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Background: Clinicians are often advised to use pictographs to communicate risk, but whether they offer benefits when communicating risk imprecision (e.g., 65%-79%) is unknown. Purpose: To test whether any of three approaches to visualizing imprecision would more effectively communicate breast and ovarian cancer risk for BRCA1 pathogenic variant carriers. Methods: 1,300 UK residents were presented with a genetic report with information about BRCA1-related risks, with random assignment to one of four formats: no visualization (text alone), or a pictograph using shaded icons, a gradient, or arrows marking range endpoints. We also tested pictographs in two layouts. Analysis of variance (ANOVA) and regression was employed. Results: There was no effect of format. Participants shown pictographs vs. text alone had better uptake of breast cancer risk messages (p < .05, η2 = 0.003). Pictographs facilitated memory for the specific amount of risk (p < 0.001, η2 = 0.019), as did the tabular layout. Individuals not having completed upper secondary education may benefit most. Conclusions: We found weak evidence in favor of using simple pictographs with ranges to communicate BRCA risk (versus text alone), and of the tabular layout. Innovation: Testing different ways of communicating imprecision within pictographs is a novel and promising line of research.

Introduction: Number needed to treat (NNT) is a clinically useful "yardstick" used to gauge the efficacy of therapeutic interventions. The objective of this project was to develop and pilot a series of pictograms and assess their impact on pharmacist understanding of the NNT., Methods: Three decision aids containing NNT pictograms were developed following a preliminary literature review and three focus groups with current Australian-registered pharmacists and pharmacist interns. Pharmacists then tested the pictograms in a research pilot in clinical encounters until (1) ≥ 3 sessions had occurred or (2) a two-week period had elapsed from commencement. Knowledge assessment was administered both pre- and post-pilot. Transcription and inductive thematic analysis were applied to focus group data. Descriptive statistics, Wilcoxon signed rank, and McNemar's tests were used to analyse the pilot data., Results: Six core themes regarding NNT decision aid development were identified with >80% consensus across three focus groups (N = 11). Comparison of the pre-post measures (n = 10) showed an increase in median scores after use of NNT decision aids, correlating to a moderate Cohen classified effect size (d = 0.54). Wilcoxon matched pairs test demonstrated a statistically insignificant influence of NNT pictograms on the knowledge assessment survey (P > .05)., Conclusions: While the NNT is not a new concept, its incorporation as part of pictograms for health practitioner enrichment is novel. This pilot study suggests that utilizing decision aids with NNT pictograms as counselling adjuncts appears promising in the realm of enhancing pharmacists' understanding of the NNT., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier Inc.)

