Abstract
One of the sources of poor health outcomes is the lack of compliance with the prescribed treatment plans, often due to communication barriers between healthcare professionals and patients. Pictograms are a form of communication that conveys meaning through its pictorial resemblance to a physical object or an action. Pharmaceutical pictograms are often associated with a better comprehension of treatment regimens, although their use is still subject to limitations. The main goal of this study was to examine the potential understanding of pharmaceutical pictograms by a cultural minority when providing patient information while comparing the effectiveness of two reference systems (United States Pharmacopeia USP and International Pharmacy Federation FIP) for this purpose. A self-administered questionnaire was developed comprising 30 pictograms, 15 selected from the United States Pharmacopeia Dispensing Information and the equivalent from the International Pharmaceutical Federation. The questionnaire comprised plain instructions, socio-demographic data, self-reported language fluency and pictogram labels in Portuguese presented to conveniently selected members of the Hindu community of Lisbon (Portugal) until reaching a quota of 50. Participants showed difficulties in understanding some pictograms, which was related to the self-reported reduced fluency in Portuguese. Overall, the interpretation of USP pictograms was better than FIP ones, as well as for pictograms composed of multiple images, presenting a negative reading, or when conveying information unrelated to medication instructions. Even using internationally validated pictograms, added care should be taken when community pharmacists use such communication resources with cultural minorities. It is important not to disregard other forms of patient communication and information, considering pictograms as a complement to other forms of patient counselling.
Highlights
It is well accepted that it is the responsibility of community pharmacists to actively contribute to the safe and effective use of medications [1,2]
The present study addressed the comprehension of well-known pharmaceutical pictograms by a population that does not necessarily share the cultural and linguistic background of the native population, requiring additional resources for effective communication
This study found only one pictogram (#27) out of 30 that could be immediately used in pharmacy practice, according to the International Standards Organization (ISO)-3864 legibility criteria, i.e., using the 67% correct interpretation cut-off
Summary
It is well accepted that it is the responsibility of community pharmacists to actively contribute to the safe and effective use of medications [1,2]. While their primary mission is to assure the quality of the products dispensed, the current focus on pharmaceutical care practice adds a professional responsibility towards patient medication outcomes [3]. Pharmacy 2018, 6, 22 negative patient outcomes [5,6] and usually emerges from therapy costs and complexity of the regimen, being communication barriers between health professionals and patients known to contribute to non-compliance [6]. Frequently considered a beneficial solution, is the use of pictograms
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