 1

• Figure 2

Ben-Zeev D, Brenner CJ, Begale M, Duffecy J, Mohr DC, Mueser KT. ‘Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone Intervention for Schizophrenia’. Schizophrenia Bulletin. 40(6), 1244–1253. [DOI]. [N=33, USA, Schizophrenia, Smartphone.] [Brown].

• Figure 1

• Figure 2

Chan H-K, Hassali MA. ‘Modified labels for long-term medications: influences on adherence, comprehension and preferences in Malaysia’. International Journal of Clinical Pharmacy. 36, 904-913. [DOI]. [N=110, Malaysia, oral antihypertensive or antidiabetic outpatients, standard-font-enlarged-pictogram.] [Beusekom 49, Menon, Merks, Schubbe 73, Sedeh 60, Sletvold 34]].

• Figure 1

• Figure 2

Doucette D, Vaillancourt R, Berthenet M, Li LS, Pouliot A. ‘Validation of a Pictogram-Based Diabetes Education Tool in Counselling Patients with Type 2 Diabetes.’. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada. 147, 340–344. [DOI]. [N=17, Canada, type 2 diabetes, 15 pictograms.] [Merks, Sedeh 61, Wang 36].

• Figure 1

• Figure 2

Dowse R, Barford K, Browne SH. ‘Simple, illustrated medicines information improves ARV knowledge and patient self-efficacy in limited literacy South African HIV patients’. AIDS care. 26(11), 1400-1406. [DOI]. [N=116, South Africa, HIV patients, two-page leaflet.] [Beusekom 48, Mbanda 96, Menon, Merks, Nualdaisri 16, Schubbe 78, Sedeh 62, Sletvold 35, Wang 58].

• Figure 1

Emich B, Dijk L van, Monteiro SP, Gier JJ. ‘A study comparing the effectiveness of three warning labels on the package of driving-impairing medicines’. Int J Clin Pharm. 36(6), 1152–1159. [DOI]. [N=298, The Netherlands, Three warning labels, 2 with pictograms] [Beusekom 29].

• Figure 1

• Figure 2

Hawkins LA, Firek CJ. ‘Testing a novel pictorial medication sheet to improve adherence in veterans with heart failure and cognitive impairment’. Heart & Lung. 43, 486-493. [DOI]. [N=27, USA, veterans, Pictorial medication sheet.] [Brown, Faustino 18, Merks, Sedeh 63, Wang 46].

• Figure 1

Kheir N, Awaisu A, Radoui A, El Badawi A, Jean L, Dowse R. ‘Development and evaluation of pictograms on medication labels for patients with limited literacy skills in a culturally diverse multiethnic population.’. Research in Social and Administrative Pharmacy. 10(5), 720-30. [DOI]. [N=123, Qatar, poor English or poor Arabic, 11 label instructions.] [Beusekom 71, Mbanda 87, Menon, Nualdaisri 128, Schubbe 88, Sedeh 64, Wang 32].

• Figure 1

• Figure 2

Mira JJ, Navarro I, Botella F, Borrás F, Nuño-Solinís R, Orozco D, Iglesias-Alonso F, Pérez-Pérez P, Lorenzo S, Toro N. ‘A Spanish Pillbox App for Elderly Patients Taking Multiple Medications: Randomized Controlled Trial’. Journal of Medical Internet Research. 16(4), e99, 1. [DOI]. [N=99, Spain, elderly patients taking multiple medications, Self-management app.] [Brown].

• Figure 1

Mohan A, Riley MB, Schmotzer B, Boyington DR, S Kripalani. ‘Improving Medication Understanding Among Latinos Through Illustrated Medication Lists’. Am J Manag Care. 20(12), e547-e555. [Website]. [N=197, USA, latino patients with diabetes, PictureRx medication instructions.] [Brown, Merks, Schubbe 98, Sedeh 65, Sletvold 38].

• Figure 1

Peng Y, Wu R, Qu W, Wu W, Chen J, Fang J, Chen Y, Farella M, Mei L. ‘Effect of visual method vs plaque disclosure in enhancing oral hygiene in adolescents and young adults: a single-blind randomized controlled trial’. Am. J. Orthod. Dentofacial Orthop. 145(3), 280-286. [DOI]. [N=148, China, 11 to 25 years, Images-tablets-both-none.] [Schubbe 105].

• Figure 2

Picard AJ, Estrella MR, Boynton J, Maxwell A, Inglehart MR. ‘Educating Parents of Children Receiving Comprehensive Dental Care Under General Anesthesia With Visual Aids’. Pediatric Dentistry. 36(4), 329-335. [Website]. [N=54, USA, Parents, Visual aids.] [Schubbe 106].

• Figure 1

• Figure 2

Sharif SI, Abdullah M, Yousif A, Mohamed D. ‘Interpretation of pharmaceutical pictograms by pharmacy and non-pharmacy university students.’. Pharmacol Pharm. 5(8), 821–7. [DOI]. [N=300, United Arab Emirates, university students, USP pictograms.] [Nualdaisri 133].

Shet A, Costa A de, Kumarasamy N, Rodrigues R, Rewari BB, Ashorn P, Eriksson B, Diwan V, and the HIVIND study team. ‘Effect of mobile telephone reminders on treatment outcome in HIV: evidence from a randomised controlled trial in India’. British Medical Journal. 349, g5978. [DOI]. [N=631, India, HIV infected adults, mobile phone reminders.] [Sedeh 66, Sletvold 32].

Tack J, Carbone F, Holvoet L, Vanheel H, Vanuytsel T, Vandenberghe A. ‘The use of pictograms improves symptom evaluation by patients with functional dyspepsia’. Alimentary Pharmacology and Therapeutics. 40, 523–530. [DOI]. [N=76, location, functional dyspepsia, Pictograms accompanying verbal descriptors.] [Sedeh 67].

• Figure 1

Tanner S, Wells M, Scarbecz M, McCann Sr BW. ‘Parents’ understanding of and accuracy in using measuring devices to administer liquid oral pain medication’. J. Am. Dent. Assoc. 145, 141–149. [DOI]. [N=120, location, parent-child pairs, text only-text with pictograms.] [Schubbe 109].

• Figure 1

• Figure 2

Tsahakis JM, Issar NM, Kadakia RJ, Archer KR, Barzyk T, Mir HR. ‘Health literacy in an orthopaedic trauma patient population: improving patient comprehension with informational intervention.’. Journal of Orthopaedic Trauma. 28(4), e75–79. [DOI]. [N=299, USA, patients, additional information sheet.] [Wang 49].

Zeng-Treitler Q, Perri S, Nakamura C, Kuang J, Hill B, Bui DDA. ‘Evaluation of a pictograph enhancement system for patient instruction: a recall study.’. J Am Med Inform Assoc. 21(6), 1026-31. [DOI]. [N=84, USA, convenience sample, illustrations of 49 instructions.] [Beusekom 47, Wang 59]

• Figure 1

• Figure 2

Zikmund-Fisher BJ, Witteman HO, Dickson M. ‘Blocks, ovals, or people? icon type affects risk perceptions and recall of pictographs.’. Medical Decision Making. 34(4), 443–53. [DOI]. [N=1502, online, online, cardiovascular risk calculator.] [Wang 54].

• Figure 1

2013

Advani AA, Lopez J, Joness J, Patel S. ‘The Role of Pictograms for Enhancement of Patient Prescription Medication Information in the US’. Journal of Pharmacy Technology. 29(1), 40-45. [DOI]. [N=84, USA, USP pictograms on handout.] [Beusekom 58, Wang 62].

• Figure 1

• Figure 2

Chan AHS, Chan KWL. ‘Effects of prospective-user factors and sign design features on guessability of pharmaceutical pictograms’. Patient Education and Counseling. 90, 268-275. [DOI]. [N=160, Hong Kong, Student population, 25 USP pictograms.] [Beusekom 87, Nualdaisri 99, Saif 21].

