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Medical pictograms for low-literate patients
Transparency and translucency

Mara van Beusekom  

Introduction/objectives Pictograms are effective tools to improve communication on health and medicine, especially for people with low health literacy. However, it can be challenging to design visuals that are universally understood for more complex messages. The 'guessability' (transparency) of a pictogram, and how well people think the pictogram represents its message (translucency) determine the comprehensibility of a pictogram (Barros, 2014). Five pictograms for antihypertensive drugs were developed in collaboration with low-literate people. This study aims to evaluate the comprehensibility of these pictograms and to gain insight into the effect that repeated exposure has on pictograms' transparency. Methods In three pharmacies in the Netherlands, a total of 150 participants were interviewed. Health literacy levels were determined using the Short Assessment of Health Literacy in Dutch (SAHL-D). Participants were first asked to guess the pictograms' meaning. After they had been given the correct answer, they were asked to rate translucency on a 7-point scale. In follow-up, transparency was determined again with 97 participants. Results Eighty-nine of the initial 150 participants were low health literate, and 50 of the 97 follow-up participants. Between the first and second round, transparency of the five pictograms increased from 32% to 65%, from 43% to 61%, from 53% to 65%, from 59% to 70%, and from 93% to 99%. This increase was significant for three pictograms. Translucency scores ranged from 5.8 to 6.7 out of 7. Discussion/implications The increase in transparency after previous exposure shows that there is potential for pictograms with relatively high translucency and lower initial transparency. Perhaps they should be explained at first exposure, for example by the healthcare provider that distributes the information. This is especially valuable for pictograms with more complex messages, which might not reach adequate comprehension initially, but with repeated exposure could help patients to better understand their treatment.

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