The Effect of Using Pictograms on Comprehension of Medical Information- A Meta-Analysis

This is a meta-analysis to study the effect of using pictorial aids on medication packaging and inserts on the comprehension of medication related information. Health literacy is a growing concern amongst health care systems globally. Research has demonstrated that people with low or marginal levels of literacy have lesser knowledge about their condition and understand “text-only” medication instructions inaccurately. Building on such findings, incorporation of illustrations in the form of pictures have been thought of and studied to improve some of the outcomes related to medication understanding. This meta- analysis aimed to synthesize and analyze data from such studies and unveil avenues for further research which can prove to aid interpretation of medical information via such visual aids. Studies included in this analysis used a specific treatment intervention which comprised of medical information provided as text in conjunction with pictograms, and compared this to a text-only intervention which was treated as the control. All the patients in these studies were randomized to both the interventions. They received medical information in the form of patient label; patient information leaflets (PILs) or consult demonstration by a healthcare provider. Meta-analysis was performed using random effects model. Results supported the primary hypothesis of pictograms aiding in medical comprehension with a p<0.0001. The summary effect size was found to be g = 0.5 [0.19, 0.8]. The I 2 value for this omnibus test was almost 88%, implying a huge amount of heterogeneity in the sample. Amongst the moderators tested, number of years of education was found to be close to significance (p=0.09) and the type of visual aid used was not significant (p=0.87). This analysis could not assess the type of literacy testing because of the lack of standardized testing using tools like REALM or TOFHLA in the included studies. Further, efforts should be made in order to understand how pictograms affect medical comprehension with a follow up to achieve tangible outcomes such as medication compliance and adherence.