• Table 1

• Table 2

• Table 5

Choi J. ‘Older adults’ perceptions of pictograph-based discharge instructions after hip replacement surgery.’. Journal of Gerontological Nursing. 39, 48–54. [DOI]. [No digital copy.] [Mbanda 80, Park, Sedeh 55, Wang 43].

Fierro I, Gómez-Talegón T, Alvarez FJ. ‘The Spanish pictogram on medicines and driving: The population’s comprehension of and attitudes towards its use on medication packaging’. Accid Anal Prev. 50, 1056-61. [DOI]. [N=1385, Spain, Driving pictogram] [Beusekom 30, Wang 42].

• Figure 1

Hu H, Wu F-LL, Hu F-C, Yang H-Y, Lin S-W, Shen LJ. ‘Effectiveness of Education Programs About Oral Antibiotic Suspensions in Pediatric Outpatient Services’. Pediatrics and Neonatology. 54, 34-42. [DOI]. [N=150, Taiwan, caregivers, Photgraphs and text instructions.] [Chan, Sedeh 51].

• Figure 1

• Figure 2

Kalichman SC, Cherry C, Kalichman MO, Amaral C, White D, Grebler T, Eaton LA, Cruess D, Detorio MA, Caliendo AM, Schinazi RF. ‘Randomized Clinical Trial of HIV Treatment Adherence Counseling Interventions for People Living with HIV and Limited Health Literacy’. Journal of Acquired Immune Deficiency Syndromes. 63(1), 42–50. [DOI]. [N=446, USA, low literacy people living with HIV, pictograph-guided adherence counseling.] [Mbanda 103, Menon, Merks, Park, Sedeh 56 , Sletvold 29, Wang 70].

Korenevsky A, Vaillancourt R, Pouliot A, Revol M, Steed E, Besançon L, Wahrendorf M-S, Patel JR. ‘How Many Words Does a Picture Really Tell? Cross-sectional Descriptive Study of Pictogram Evaluation by Youth.’. Can J Hosp Pharm. 66(4), 219-26. [DOI]. [N=86, Canada, Youth 12-18, 204 FIP pictograms.] [Beusekom 91].

Mathew EM, Rajiah K, Sharma KK. ‘Consumer’s perception on design and layout of consumer medical information leaflets on obesity and lipid lowering drugs.’. J Clin Diagn Res. 7(12), 2800–2. [DOI]. [N=1500, India, using anti-obesity or lipid lowering drugs, Consumer Medical Information Leaflets (CMILs).] [Nualdaisri 48].

McCarthy DM, Davis TC, King JP, Mullen RJ, Bailey SC, Serper M, Jacobson KL, Parker RM, Wolf MS. ‘Take-wait-stop: a patient-centered strategy for writing PRN medication instructions.’. J Health Commun. 18(Suppl 1), 40–48. [DOI]. [N=87, USA, acetaminophen patients, labeling standards for ‘as needed’.] [Saif 23, Sharko 52].

• Figure 1

Monteiro SP, Huiskes R, Dijk LV, Van Weert JC, De Gier JJ. ‘How effective are pictograms in communicating risk about driving-impairing medicines?’. Traffic Injury Prevention. 14(3), 299-308. [DOI]. [N=270, Netherlands, drivers, 2 ‘do not drive’ pictograms.] [Beusekom 28]

• Figure 1

• Figure 2

Murphy J, Oliver T. ‘The use of Talking Mats to support people with dementia and their carers to make decisions together’. Health and Social Care in the Community. 21(2), 171–180. [DOI]. [N=18 couples, Scotland/North of England, a person with dementia and their family carer, talking mats with illustrations.] [Chen 35].

• Figure 1

• Figure 2 and figure 3

Negarandeha R, Mahmoodib H, Noktehdanb H, Heshmatc R, Shakibazadehd E. ‘Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes’. Primary Care Diabetes. 7(2), 111–118. [DOI]. [N=127, Iran, low health literacy with Type 2 Diabetes, pictorial image.] [Brown, Menon, Merks, Schubbe 100, Sedeh 57, Sletvold 30, Wang 61].

Richler M, Vaillancourt R, Celetti SJ, Besançon L, Arun K, Sebastien F. ‘The use of pictograms to convey health information regarding side effects and/or indications of medications.’. Journal of Communication in Healthcare. 5(4), 220-226. [DOI]. [N=2719 online - global, participants, 28 sets of pictograms.] [Beusekom 15, Sedeh 54]

• Figure 1

• Figure 2

Sharaideh R, Wazaify M, Albsoul-Younes A. ‘ Knowledge and attitude of school children in Amman/Jordan toward the appropriate use of medicines: A cross-sectional study.’. Saudi Pharm J. 21(1), 25-33. [DOI]. [N=200, Jordan, children 7-9, 15 USP pictograms.] [Beusekom 14]

• Figure 1

• Table 2a

• Table 2b

Smyth T, Sheehan M, Siskind V, Mercier-Guyon C, Mallaret M. ‘Consumer perceptions of medication warnings about driving: a comparison of French and Australian labels.’. Traffic Inj Prev. 14(6), 557-64.[DOI]. [N=358 in Australia, N=75 in France, participants, do not drive pictograms.] [Beusekom 31]

• Table 1

• Table 2

Stones C, Knapp P, Malmgren L. ‘The interpretation of triangular borders to indicate warning in medicines pictograms and the potential influence of being a driver.’. Information Design Journal. 20(2), 161-170. [DOI]. [N=182, UK, adult drivers, warnings with triangular borders.] [Beusekom 56]

• Figure 1

Tork HMM. ‘A pictogram-based intervention to reduce parental liquid medication errors: health literacy approach’. American Journal of Nursing Science. 2(3), 27-32. [DOI]. [N=250, Egypt, caregivers, 10 USP pictograms.] [Chan, Sedeh 58].

• Figure 1

Yu B, Willis M, Sun P, Wang J. ‘Crowdsourcing participatory evaluation of medical pictograms using Amazon Mechanical Turk.’. J Med Internet Res. 15(6): e108. [DOI]. [N=100, USA-online, anonymous MTurk, 20 USP pictograms.] [Beusekom 70]

• Figure 1

• Figure 2

• Figure 3

• Figure 7

2012

Bailey SC, Sarkar U, Chen AH, Schillinger D, Wolf MS. ‘Evaluation of language concordant, patient-centered drug label instructions.’. J Gen Intern Med. 27(12), 1707–1713 [DOI]. [N=202, USA, adults speaking five non-English languages, Rx bottles.] [Sharko 49].

Carpenter SH, Olson KM. ‘Are Pictures Good for Leaming New Vocabulary in a Foreign Language? Only If You Think They Are Not’. Joumal of Experimental Psychology: Learning. Memory, and Cognition. 38(1), 92-101. [DOI]. [N=116 + N=24 + N=50 + N=64, USA, University undergraduate students, Swahili words with or without a picture.] [Del Re].

Choi J. ‘Development and pilot test of pictographenhanced breast health-care instructions for community residing immigrant women.’. International Journal of Nursing Practice. 18, 373–378. [DOI]. [N=6, USA, six immigrant women with limited literacy skills, hospital discharge instructions.] [Park, Wang 9].

• Figure 1

Coylewright M, Shepel K, LeBlanc A, Pencille L, Hess E, Shah N, Montori VM, Ting HH. ‘Shared decision making in patients with stable coronary artery disease: PCI choice.’. PLoS One. 7(11), e49827. [DOI]. [N=25, USA, Percutaneous coronary intervention patients, patient-centered decision aid.] [Wang 34].

• Figure 3

• Figure 4

Hess EP, Knoedler MA, Shah ND, Kline JA, Breslin, M, Branda MA, Pencille LJ, Asplin BR, Nestler DM, Sadosty AT, Stiell IG, Ting HH, Montori VM. ‘The chest pain choice decision aid: a randomized trial.’. Circulation: Cardiovascular Quality and Outcomes. 5, 251–9. [DOI]. [N=204, USA, nontraumatic chest pain, decision aid (100-person pictograph).] [Wang 78].