Objective: To develop evidence-based recommendations for improving comprehension of quantitative medication instructions., Methods: This review included a literature search from inception to November 2021. Studies were included for the following: 1) original research; 2) compared multiple formats for presenting quantitative medication information on dose, frequency, and/or time; 3) included patients/lay-people; 4) assessed comprehension-related outcomes quantitatively. To classify the studies, we developed a concept map. We weighed 3 factors (risk of bias in individual studies, consistency of findings among studies, and homogeneity of the interventions tested) to generate 3 levels of recommendations., Results: Twenty-one studies were included. Level 1 recommendations are: 1) use visualizations of medication doses for liquid medications, and 2) express instructions in time-periods rather than times per day. Level 2 recommendations include: validate icons, use panels or tables with explanatory text, use visualizations for non-English speaking populations and for those with low health literacy and limited English proficiency., Conclusions: Visualized liquid medication doses and time period-based administration instructions improve comprehension of numerical medication instructions. Use of visualizations for those with limited health literacy and English proficiency could result in improved outcomes., Practice Implications: Practitioners should use visualizations for liquid medication instructions and time period-based instructions to improve outcomes., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Despite living in a visually saturated world, with visual content permeating seemingly every aspect of our lives, an area in which visuals are still under-represented is health communication. Written health information, including medicines information, has generally been reported as being reader-unfriendly, offering challenges and barriers to even the most literate of readers with its often lengthy, detailed documents, use of medical jargon, and densely packed small text. The inclusion of visual content in the form of pictograms offers the potential to enhance the attractiveness and reader-friendliness of the information as well as improving comprehension and recall of medicines and general health information. This commentary presents the case of pictograms as a valuable tool in medicines information, urging pharmacists to consider their adoption in practice, but also sounding a note of caution when using pictograms., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: The aim of this systematic review was to investigate the potential effect of pictograms on patient adherence to medication therapies., Method: PubMed, MEDLINE, Embase, CINAHL, and CENTRAL were searched for relevant articles. Experimental studies testing the use of pictograms in patient counselling regarding medication therapy, which quantitatively measured adherence, were included., Results: Seventeen studies were identified that fulfilled our inclusion criteria. These were heterogeneous with respect to study setting, population size, and the medication regimen tested. All the studies had methodological quality limitations. The pictogram interventions differed with respect to complexity, intervention length, and the measured adherence outcome. Ten studies (58.8 %) reported a statistically significant effect, of the pictogram intervention in question, on patient adherence to medication therapies. Of these, 80 % involved populations at elevated risk for non-adherence., Conclusion and Practice Implications: 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., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Prompt management of side effects is critical to supporting adherence to antiretroviral (ARV) medication., Objective: This study examines the impact of presenting side effect information using simple text combined with pictograms on sustained knowledge of ARV side effects over three months., Method: Previously designed side effect pictograms, combined with simple text, were incorporated into a side effects panel within an ARV information leaflet. In a randomised controlled study, 116 limited literacy HIV patients taking ARVs were randomly allocated to either control (standard care) or intervention groups (standard care plus illustrated information). Side effect knowledge was assessed at baseline, and intervention patients received the illustrated leaflet. Knowledge was re-tested at one and three months. Interpretation of side effect pictograms was evaluated at one month., Results: In intervention patients, mean side effect knowledge increased from 45.9% (baseline) to 95.7% (three months; p<0.0001), and pictogram interpretation was good. Knowledge did not change significantly in the control group. All found the pictograms clear and useful, and endorsed their routine use., Conclusions: Providing patients with simple written information containing pictograms on ARV side effects significantly improved side effect knowledge, sustained over time, in limited literacy, rural South African HIV patients., (Copyright © 2018. Published by Elsevier Inc.)

Background: The ability of patients to understand pharmacotherapy information is critical to the successful use of medications. One of the risk factors that may predispose the patient to non-adherence is the low retention of verbal information. Thereby, one way to facilitate the understanding of patients regarding prescribed pharmacotherapy is to incorporate pictograms to transmit information in a clear, expeditious, and simple manner., Objective: To evaluate literature on the use of pictograms for health professionals and assess their impact on helping patients increase the understanding of and compliance with medical instructions., Methods: Searches were conducted from February to March 2012. We searched articles in databases, using the keywords: "pictograms," "health," "health care professionals," "medication" and "pictorial representation." After this step, we performed a manual sorting, evaluating titles and abstracts. The articles were carefully examined according to the following variables: (1) geographic location and setting of the studies; (2) study design; (3) number of pictograms used; (4) education; (5) sample size; (6) age of participants; (7) function of pictograms; (8) limitations described in the literature evaluated., Results: The research identified 136 published studies. After the exclusion process, 24 studies met inclusion criteria and from those, 50% were conducted in Africa, and 51.4% were considered effective. In the evaluation of the function of the pictograms, to verify their utility, 23 studies used to educate patients on the use of medications. The translation and cultural adaptation of pictograms was performed in five studies, and one study considered this process as validation., Conclusion: In this review, the literature contained only a few studies employing pictograms by health professionals, and most of these were meant for the use of medications. Moreover, the specific results reinforce the need for more studies in this area to provide a more complete approach about pictograms in the heath care., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: With concerns about the medication literacy skills of patients comes the need to develop various types of information materials that will enhance understanding and drug use., Objectives: To review pictogram development projects and to propose a model for pharmaceutical pictogram development and testing for comprehension and use., Methods: Previous efforts in developing specific types of pictograms in engineering and safety as well as in health care and pharmacy are collected and summarized in terms of level of comprehension and recall. The impact of pictogram-enhanced medication information materials on knowledge acquisition, information retention, and adherence is assessed., Results and Conclusions: Pictograms are a key component in re-designing medication information to improve comprehension, recall, and adherence. Many types of pictograms still produce low levels of comprehension and the impact of pictograms on medication knowledge is inconsistent. Prior training through patient counseling on the intended meaning and use of pictograms greatly increases their effectiveness. A model for the development and testing of pictograms and pictogram sequences for comprehension and use in medication information is presented and discussed., (Copyright © 2013 Elsevier Inc. All rights reserved.)