DOHA: A novel strategy adopted by Qatar University (QU) researchers and external collaborators to use pictograms to match common labelling instructions on medicines was found to be of considerable benefit to migrant workers with low literacy skills who make up the majority of the labour workforce in the country.
The study ‘Development and evaluation of pictograms on medication labels for patients with limited literacy skills in a culturally-diverse multiethnic population’ was funded by Qatar National Research Fund under its Undergraduate Research Experience Programme. It was conducted by College of Pharmacy faculty and Principal Investigator Dr Nadir Kheir, faculty Dr Ahmed Awaisu, pharmacy graduates Amina Radoui and Aya Elbadawi, Linda Jean from Qatar Petroleum (QP) Medical Services and Dr Ros Dowse from Rhodes University, South Africa.
In the study, the team considered the low literacy level of foreign workers and their lack of English and Arabic language skills which present a challenge for healthcare professionals. Its core objective was to address the often inappropriate use of prescribed medications due to patients’ low literacy or lack of understanding of usage instructions, resulting in serious consequences worldwide which were largely preventable.
As medicine labels in Qatar are typically in Arabic and English, they are poorly understood by many migrant workers. Additionally, verbal explanations of the written label pose a similar challenge for the healthcare professional and migrant worker/patient. Pharmacists in Qatar expressed frustration in trying to explain instructions related to medication to patients who cannot speak or understand English or Arabic, and have to limit their verbal communication to the most basic of instructions such as frequency of dosage.
The team developed pictograms (simple drawings or cartoons depicting the dosage instructions or precautions) for selected medicine labels, and evaluated their comprehension by workers of low literacy level in Doha, in tandem with their comprehension of conventional text supported by verbal instructions and of pictogram-only labels.
The study was conducted in a primary healthcare facility within QP which has a large population of foreign workers. The company has four primary healthcare clinics, each with an outpatient pharmacy. A total of 123 people (18 to 65 years) took part in the study which involved a consultative approach with input from researchers, a local graphic artist, and members of the target population. Of the participants, around 70 percent had a poor level of English, and almost 95 percent a poor level of Arabic.
Eleven common labelling instructions were selected out of 23 screened and pictograms were developed using visual concepts and ideas from the literature. Participants were randomised in three groups for comprehension testing — written text plus verbal instructions; pictogram-only labels; and pictogram with verbal instructions.
Researchers found that the group tested on pictogram plus verbal instructions achieved better results in comprehension and interpretation than the group tested on written text plus verbal instructions in a language they did not understand. Comprehension of pictogram-only labels ranked lowest among the group.
Findings revealed that the best interpreted pictograms with verbal instructions included: “Take two tablets three times a day”, “Take one tablet in the morning and one tablet at night”, and “Instil one drop in the eye”. The worst interpreted pictograms with verbal instructions were: “Do not take with dairy products” and “Do not use by mouth”. It was also found that some pictograms were difficult to interpret even when accompanied by verbal instructions, suggesting the need to thoroughly pilot them among users before implementation. The Peninsula