• Figure 1

King SR, McCaffrey III DJ, Bentley JP, Bouldin A, Hallam J, Wilkin NE. ‘The influence of symbols on the short-term recall of pharmacy-generated prescription medication information in a low health literate sample.’. J Health Commun. 17(sup3): 280-93. [DOI]. [N=161, USA, low-literate, 3 versions of a leaflet for patients with USP pictograms.] [Beusekom 55, Del Re, Lühnen 28, Schubbe 89].

• Figure 1

Kripalani S, Schmotzer B, Jacobson TA. ‘Improving Medication Adherence through Graphically Enhanced Interventions in Coronary Heart Disease (IMAGE-CHD): A Randomized Controlled Trial’. J Gen Intern Med. 27(12), 1609–17. [DOI]. [N=435, USA, Adults with coronary heart disease, Illustrated medication schedule.] [Brown, Menon, Merks, Schubbe 91, Sedeh 52, Sletvold 37].

• Figure 1

• Figure 2

Martin D, Kripalani S, DuPapau Jr VJ. ‘Improving Medication Management among At-risk Older Adults’. J Gerontol Nurs. 38(6), 24–37. [DOI]. [N=20, USA, Community-dwelling older adults, PictureRX.] [Brown, Faustino 25].

• Figure 1

Martin RW, Brower ME, Geralds A, Gallagher PJ, Tellinghuisen DJ. ‘An experimental evaluation of patient decision aid design to communicate the effects of medications on the rate of progression of structural joint damage in rheumatoid arthritis.’. Patient Education and Counseling. 86, 329–34. [DOI]. [N=182, USA, students and patients, patient decision aid.] [Wang 77].

• Figure 1

Mbuagbaw L, Ndongmanji E. ‘Patients’ understanding of prescription instructions in a semi-urban setting in Cameroon.’. Patient Education and Counseling. 88, 147–151. [DOI]. [N=204, Cameroon, 4 modalities: pictograms, written out, symbols, latin abbreviations.] [Barros 27, Beusekom 54, Mbanda 88, Nualdaisri 32, Sedeh 53].

• Figure 1

• Figure 2

McCaffery KJ, Dixon A, Hayen A, Jansen J, Smith S, Simpson JM ‘The influence of graphic display format on the interpretations of quantitative risk information among adults with lower education and literacy: a randomized experimental study.’. Medical Decision Making. 32, 532–44. [DOI]. [N=120, Australia, adults with lower education and literacy, pictographs and bar charts.] [Wang 51].

• Appendix Figure 1

• Appendix Figure 2

• Appendix Figure 3

Nakamura C, Zeng-Treitler Q. ‘A taxonomy of representation strategies in iconic communication.’. International Journal of Human-Computer Studies. 70(8), 535-51. [DOI]. [Taxonomy, no experimental data.] [Beusekom 92]

• Figure 1

• Figure 2

• Figure 3

• Figure 5

• Figure 6

• Figure 7

• Figure 8

• Figure 9

• Figure 10

• Figure 11

• Figure 12

• Figure 13

• Figure 14

• Figure 15

• Figure 16

Poureslami I, Nimmon L, Doyle-Waters M, Rootman I, Schulzer M, Kuramoto L, FitzGerald M. ‘Effectiveness of Educational Interventions on Asthma Self-Management in Punjabi and Chinese Asthma Patients: A Randomized Controlled Trial’. Journal of Asthma. 49(5), 542–551. [DOI]. [N=92 physician-diagnosed adult asthma patients (47 Chinese and 45 Punjabi), Canada, asthma patients, Videos vs pictorial pamphlet.] [Faustino 21].

Rajesh R, Vidyasagar S, Varma DM, Sharma. ‘Design and evaluation of pictograms for communicating information about adverse drug reactions to antiretroviral therapy in Indian human immunodeficiency virus positive patients’. Journal of Pharmaceutical and Biomedical Sciences,. 16(10), 1–11. [Link]. [N=50, India, hospitalized HIV positive patients, 20 pictograms.] [Nualdaisri 47].

• Figure 1

Sahm LJ, Wolf MS, Curtis LM, Behan R, Brennan M, Gallwey H, McCarthy S. ‘What’s in a label? An exploratory study of patient-centered drug instructions.’. Eur J Clin Pharmacol. 68(5), 777–82. [DOI]. [N=94, Ireland, outpatients, patient-centered label (PCL) instructions.] [Lühnen 23, Saif 24, Sharko 47].

• Table 1

Soares MA. ‘Legibility of USP pictograms by clients of community pharmacies in Portugal.’. Int J Clin Pharm. 35(1), 22-29. [DOI]. [N=751, Portugal, community pharmacy clients, 15 USP pictograms.] [Beusekom 12, Sedeh 59]

• Table 2a

• Table 2b

• Table 3a

• Table 3b

Tae JW, Lee JC, Hong SJ, Han JP, Lee YH, Chung JH, Yoon HG, Ko BM, Cho JY, Lee JS, Lee MS. ‘Impact of patient education with cartoon visual aids on the quality of bowel preparation for colonoscopy’. Gastrointestinal Endoscopy. 76, 804–811. [DOI]. [N=205, Korea, colonoscopy preparation, written vs illustrated.] [Schubbe 108].

• Figure 1

Tait AR, Voepel-Lewis T, Brennan-Martinez C, McGonegal M, Levine R. ‘Using animated computer-generated text and graphics to depict the risks and benefits of medical treatment’. The American Journal of Medicine. 125(11), 1103–1110. [DOI]. [N=200, USA, participants, animated computerized text and graphics.] [Wang 75].

• Figure 1

• Figure 2

• Figure 3

• Figure 4

Wallace LS, Keenum AJ, DeVoe JE, Bolon SK, Hansen JS. ‘Women’s understanding of different dosing instructions for a liquid pediatric medication.’. J Pediatr Health Care Publ Natl Assoc Pediatr Nurse Assoc Pract. 26(6), 443–50. [DOI]. [N=193, USA, young women, medication bottle instructions.] [Sharko 48].

Wilson EA, Vaillancourt R, Pascuet E, Besançon LJ, Wolf MS. ‘Seeking international consensus in the use of icons for medication instructions.’. J Commun Healthc. 5(1), 67–72. [DOI]. [N=850, online, online, global icons.] [Nualdaisri 168].

• Figure 1

2011

Braich PS, Almeida DR, Hollands S, Coleman MT. ‘Effects of pictograms in educating 3 distinct lowliteracy populations on the use of postoperative cataract medication.’. Canadian Journal of Ophthalmology. 46, 276–281. [DOI]. [N=225, India, postoperative cataract (eye drops), instructions.] [Barros 5, Beusekom 53, Menon, Schubbe 67, Sedeh 44, Sletvold 33].

• Figure 2

• Figure 3

Calderwood AH, Lai EJ, Fix OK, Jacobson BC. ‘An endoscopist-blinded, randomized, controlled trial of a simple visual aid to improve bowel preparation for screening colonoscopy’. Gastrointestinal Endoscopy. 73, 307–314. [DOI]. [N=969, USA, colonoscopy outpatients, visual aid.] [Schubbe 71].

• Figure 1

Choi J. ‘Pictograph-based discharge instructions for low-literate older adults after hip replacement surgery: Development and validation.’. Journal of Gerontological Nursing. 37(11), 47–56. [DOI]. [N=5, USA, older adults after hip replacement surgery, pictograph-based discharge instructions.] [Park, Wang 33].

Dowse R, Ramela T, Browne SH. ‘An illustrated leaflet containing antiretroviral information targeted for low-literate readers: development and evaluation.’. Patient Educ Couns. 85, 508–515. [DOI]. [N=39, South Africa, HIV/AIDS, instruction leaflet.] [Barros 8, Beusekom 62, Mbanda 97, Nualdaisri 20, Sedeh 45].

