Article published In: Information Design Journal
Vol. 26:3 (2021) ► pp.175–192
Simplification of pharmaceutical pictograms to improve visual acuity
Published online: 15 April 2022
https://doi.org/10.1075/idj.21003.ped
https://doi.org/10.1075/idj.21003.ped
Abstract
The purpose of pharmaceutical pictograms is to help patients manage their medicinal treatment. However, the
pictograms often lack perceptual clarity. While they are frequently tested for aspects such as comprehension, little attention has
been paid to their legibility. This paper presents the conception and results of an experiment adapted from the ISO ‘Method for
testing perceptual quality’ (ISO 9186-2:2008) to measure the visibility of pictogram elements in two sets: 15 American USP
pictograms and 15 redesigned versions reduced in complexity. The statistical analysis did not show reliable significant
differences, which indicates that there are more factors at stake.
Article outline
- 1.Introduction
- 1.1Medicine leaflets
- 1.2Legibility versus comprehension
- 1.3Visual complexity
- 1.4Crowding
- 2.Experiment
- 2.1Respondents
- 2.2Stimuli
- 2.3Procedure
- 3.Results
- 3.1Scoring system
- 3.2Data analysis
- 3.3Recognition accuracy
- 3.4Recognition acuity
- 4.Qualitative explorations
- 4.1Perimetric complexity
- 4.2Effects of crowding
- 5.Discussion
- 5.1Identification versus interpretation
- 5.2Methodological approach and implications of results
- 6.Conclusion
- Acknowledgements
References
References (46)
Askehave, I., & Zethsen, K. K. (2014). A
comparative analysis of the lay-friendliness of Danish EU patient information leaflets from 2000 to
2012. Communication &
Medicine, 11(3), 209–222.
Barros, I. M. C., Alcântara, T. S., Mesquita, A. R., Santos, A. C. O., Paixão, F. P., & Lyra, Jr. (2014). The
use of pictograms in the health care: A literature review. Research in Social and
Administrative
Pharmacy, 10(5), 704–719.
Beier, S., Bernard, J.-B., & Castet, E. (2018, June 28). Numeral
Legibility and Visual Complexity. Design Research Society
Conference 2018.
Bernard, J. B., & Chung, S. T. (2011). The
dependence of crowding on flanker complexity and target–flanker similarity. Journal of
Vision, 11(8).
Boersema, T., & Adams, A. S. (2017). Does
my symbol sign work? Information Design: Research and Practice, Edited
by Alison Black, Paul Luna, Ole Lund and Sue Walker (pp. 303–314). Routlege.
Choi, J. (2011). Literature
review: Using pictographs in discharge instructions for older adults with low-literacy
skills. Journal of Clinical
Nursing, 20(21–22), 2984–2996.
Del Re, L., Vaillancourt, R., Villarreal, G., & Pouliot, A. (2016). Pictograms:
Can They Help Patients Recall Medication Safety Instructions? Visible
Language, Vol. 50(1), 127–151.
Dickinson, D., & Gallina, S. (2017). Chapter
47: Information design in medicine package leaflets – How detailed design and usability testing can help medicine
users. In Information Design – Research and
Practice (pp. 685–700). Routlege.
Directive 92/27/EEC, Council Directive
92/27/EEC of 31 March 1992 on
the labelling of medicinal products for human use and on package leaflets OJ No L 113 of
30.4.1992 (1992).
Dowse, R. (2021). Designing
and reporting pictogram research: Problems, pitfalls and lessons learnt. Research in Social and
Administrative
Pharmacy, 17(6), 1208–1215.
Dowse, R., & Ehlers, M. S. (1998). Pictograms
in pharmacy. International Journal of Pharmacy
Practice, 6(2), 109–118.
Hamm, L. M., Yeoman, J. P., Anstice, N., & Dakin, S. C. (2018). The
Auckland Optotypes: An open-access pictogram set for measuring recognition acuity. Journal of
Vision, 18(3), 13.
Hill, L. H. (2006). Using
visual concept mapping to communicate medication information to patients with low health literacy; a preliminary
study. Second International Conference on Concept
Mapping, 621–628.
Houts, P. S., Doak, C. C., Doak, L. G., & Loscalzo, M. J. (2006). The
role of pictures in improving health communication: A review of research on attention, comprehension, recall, and
adherence. Patient Education and
Counseling, 61(2), 173–190.
ISO 9186-2:2008. (2008). Graphical
symbols – Test methods – Part 2: Method for testing perceptual
quality. Geneva: ISO.
Kanji, L., Xu, S., & Cavaco, A. (2018). Assessing
the Understanding of Pharmaceutical Pictograms among Cultural Minorities: The Example of Hindu Individuals Communicating in
European
Portuguese. Pharmacy, 6(1:22).
Katz, M. G., Kripalani, S., & Weiss, B. D. (2006). Use
of pictorial aids in medication instructions: A review of the literature. American Journal of
Health-System
Pharmacy, 63(23), 2391–2397.
