Taking into account the culture of the target population is essential. Studies have shown, the way people interpret an image depends on several factors such as age or culture.1,2
The pictograms developed by FIP have been tested in several populations and adapted to suit their target demographic.
EXAMPLE 1: frequency
The pictogram “take three times daily” could be misinterpreted by a patient who may not take their medication on a cloudy day or where the sun doesn’t set during certain months.
EXAMPLE 2: Take with food
This pictogram on the left was used in a country like Haiti where the meals are mainly composed of fish and grains, while the pictogram on the right is used in USA where the typical diet contains chicken and rice.
EXAMPLE 3: take 1 capsule
This pictogram on the left was used in a country like USA while the pictogram on the right is used in First Nations (Canada).
It is important to develop illustrations adapted to the target population.3 As part of the Asthma Action Plan (link), pictograms specifically dedicated to children were created.
Know more about action plans dedicated to children:
- Asthma action plan
- Anaphylaxis action plan
- Make medication taste better
- Eczema Action Plan
Primary patient information should be easy for the patient, especially elderly patients, to read. A study with visually impaired elderly population showed larger pictograms were significantly better interpreted than the small ones.4 It is important to take into account the patient’s visual acuity when providing pictograms.
Shape and Color
The international language of ISO graphical symbols5,6,7 proposed a standardization of colors and shapes of signs to improve the comprehension of pictograms worldwide. The FIP uses these recommendations to create their own illustrations.
Similar to pictograms, traffic signs are recognized based on their color, and classified according to their shape. Traffic signs utilizes the pictogram’s inherent universality and fast recognition.
A yellow triangle is the standardized symbol to convey warning messages. A prohibition sign should be easily identified as a circle with a diagonal bar across. A red color is associated with a prohibition message. A mandatory action sign is a blue circle. Lastly, a green square is associated to a safety message.5,6,7
PICTOGRAMS AS WORDS OR SENTENCES
Simple pictograms are used as a graphical representations of an object. More complex pictograms will include several graphical elements to illustrate a sentence or action.
Ex. “Capsule” verses “Do not crush”
1.Kassam R, Vaillanourt R, Collins JB. Pictographic instructions for medications: do different cultures interpret them accurately? Int J Pharm Pract 2004;12:199–209
2.Tulloch J, Vaillancourt R, Irwin D, Pascuet E. Evaluation, modification and validation of a set of asthma illustrations in children with chronic asthma in the emergency department. Can Respir J.2012;19(1):26-31 Poster
3.Hoffmann T, Worrall L. Designing effective written health education materials:considerations for health professionals. Disabil Rehabil 2004; 26: 1166-73.
4.Knapp P, Raynor DK, Jebar AH. Interpretation and Recall of Different Sizes of Pictograms by Older People. Peer Reviewed Proceedings of the 13th International Social Pharmacy Workshop, Malta, 19-23 July 2005
5. International Organization for Standardization [Internet]. ISO 3864-3:2012[updated 2012 June]. Available from: https://www.iso.org/standard/55814.html
6. International Organization for Standardization [Internet]. ISO 7010:2011/ Amd 8:2017[ accessed 2012 June]. Available from: https://www.iso.org/standard/74359.html
7. International Organization for Standardization[Internet]. The international language of ISO graphical symbols[ 2018 Nov]. Available from: https://www.iso.org/files/live/sites/isoorg/files/archive/pdf/en/graphical-symbols_booklet.pdf