• Figure 1

Grenier S, Vaillancourt R, Pynn D, Cloutier MC, Wade J, Turpin PM, Pascuet E, Preston C. ‘Design and development of culture-specific pictograms for the labeling of medication for first nation communities.’. J Commun Healthc. 4, 238–245. [DOI]. [N=66, Canada (first nations), culture?]. [Barros 15, Beusekom 46, Sedeh 46].

• Figure 1

Joshi Y, Kothiyal P. ‘A pilot study to evaluate pharmaceutical pictograms in a multispecialty hospital at Dehradun.’. J Young Pharm . 3, 163–166. [DOI]. [N=200, India (illiterate), 10 USP pictograms.] [Barros 26, Beusekom 80, Sedeh 47].

• Figure 1

Karan AM, Campbell DJ, Mayer HR. ‘The effect of a visual aid on the comprehension of cataract surgery in a rural, indigent South Indian population’. Digital Journal of Ophthalmology. 17, 16–22. [DOI]. [N=60, India, cataract surgery, visual aid.] [Schubbe 87].

• Figure 2

Kasper J, Heesen C, Köpke S, Mühlhauser I, Lenz M. ‘Why not? – communicating stochastic information by use of unsorted frequency pictograms – a randomized controlled trial.’. GMS Psychosoc Med. 8, 1–11. [DOI]. [N=111, Germany, Multiple sclerosis, multi-figure pictographs.] [Barros 30].

• Figure 1

King JP, Davis TC, Bailey SC, Jacobson KL, Hedlund LA, Di Francesco L, Parker RM, Wolf MS. ‘Developing consumer-centered, nonprescription drug labeling a study in acetaminophen.’. Am J Prev Med. 40(6), 593–8. [DOI]. [N=45 in 6 focus groups, USA, general, (OTC) acetaminophen labels.] [Sharko 44].

• Figure 1

• Figure 2

Meesmann U, Boets S, de Gier H, Knoche A, Monteiro S, Fierro F, Álvarez, J. ‘Main DRUID results to be communicated to different target groups’. European Commission, Transport RTD Programme, 6th Framework Project No. TREN-05-FP6TR-S07.61320-518404-DRUID. [Website]. [N=270 + N=736, Netherlands + Spain, pharmacy-visitors, 2 ‘don’t drive’ pictograms.] [Beusekom 45, not in main article]

• Figure 1

• Figure 2

• Figure 3

• Figure 13

• Figure 14

• Figure 15

• Figure 16

Mishra N, Khatri S, Gehlaut R, Mittal P, Yadav S. ‘Awareness and understanding of pharmaceutical pictograms in non pharmacy students: A case study.’. J App Pharm Sci. 1(10), 207-210. [PDF]. [N=140, India, students, 20 USP and 20 local pictograms.] [Beusekom 43]

Montori VM, Shah ND, Pencille LJ, Branda ME, Houten HK van, Swiglo BA, Kesman RL, Tulledge-Scheitel SM, Jaeger TM, Johnson RE, Bartel GA, Melton III LJ, Wermers RA. ‘Use of a decision aid to improve treatment decisions in osteoporosis: the osteoporosis choice randomized trial.’. The American Journal of Medicine. 124, 549–56. [DOI]. [N=100, USA, postmenopausal women, decision aid about bisphosphonate therapy.] [Wang 76].

• Figure 1

Kakkilaya V, Groome LJ, Platt D, Kurepa D, Pramanik A, Caldito G, Conrad L, Bocchini Jr JA, Davis TC. ‘Use of a Visual Aid to Improve Counseling at the Threshold of Viability’. Pediatrics. 128(6), e1511–e1519. [DOI]. [N=89, USA, Pregnant women, 2-page brochure with photographs and line drawings.] [Del Re].

• Appendix 1a

• Appendix 1b

Owais A, Hanif B, Siddiqui AR, Agha A, Zaidi AK. ‘Does improving maternal knowledge of vaccines impact infant immunization rates? A communitybased randomized-controlled trial in Karachi, Pakistan’. BMC Public Health. 11, 239. [DOI]. [N=366, Pakistan, mother-infant pairs, pictorial messages regarding vaccines.] [Schubbe 104].

Wilby K, Marra CA, da Silva JH, Grubisic M, Harvard S, Lynd LD. ‘Randomized controlled trial evaluating pictogram augmentation of HIV medication information.’. Ann Pharmacother. 45, 1378–1383. [DOI]. [N=82, Canada, HIV, Pharmaglyph pictograms. Pharmaglyph website: not found.] [Barros 29, Beusekom 83, Del Re, Merks, Schubbe 112, Sedeh 48].

Wolf MS, Davis TC, Curtis LM, Webb JA, Bailey SC, Shrank WH, Lindquist L, Ruo B, Bocchini M, Parker R, Wood A. ‘Effect of standardized, patient-centered label instructions to improve comprehension of prescription drug use.’. Medical Care. 49(1), 96–100. [DOI]. [N=500, USA, participants, patientcentered label (PCL) instructions.] [Sharko 51].

• Table 1

Yin HS, Mendelsohn AL, Fierman A, van Schaick L, Bazan IS, Dreyer BP. ‘Use of a pictographic diagram to decrease parent dosing errors with infant acetaminophen: a health literacy perspective.’. Academic Pediatrics. 11(1), 50-7. [DOI]. [N=299, USA (New York), parents, text-only or text-plus-pictogram instructions for dropper.] [Beusekom 67, Chan, Lühnen 24, Schubbe 114, Sedeh 49, Sharko 14, Wang 69]

• Figure 1

You WB, Grobman W, Davis T, Curtis, LM, Bailey SC, Wolf M. ‘Improving pregnancy drug warnings to promote patient comprehension.’. American Journal of Obstetrics and Gynecology. 204, 1–5. [DOI]. [Saif 22, Vendruscolo].

• Figure

Zargarzadeh AH, Law AV. ‘Design and test of preference for a new prescription medication label.’. Int J Clin Pharm. 33(2), 252–9. [DOI]. [N=444 patients, 115 pharmacists, 69 physicians, USA, prescription labels.] [Saif 26, Sharko 59].

• Figure 1

Zerafa N, Zarb Adami M, Galea J. ‘Impact of drugs counselling by an undergraduate pharmacist on cardiac surgical patient’s compliance to medicines’. Pharmacy Practice (Internet). 9(3), 156-161. [Website]. [N=80, Malta, Open heart surgery, a chart with pictorial explanation.] [Menon, Merks, Sedeh 50, Sletvold 18, Wang 65].

• Figure 1

2010

Ali H, Seale H, Ward K. ‘A picture speaks a thousand words: evaluation of a pictorial post-vaccination care resource in Australia.’. Aust J Prim Health. 16, 246–51. [DOI]. [N=12+29, Australia, General practitioners + practice nurses, post-vaccination care resource.] [Wang 44].

• Figure 1

Chuang M-H, Lin C-L, Wang YF, Cham T-M. ‘Development of Pictographs Depicting Medication Use Instructions for Low-Literacy Medical Clinic Ambulatory Patients’. Journal of Managed Care Pharmacy. 16(5), 337-345. [DOI]. [N=500, Taiwan, low-literacy patients and healthcare providers, 12 pictographs illustrating 4 instructions.] [Beusekom 44, Mbanda 101, Nualdaisri 100, Park, Sedeh 41, Wang 39].

• Figure 1

• Figure 2

• Table 2

• Table 3

Dowse R, Ramela T, Barford K-L, Browne S.‘Developing visual images for communicating information about antiretroviral side effects to a low-literate population’. African Journal of AIDS Research. 9(3), 213-24. [DOI]. [N=40, South Africa, Low-literate Xhosa, 6 locally developed visuals.] [Beusekom 84, Mbanda 98, Nualdaisri 24].

• Figure 1

Gazmararian J, Jacobson KL, Pan Y, Schmotzer B, Kripalani S. ‘Effect of a Pharmacy-Based Health Literacy Intervention and Patient Characteristics on Medication Refill Adherence in an Urban Health System’. The Annals of Pharmacotherapy. 44, 80-7. [DOI]. [N=173 + 102 control, Atlanta (USA), inner-city patients, picture prescription card.] [Faustino 17].