Kline, D. W., & Fuchs, P. (1993). The
Visibility of Symbolic Highway Signs Can Be Increased among Drivers of All Ages. Human Factors:
The Journal of the Human Factors and Ergonomics
Society, 35(1), 25–34.
Knapp, P., Raynor, D. K., Jebar, A. H., & Price, S. J. (2005). Interpretation
of Medication Pictograms by Adults in the UK. Annals of
Pharmacotherapy, 39(7–8), 1227–1233.
Korenevsky, A., Vaillancourt, R., Pouliot, A., Revol, M., Steed, E., Besançon, L., Wahrendorf, M.-S., & Patel, J. R. (2013). How
Many Words Does a Picture Really Tell? Cross-sectional Descriptive Study of Pictogram Evaluation by
Youth. The Canadian Journal of Hospital
Pharmacy, 66(4), 219–226.
Lalor, S. J. H., Formankiewicz, M. A., & Waugh, S. J. (2016). Crowding
and visual acuity measured in adults using paediatric test letters, pictures and
symbols. Vision
Research, 1211, 31–38.
Legge, G. E., Cheung, S.-H., Yu, D., Chung, S. T., Lee, H.-W., & Owens, D. P. (2007). The
case for the visual span as a sensory bottleneck in reading. Journal of
Vision, 7(2), 9–9.
Lesch, M. F., Powell, W. R., Horrey, W. J., & Wogalter, M. S. (2013). The
use of contextual cues to improve warning symbol comprehension: Making the connection for older
adults. Ergonomics, 56(8), 1264–1279.
Pander Maat, H., & Lentz, L. (2010). Improving
the usability of patient information. Patient Education and
Counseling, Volume 80(Issue 1), 113–119.
Pedersen, P. (2019). Legibility
of Pharmaceutical Pictograms: Towards defining a paradigm. Visible
Language, 53(2), 72–99.
Pelli, D. G., Burns, C. W., Farell, B., & Moore-Page, D. C. (2006). Feature
detection and letter identification. Vision
Research, 46(28), 4646–4674.
Radner, W. (2017). Reading
charts in ophthalmology. Graefe’s Archive for Clinical and Experimental
Ophthalmology, 255(8), 1465–1482.
Rosa, E., Perea, M., & Enneson, P. (2016). The
role of letter features in visual-word recognition: Evidence from a delayed segment
technique. Acta
Psychologica, 1691, 133–142.
Rosen, S., Chakravarthi, R., & Pelli, D. G. (2014). The
Bouma law of crowding, revised: Critical spacing is equal across parts, not objects. Journal of
Vision, 14(6), 10–10.
Sayim, B., & Wagemans, J. (2017). Appearance
changes and error characteristics in crowding revealed by drawings. Journal of
Vision, 17(11), 8.
Schubert, T. (2017). Why
are digits easier to identify than
letters? Neuropsychologia. 951, 136–155.
Sharif, S. I., Abdulla, M., Yousif, A., & Mohamed, D. (2014). Interpretation
of Pharmaceutical Pictograms by Pharmacy and Non-Pharmacy University Students. Pharmacology
Pharmacy, 05(08), 821–827.
Strauss, A., & Zender, M. (2017). Design
by Consensus: A New Method for Designing Effective Pictograms. Visible
Language, 51(2), 7–33.
Vaillancourt, R., Giby, C. N., Murphy, B. P., Pouliot, A., & Trinneer, A. (2019). Recall
of Pharmaceutical Pictograms by Older Adults. The Canadian Journal of Hospital
Pharmacy, 72(6).
Waarde, K. van der. (2008). Measuring the quality of
information in medical package leaflets: Harmful or helpful? Information Design
Journal, 16(3), 216–228.
. (2010). Visual Communication for
Medicines: Malignant Assumptions and Benign Design? Visible
Language, Vol. 44(1), 39–69.
. (2017). Chapter 49 Medical
information design and its legislation. In A. Black, P. Luna, O. Lund, & S. Walker (Eds.), Information
Design – Research and
Practice (pp. 715–730). Routlege.
Waarde, K. van der, & Spinillo, C. (2015). Chapter
12: The development of visual information about medicines in
Europe. In J. Frascara (Ed.), Information
design as principled action: Making information accessible, relevant, understandable, and
usable (pp. 185–189). Common Ground Publishing.
Wogalter, M. S., Conzola, V. C., & Smith-Jackson, T. L. (2002). Research-based
guidelines for warning design and evaluation. Applied
Ergonomics, 33(3), 219–230.
Wogalter, M. S., La Murray, T. A., Glover, B. L., & Shaver, E. F. (2002). Comprehension
of Different Types of Prohibitive Safety Symbols with Glance Exposure. Proceedings of the Human
Factors and Ergonomics Society Annual
Meeting, 46(19), 1753–1757.
Wong, B., & Szücs, D. (2013). Single-digit
Arabic numbers do not automatically activate magnitude representations in adults or in children: Evidence from the symbolic
same–different task. Acta
Psychologica, 144(3), 488–498.
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