Goel G. ‘A comparative study to evaluate patients interpretation of U.S.P and locally designed pharmaceutical pictograms.’. Pharma Times. 42, 16–19. [DOI]. [N=100?, India, 16 USP pictograms. Article: not found] [Barros 22, Sedeh 42].

Hickman MS, White WL, White WA. ‘Illustrations as a patient education tool to improve recall of postoperative cataract medication regimens in the developing world’. Hawaii Med. J. 69, 212–215. [DOI]. [N=65, Hawaii, patients undergoing cataract surgery, detailed illustrations regarding the morning, noon, evening, and bedtime use.] [Schubbe 84].

• Figure 1

• Figure 2

• Figure 3

• Figure 4

• Figure 5

Tait AR, Voepel-Lewis T, Zikmund-Fisher BJ, Fagerlin, A. ‘Presenting research risks and benefits to parents: does format matter?’. Anesthesia & Analgesia. 111(3), 718–23. [DOI]. [N=408, USA, Parents, text-tables-pictographs.] [Wang 71].

• Figure 1

Tait AR, Voepel-Lewis T, Zikmund-Fisher B, Fagerlin, A. ‘The effect of format on parents’ understanding of the risks and benefits of clinical research: a comparison between text, tables, and graphics.’. J Health Commun. 15, 487–501. [DOI]. [N=4685, internet, parents, text-tables-pictographs.] [Wang 73].

• Figure 1

• Figure 2

• Figure 3

Thompson AE, Goldszmidt MA, Schwartz AJ, Bashook PG. ‘A randomized trial of pictorial versus prosebased medication information pamphlets.’. Patient Education and Counseling. 78, 389–393. [DOI]. [N=100, Canada, pamphlet: not found]. [Barros 14, Beusekom 7, Del Re, Lühnen 34, Schubbe 110, Sedeh 43, Wang 64].

Welch JL, Siek KA, Connelly KH, Astroth KS, McManus MS, Scott L, Heo S, Kraus MA. ‘Merging health literacy with computer technology: self-managing diet and fluid intake among adult hemodialysis patients. ’. Patient Education and Counseling. 79(2), 192–198. [DOI]. [N=40, USA, hemodialysis, Digital Dietary Intake Monitoring Application.] [Wang 35].

• Figure 1

• Figure 2

• Figure 3

Wolf MS, Davis TC, Bass PF, Curtis LM, Lindquist LA, Webb JA, Bocchini MV, Cooper Bailey S, Parker RM. ‘Improving Prescription Drug Warnings to Promote Patient Comprehension.’. Arch Intern Med. 170(1), 50-56. [DOI]. [USA, N= 530. Pictograms/icons on warning labels on Target Rx bottles.] [Beusekom 6, Ferreira, Vendruscolo].

• Figure 1

• Table 1a

• Table 1b

2009

Bennett D, Dharia C, Ferguson K, Okon A. ‘Patient-physician communication: informed consent for imaging-guided spinal injections’. Journal of the American College of Radiology. 6(1), 38–44. [DOI]. [N=99, USA, Spinal injury, control-teach the teacher- diagram.] [Schubbe 66].

• Figure 1

Cordasco KM, Asch SM, Bell DS, Guterman JJ, Gross-Schulman S, Ramer L, Elkayam U, Franco I, Leatherwood CL, Mangione CM. ‘A Low-Literacy Medication Education Tool for Safety-Net Hospital Patients’. American Journal of Preventive Medicine. 37, 6S1. [DOI]. [N=166, USA, cardiac patients, low-literacy picture- and icon-based medication education tool.] [Brown, Faustino 22, Schubbe 76].

• Figure 1

Davis TC, Federman AD, Bass 3rd PF, Jackson RH, Middlebrooks M, Parker RM, Wolf MS. ‘Improving patient understanding of prescription drug label instructions.’. J Gen Intern Med. 24(1), 57–62. [DOI]. [N=359, USA, adults, label instructions.] [Saif 9, Sharko 13].

Dotson A. ‘Use of a pictorial medication labeling system to improve comprehension of drug information and adherence to drug regimen: A randomized trial among pregnant women in a rural maternal and child health clinic in Kutch, India’. MA thesis, Department of Population, Family, and Reproductive Health, Johns Hopkins University. [Website]. [N=137, India, Pregnant women. Local developed pictorial labels.] [Beusekom 64].

• Figure 3

• Figure 4

• Figure 5

Kim H, Nakamura C, Zeng-Treitler Q. ‘Assessment of pictographs developed through a participatory design process using an online survey tool.’. J Med Internet Res. 11(1): e4. [DOI]. [N=37, USA, 20 + 20 pictographs.] [Beusekom 90, Choi, Wang 67].

• Figure 1

• Figure 2

• Figure 3

• Figure 4

• Figure 5

• Figure 6

Liu CJ, Kemper S, McDowd J. ‘The use of illustration to improve older adults’ comprehension of health-related information: is it helpful?’. Patient Educ. Couns. 76, 283–288. [DOI]. [N=26 and N=30, USA, older adults and younger adults, short health-related texts with/without illustrations.] [Schubbe 93].

• Appendix

Marques LAM, Figueiredo ACS.‘The interpretation of pictograms used in the dispensation of medications according to the perspective of people with different education levels.’. Pharmaceutical Care España. 11, 152–156. [DOI]. [N=55, Brazil. pictograms: not found; article: not found.] [Barros 34].

Mayhorn, C. B., & Goldsworthy, R. C. ‘New and improved: The role of text augmentation and the application of response interpretation standards (coding schemes) in a final iteration of birth defects warnings development.’. Birth Defects Research. 85, 864–871. [DOI]. [Vendruscolo].

• Table 1

• Figure 1

• Figure 3

Roberts NJ, Mohamed Z, Wong P, Johnson M, Loh L-C, Partridge MR. ‘The development and comprehensibility of a pictorial asthma action plan.’. Patient Education and Counseling. 74, 12–18. [DOI]. [N=10 and N=19, Somalis living in Manchester (UK) and Malaysians in Seremban (Malaysia), Pictorial Asthma action plan.] [Wang 31].

• Figure 1

• Figure 2

• Table 2

• Table 3

Sorfleet C, Vaillancourt R, Groves S, Dawson J. ‘Design, development and evaluation of pictographic instructions for medications used during humanitarian missions.’. Can Pharm J. 142, 82–88. [DOI]. [N=525, Gabon, pictographic storyboards.] [Barros 13, Beusekom 37, Del Re].

• Figure 1

• Figure 2

2008

Goldsworthy RC, Schwartz NC, Mayhorn CB.‘Interpretation of Pharmaceutical Warnings Among Adolescents.’. Journal of Adolescent Health. 42, 617–625. [DOI]. [Vendruscolo].

• Figure 1

• Table 1

• Table 2

• Table 3

• Table 4

• Table 5

• Table 6

Hawley ST, Zikmund-Fisher B, Ubel P. ‘The impact of the format of graphical presentation on health-related knowledge and treatment choices.’. Patient Education and Counseling. 73, 448–55. [DOI]. [N=2412, USA, online, six graph formats.] [Wang 50].

• Figure 1

• Figure 2

• Figure 3

• Figure 4

• Figure 5

• Figure 6

Henry E, Brown T, Bartlett C, Massoud E, Bance M. ‘Informed consent in otologic surgery: prospective randomized study comparing risk recall with an illustrated handout and a nonillustrated handout’. J Otolaryngol Head Neck Surg. 37(2), 273-8. [Website]. [N=51, Canada, Patients undergoing otologic surgery, text with/without pictures.] [Schubbe 83].

• Figure 1

• Figure 2

Yin HS, Dreyer BP, Van Schaick L, et al. ‘Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children.’. Arch Pediatr Adolesc. 162, 814–822. [DOI]. [N=245, USA (Children), liquid medication, HELPix medication instruction sheet: not found.] [Barros 28, Beusekom 66, Chan, Dermody, Menon, Schubbe 113, Sedeh 40, Sletvold 28].

Webb J, Davis TV, Bernadella P, Clayman ML, Parker RM, Adler D, Wolf MS. ‘Patient-centered approach for improving prescription drug warning labels.’. Patient Education and Counseling. 72, 443–449. [DOI]. [Beusekom 39, Vendruscolo].

• Table 2

Zeng-Treitler Q, Kim H, Hunter M. ‘Improving patient comprehension and recall of discharge instructions by supplementing free texts with pictographs.’. AMIA Annual Symposium Proceedings 2008. 849. [DOI]. [N=13, USA, healthy volunteers, Text with and without pictograms.] [Beusekom 8, Del Re, Wang 40]

• Figure 1

• Figure 3

Zikmund-Fisher BJ, Fagerlin A, Ubel PA. ‘Improving understanding of adjuvant therapy options by using simpler risk graphics.’. Cancer. 113, 3382–90. [DOI]. [N=1619, online, women, four risk graphics.] [Wang 53].

• Figure 1

• Figure 2

Zikmund-Fisher BJ, Ubel PA, Smith DM, Derry HA, McClure JF, Stark A, Pitsch RK Fagerlin A. ‘Communicating side effect risks in a tamoxifen prophylaxis decision aid: the debiasing influence of pictographs.’. Patient Education and Counseling. 73(2), 209–14. [DOI]. [N=631, USA, women, Presentation format.] [Wang 74].

• Figure 1

• Figure 2

2007

Kripalani S, Robertson R, Love-Ghaffari MH, Henderson LE, Praska J, Strawder A, Katz MG, Jacobson TA. ‘Development of an illustrated medication schedule as a low-literacy patient education tool.’. Patient Educ Couns. 66(3), 368-77. [DOI]. [N=209, USA, low health literacy, illustrated medication schedule.] [Beusekom 63, Choi, Faustino 24, Park, Sedeh 35]

• Figure 2

Machtinger EL, Wang F, Chen L-L, Rodriguez M, Wu S, Schillinger D. ‘A Visual Medication Schedule to Improve Anticoagulation Control: A Randomized, Controlled Trial.’. The Joint Commission Journal on Quality and Patient Safety. 33, 625–635. [DOI]. [N=147, USA, chronic warfarin users, visual medication schedule.] [Merks, Schubbe 95, Sedeh 36].

• Figure 1

Mansoor L, Dowse R. ‘Written medicines information for South African HIV/AIDS patients: does it enhance understanding of co-trimoxazole therapy?’. Health Educ Res. 22(1), 37-48. [DOI]. [N=120, South Africa, participants, 2 PILs for co-trimoxazole tablets.] [Barros 16, Beusekom 9, Merks, Nualdaisri 15, Schubbe 96, Sedeh 37]

• Figure 2

Mayhorn CB, & Goldsworthy RC. ‘Refining teratogen warning symbols for diverse populations.’. Birth Defects Research. 79, 494–506. [DOI]. [Vendruscolo].

• Figure 1

• Figure 2

• Figure 3

• Table 1

• Table 2

• Table 3

• Table 4

• Table 5

• Table 6

Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, Stroupe KT, Wu J, Clark D, Smith F, Gradus-Pizlo I, Weinberger M, Brater DC. ‘Pharmacist Intervention to Improve Medication Adherence in Heart Failure’. Annals of Internal Medicine. 146, 714-725. [DOI]. [N=314, USA, low income over 50 with heart failure, written material with icons.] [Brown, Menon, Sedeh 38, Sletvold 27].

Mwingira B, Dowse R. ‘Development of written information for antiretroviral therapy: comprehension in a Tanzanian population.’. Pharm World Sci. 29, 173–182. [DOI]. [N=60, Tanzania, HIV, patient information leaflet with pictograms.] [Barros 10, Beusekom 61, Nualdaisri 35, Sedeh 39].

• Figure 1

• Figure 2

Sudore RL, Efeld CS, Barnes DE, Lindquist K, Williams BA, Brody R, Schillinger D. ‘An advance directive redesigned to meet the literacy level of most adults: a randomized trial’. Patient Education and Counseling. 69(1-3), 165–195. [DOI]. [N=205, USA, limited literacy, Comparing 2 forms.] [Schubbe 107].

• Appendix B

Walker MS, Farria D, Schmidt M, Monsees B, Wiele K, Bokern J, Swatske ME. ‘Educational intervention for women undergoing image-guided breast biopsy: results of a randomized clinical trial’. Cancer Control. 14, 380–387. [DOI]. [N=122, USA, breast biopsy, educational flip chart.] [Schubbe 111].

• Figure 1

2006

Brotherstone H, Miles A, Robb KA, Atkin W, Wardle J. ‘The impact of illustrations on public understanding of the aim of cancer screening’. Patient Educ. Couns. 63(3), 328–335. [DOI]. [N=318, UK, flexible sigmoidoscopy (FS) screening, brochure with/without illustrations.] [Schubbe 68].

• Figure 1

• Appendix 1a

• Appendix 1b

Chin-Quee D, Wong E, Cuthbertson C. ‘Evaluating information on oral contraceptive use: a randomized controlled trial to assess missed pill instructions’. Human Reproduction. 21(12), 3137-45. [DOI]. [N=864, Jamaica, current and past pill users, four types of instructions.] [Schubbe 75].

• Figure 1

Galato F, Just MC, Galato D, Silva WB da. ‘Development and validation of pictograms for the proper use of Medications: description of a pilot study.’. [In Portuguese: ‘Desenvolvimento e Validação de Pictogramas para o Uso Correto de Medicamentos: Descrição de um Estudo-Piloto’.] Acta Farmacéutica Bonaerense. 25, 131–138. [Website]. [N=73, Brazil, 6 pictograms.] [Barros 33].

• Tabel 2

Girardi S, Gaudy C, Gouvernet J, Teston J, Richard MA, Grob JJ. ‘Superiority of a cognitive education with photographs over ABCD criteria in the education of the general population to the early detection of melanoma: a randomized study’. International Journal of Cancer. 118(9), 2276–2280. [DOI]. [N=255, France, general adult population, 3 leaflets.] [Schubbe 81].

• Figure 1

Goldsworthy R, Kaplan B. ‘Exploratory evaluation of several teratogen warning symbols.’. Birth Defects Research. 76, 453–460. [DOI]. [Vendruscolo].

• Figure 1

• Figure 2

• Figure 3

• Table 1

• Table 2

• Table 3

• Table 4

Kools M, MW van de, Ruiter RA, Kok G. ‘Pictures and text in instructions for medical devices: effects on recall and actual performance’. Patient Education and Counseling. 64, 104–111. [DOI]. [N=99, Netherlands, general public, instructions for using asthma devices.] [Schubbe 90].

• Figure 1

• Figure 2

Mansoor L, Dowse R. ‘Medicines information and adherence in HIV/AIDS patients’. J Clin Pharm Ther. 31(2), 7–15. [DOI]. [N=120, South Africa, HIV, Patient information leaflet.] [Barros 20, Beusekom 65, Menon, Merks, Nualdaisri 14, Sedeh 34, Sletvold 23].

• Figure 2

Mwingira B, Dowse R. ‘Comprehension and acceptability of a patient information leaflet (PIL) for antiretroviral therapy.’. Health SA Gesondheid. 11(3), 49-59. [DOI]. [N=60, South Africa, Xhosa 18-61, Package leaflet.] [Beusekom 60, Nualdaisri 21]

2005

Dowse R, Ehlers MS. ‘Medicine labels incorporating pictograms: do they influence understanding and adherence?’. Patient Education and Counseling. 58(1), 63-70. [DOI]. [N=87, South Africa, antibiotics, self adhesive labels with/without pictograms.] [Barros 23, Beusekom 10, Choi, Faustino 10, Ferreira, Mbanda 95, Menon, Nualdaisri 13, Park, Saif 27, Schubbe 77, Sedeh 31, Sharko 56, Sletvold 24].

• Figure 1

Hwang SW, Tram CQ, Knarr N. ‘The effect of illustrations on patient comprehension of medication instruction labels.’. BMC Family Practice. 6(1), 26-31. [DOI]. [N=130, Canada, two sets of 5 medication instruction labels.] [Beusekom 82].

• Figure 1

Kalichman SC, Cain D, Fuhrel A, Eaton L, Fonzo K Di, Ert T. ‘Assessing medication adherence self-efficacy among low-literacy patients: development of a pictographic visual analogue scale’. Health Education Research. 20(1), 24-35. [DOI]. [N=81; N=64, Atlanta (USA), HIV-AIDS, pictographic self-efficacy scale.] [Mbanda 85].

• Figure 1

Kalichman SC, Cherry C, Kalichman MO, Amaral C, White D, Grebler T, Eaton LA, Cruess D, Detorio MA, Caliendo AM, Schinazi RF. ‘Randomized Clinical Trial of HIV Treatment Adherence Counseling Interventions for People Living with HIV and Limited Health Literacy’. J Acquir Immune Defic Syndr. 63(1), 42–50. [DOI]. [N=446, Atlanta (USA), HIV-AIDS, pictograph-guided adherence counseling.] [Mbanda 103].

Kalichman SC, Cherry J, Cain D. ‘Nurse-delivered antiretroviral treatment adherence intervention for people with low literacy skills and living with HIV/AIDS’. J Assoc Nurses AIDS Care. 16(5), 3-15. [DOI]. [N=45; N=30, USA, HIV-positive, Personalized Feedback Report and Medication Adherence Action Plan.] [Sedeh 32].

• Figure 2

Knapp P, Raynor DK, Jebar AH, Price SJ. ‘Interpretation of Medication pictograms by adults in the UK.’. The Annals of Pharmacotherapy. 39, 1227–1233. [DOI]. [N=227, UK, 10 pictograms, understanding.] [Barros 35, Beusekom 77, Faustino 19, Sedeh 33, Vendruscolo].

• Figure 1

• Figure 2

Schillinger D, Machtinger EL, Wang F, Chen L-L, Win K, Palacios J, Rodriguez M, Bindman A. ‘Language, Literacy, and Communication Regarding Medication in an Anticoagulation Clinic: Are Pictures Better Than Words?’. 199-212. In: Henriksen K, Battles JB, Marks ES, Lewin DI (eds.) Advances in Patient Safety: From Research to Implementation (Volume 2: Concepts andMethodology). Rockville: Agency for Healthcare Research and Quality. [DOI]. [N=220, San Francisco (USA), long-term warfarin users, Visual aids.] [Faustino 23].

• Figure 1

2004

Campbell FA, Goldman BD, Boccia ML, Skinner M. ‘The effect of format modifications and reading comprehension on recall of informed consent information by low-income parents: a comparison of print, video, and computer-based presentations’. Patient Education and Counseling. 53, 205–216. [DOI]. [N=233, USA, low-income parents, consent information.] [Schubbe 72].

Cherry KE, Dokey DE, Reese CM, Brigman S. ‘Pictorial Illustrations Enhance Memory for Sentences in Younger and Older Adults’. Experimental Aging Research. 29, 353–370. [DOI]. [N=96 + N=96, USA, undergraduate students and older adults, line illustrations.] [Del Re].

• Figure 1

Dowse R, Ehlers M. ‘Pictograms for conveying medicine instructions: comprehension in various South African language groups’. South African Journal of Science. 100 (11/12), 687-693. [DOI]. [N=304, South Africa, Low-literate. 23 USP and 23 local pictograms.] [Beusekom 38, Nualdaisri 23].

• Table 3

DeWalt DA, Pignone M, Malone R, Rawls C, Kosnar MC, George G, Bryant B, Rothman RL, Angel B. ‘Development and pilot testing of a disease management program for low literacy patients with heart failure’. Patient Education and Counseling. 55, 78–86. [DOI]. [N=25, USA, low literacy patients with heart failure, educational booklet.] [Park, Sedeh 29].

• Figure 1

• Figure 2

• Figure 3

Enzenhofer M, Bludau HB, Komm N, Wild B, Mueller K, Herzog W, Hochlehnert A. ‘Improvement of the educational process by computer-based visualization of procedures: randomized controlled trial’. J. Med. Internet Res.. 6(2), e16. [DOI]. [N=56, Germany, coronary catheters or endoscopy procedures, computerized visualization.] [Schubbe 79].

• Figure 1

• Figure 2

Hämeen-Anttila K, Kemppainen K, Enlunda H, Patricia JB, Marjad A. ‘Do pictograms improve children’s understanding of medicine leaflet information?’. Patient Educ Couns. 55, 371–378. [DOI]. [N=90, Finland (children 6-13), 15 pictograms + leaflet about penicillin-V.] [Barros 31, Beusekom 88, Sedeh 28].

• Table 1

• Table 2

Kassam R, Vaillancourt R, Collins JB. ‘Pictographic instructions for medications: do different cultures interpret them accurately?’. The International Journal of Pharmacy Practice. 12, 199–209. [DOI]. [N=39, three language groups, 16 pictograms.] [Barros 36, Beusekom 34].

• Figure 2a

• Figure 2b

Mansoor L, Dowse R. ‘Design and evaluation of a new pharmaceutical pictogram sequence to convey medicine usage.’. Ergonomics SA. 16(2), 29-41. [DOI]. [N=30 + 20, South Africa, low literate, nystatin suspension, modified USP pictograms.] [Beusekom 36, Sedeh 30]

• Figure 1

• Figure 2

Morrow DG, Weiner M, Deer MM, Young JM, Dunn S, McGuire P, Murray MD. ‘Patient-centered instructions for medications prescribed for the treatment of heart failure.’. The American Journal of Geriatric Pharmacotherapy. 2(1), 44–52. [DOI]. [Focus groups of 9 and 7, N=32 N=50, USA, Chronic heart failure, patient-centered instructions.] [Sharko 45].

Mwingira B. ‘Development and assessment of medicines information for antiretroviral therapy in Sub-Saharan Africa.’. Master of Science thesis. Faculty of Pharmacy, Rhodes University, Grahamstown. [Website]. [N=60 + 60, South Africa & Tanzania, general patients, 3 package leaflets with 6 pictograms.] [Beusekom 25]

• Page 199

• Page 200

• Page 203

• Page 204

2003

Dowse R, Ehlers MS. ‘The influence of education on the interpretation of pharmaceutical pictograms for communicating medicine instructions.’. International Journal of Pharmacy Practice. 11, 11–18. [DOI]. [N=130, South Africa, Xhosa community, 23 USP pictograms.] [Barros 25, Beusekom 32, Sedeh 26].

• Figure 1

Mansoor LE, Dowse R. ‘Effect of pictograms on readability of patient information materials.’. Ann Pharmacother. 37(7-8), 1003–1009. [DOI]. [N=60, South Africa, Xhosa community, bottle label for Nystatin suspension] [Barros 24, Beusekom 26, Choi, Ferreira, Lühnen 22, Mbanda 100, Nualdaisri 22, Park, Schubbe 97, Sedeh 27, Sharko 55].

• Figure 1

• Figure 2

Lesch MF. ‘Comprehension and memory for warning symbols: Age-related differences and impact of training’. Journal of Safety Research. 34, 495– 505. [DOI]. [N=92, USA, younger and elder, 41 warning symbols.] [Del Re].

• Figure 1

• Figure 2

2001

Daniel KL, Goldman KD, Lachenmayr S, Erickson JD, Moore C. ‘Interpretations of a Teratogen Warning Symbol.’. Teratology. 64, 148–153. [DOI]. [N=97, USA, women.] [Vendruscolo].

• Figure 1

Dowse R, Ehlers MS. ‘The evaluation of pharmaceutical pictograms in a low-literate South African population’. Patient Education and Counseling. 45(2), 87–99. [DOI]. [N=46, South Africa, Xhosa respondents, 2 sets of 23 USP pictograms.] [Barros 9, Beusekom 24, Choi, Del Re, Faustino 15, Mbanda 94, Park, Sedeh 23].

• Appendix 1a

• Appendix 1b

• Appendix 1c

• Appendix 1d

Houts PS, Witmer JT, Egeth HE, Loscalzo MJ, Zabora JR. ‘Using pictographs to enhance recall of spoken medical instructions II’. Patient Educ Couns. 43(3), 231-42. [DOI]. [N=21, USA, Adult clients with less than fifth grade reading skills, 236 medical instructions with/without 193 pictographs.] [Choi, Del Re, Sedeh 24].

• Figure 1

• Figure 3

Okonkwo PO, Akpala CO, Okafor HU, Mbah AU, Nwaiwu O. ‘Compliance to correct dose of chloroquine in uncomplicated malaria correlates with improvement in the condition of rural Nigerian children’. Transactions of the Royal Society of Tropical Medicine and Hygiene. 95(3), 320–324. [DOI]. [N=632, Nigeria, children, malaria: no intervention-pictorial insert-insert and instructions.] [Schubbe 103, Sedeh 25, Sletvold 26].

• Figure 1

Stewart DD, Stewart CB. ‘Group Recall: The Picture-Superiority Effect With Shared and Unshared Information’. Group Dynamics: Theory, Research, and Practice. 5(1), 48-56. [DOI]. [N=39, USA, classroom, illustrations and text.] [Del Re].

2000

Bernardini C, Ambrogi V, Perioli L, Tiralti MC, Fardella G. ‘Comprehensibility of the package leaflets of all medicinal products for human use: a questionnaire survey about the use of symbols and pictograms.’. Pharmacological Research. 41(6), 679–688. [DOI]. [N=1004, Italy, pictograms in package inserts.] [Barros 32, Beusekom 40].

• Table 1

• Table 2

• Table 3

• Table 4

• Table 5

• Table 6

1998

Dowse R, Ehlers MS. ‘Pictograms in pharmacy’. Int. J. Pharm. Pract. 6, 109–118. [DOI]. [Review.] [Beusekom 16].

Holzheimer L, Mohay H, Masters IB. ‘Educating young children about asthma: comparing the effectiveness of a developmentally appropriate asthma education video tape and picture book’. Child Care Health Dev. 24(1), 85–99. [DOI]. [N=80, Australia, children with asthma, ] [Sedeh 21, Sletvold 36].

Houts PS, Bachrach R, Witmer JT, Tringali CA, Bucher JA, Localio RA. ‘Using pictographs to enhance recall of spoken medical instructions’. Patient Education and Counseling. 35, 83–88. [DOI]. [N=21, USA, Student of a community junior college, pictographs.] [Choi, Del Re, Sedeh 22].

Morrow DG, Hier CM, Menard WE, Leirer VO. ‘Icons improve older and younger adults’ comprehension of medication information.’. The journals of gerontology series B. Psychol Sci Soc Sci. 53(4), P240–54. [DOI]. [N=36 + 36, N=45 + 36, USA, older adults + younger adults, dosage instructions.] [Choi, Sharko 46].

• Figure 1

• Figure 2

Sojourner RJ, Wogalter MS. ‘The Influence of Pictorials on the Comprehension and Recall of Pharmaceutical Safety and Warning Information’. International Journal of Cognitive Ergonomics. 2, 93-106. [Website]. [N=216, USA, Undergraduates/youger adults/older adults, drug information sheets.] [Del Re].

• Figure 1

1997

Hawthorne K, Tomlinson S. ‘One-to-one teaching with pictures–flashcard health education for British Asians with diabetes’. British Journal of General Practice. 47, 301–304. [Website]. [N=201, UK, Pakistani Moslem patients in Manchester with type 2 diabetes, pictorial flashcard.] [Schubbe 82].

Ngoh LN, Shepherd MD. ‘Design, development, and evaluation of visual aids for communicating prescription drug instructions to nonliterate patients in rural Cameroon’. Patient Education and Counseling. 30, 257–270. [DOI]. [N=87, Cameroon, female ambulatory patients, antibiotic prescription instructions.] [Choi, Sedeh 20, Sletvold 25].

1996

Delp C, Jones J. ‘Communicating Information to Patients: The Use of Cartoon Illustrations to Improve Comprehension of Instructions’. Academic Emergency Medicine. 3(3), 264-270. [DOI]. [N=234, USA, patients, double sided leaflet with cartoons.] [Del Re, Dermody, Schubbe 44].

• Figure 1a

• Figure 1b

Kalsher MJ, Wogalter MS, Racicot BM. ‘Pharmaceutical container labels: enhancing preference perceptions with alternative designs and pictorials.’. Int J Ind Ergon. 18(1), 83-90. [DOI]. [N=84, USA, Undergraduate students, labels with and without USP pictograms.] [Beusekom 57].

• Figure 1

Morrow DG, Leirer VO, Andrassy JM. ‘Using icons to convey medication schedule information’. Applied Ergonomics. 27(4), 267–75. [DOI]. [N=28 + 20, N=28 USA , older and younger, visual medication schedule.] [Sharko 61].

• Figure 1

1995

Austin PE, Matlack R, Dunn KA, Kesler C, Brown CK. ‘Discharge Instructions: Do Illustrations Help Our Patients Understand Them?’. Annals of Emergency Medicine. 25, 317-320. [DOI]. [N=101, USA, Convenience sample, discharge instructions with/without illustrations.] [Choi, Dermody, Schubbe 47].

• Figure 1

1994

Friedmann S, Jolly BT, Fineberg SL, Sanford SM. ‘Improving patient understanding: an evaluation of pictorial discharge instructions in the emergency department.’. Ann Emerg Med. 23(3), 627 [DOI]. [N=368, USA, Emergency department patients, Instruction sheets with/without illustrations.] [Dermody].

1993

Wolff J, Wogalter M. ‘Test and development of pharmaceutical pictorials.’. Interface. 93, 187-92. [PDF]. [N=143, USA, 9-60 years old, 28 USP pictograms in 4-page booklets.] [Beusekom 35]

• Figure 1

• Figure 2

• Figure 3

• Figure 4

• Figure 5

1992

Michielutte R, Bahnson J, Dignan MB, Schroeder EM. ‘The use of illustrations and narrative text style to improve readability of a health education brochure’. Journal of Cancer Education. 7(3), 251–260. [DOI]. [N=217, USA, women, Pamphlet with and without illustrations.] [Choi] .

1990

Patel VL, Eisemon TO, Arocha JF. ‘Comprehending instructions for using pharmaceutical products in rural Kenya’. Instructional Science. 19, 71-84. [DOI]. [N=18, Kenia, Maasai mothers, only text-no illustrations.] [Chan, Choi, Del Re].

• Figure 1

Mayer RE, Gallini JK. ‘When Is an Illustration Worth Ten Thousand Words?’. Journal of Educational Psychology. 82(4), 715-726 [DOI]. [N= 96, N=96, N=108, USA, College Students, illustrations of scientific devices.] [Del Re].

• Figure 1

• Figure 2

Morrell RW, Park DC, Poon LW. ‘Effects of Labeling Techniques on Memory and Comprehension of Prescription Information in Young and Old Adults’. Journal of Gerontology: Psychological Sciences. 45(4), 166-172. [DOI]. [N=64, USA, younger (=students) and older, medicine bottle labels.] [Del Re, Schubbe 99, Sharko 60].

• Figure 1

Earlier

Moll JMH, Wrigth V, Feffrey MR, Goode JD, Humberstone PM. (1977) ‘The cartoon in doctor-patient communication’. Annals of the Rheumatic Diseases. 36, 225-231. [DOI]. [N=50, USA, patients with gout, illustrated booklet with cartoons.] [Del Re].

• Figure 1

• Figure 2

• Figure 3