RU HEALTH PICTOGRAMS
ROS DOWSE
What are pictograms and how are they used?
A pictogram may be described as a stylized, figurative, two-dimensional drawing intended to attract the viewer’s attention and convey information to enable quick and clear communication without language or words. Pictograms enhance the attractiveness and user-friendliness of heath information and can improve its comprehension and recall. However, they can easily be misinterpreted, particularly in low health literacy populations, and should therefore never be used as the sole source of information, but they can play a valuable role as a communication tool in reinforcing both verbal and printed health and medicine information.
A common application relates to their use with medicines where they may serve to convey instructions, precautions, storage requirements, warnings, as well as medicine indication or side effects to patients or consumers. Many examples of diverse application of pictograms in the health literature have been described including health promotion materials, wound care instructions, asthma prevention and treatment, injury prevention, discharge instructions, self-care guidance, paediatric anaphylaxis plan, organ and body donation, CT scan risks and benefits, driving risks, safety symbols, decision aids for treatment, and patient-reported outcomes dashboards, amongst others.
How it all started at Rhodes University
This pictogram journey was initiated in 1993 at Rhodes University, South Africa, with a collaborative partnership of Ros Dowse and Tina Ehlers, two pharmacy academics. After looking at the USP pictograms which were developed in the USA they both had the same response: “great idea, but many of these will not be easily comprehended in our country” as South Africa is a low- to middle-income country with a large public sector patient population, many of whom have incomplete schooling and inadequate reading skills, especially in English. A process of modifying/redesigning 40 USP pictograms was initiated, with Tina drawing the initial set of RU pictograms. Both the RU and the USP pictograms were then extensively tested in different language groupings, both locally and nationally.
Since then, many additional pictograms from varied projects have been designed, tested and subsequently modified to improve interpretation. These processes have always included collaboration with target group members, health professionals and our graphic designer, Susan Abraham, who has produced our pictograms for the past 20 years.
The decision to create and make available a database of pictograms designed for viewers with limited literacy arose out of ongoing requests that have been received for either assistance with projects or to use the pictograms for research and/or practice. We hope that this collection of pictograms will prove useful to researchers, healthcare providers, health communication and health promotion practitioners, health literacy experts, public health personnel and others.
RU PICTOGRAM DATABASE
The database consists of 8 categories containing around 100 pictograms most of which have undergone multiple cycles of testing and modification. New pictograms generated during future projects will continue to be added.
An overview of all 8 categories is available in PDF format by completing the form below.
PICTOGRAM CATEGORIES
- Dosage and frequency
- Route of administration
- Additional medicine instructions
- Side effects or indication
- Storage of medicines
- Tablets, capsules, bottles, droppers
- Miscellaneous
- TB-related pictograms
DISCLAIMER: No responsibility is assumed for any possible misinterpretation or adverse outcomes/effects possibly linked to the use of the RU Pictograms.
Acknowledgements
Many people from various projects over the span of two decades have contributed to the design of various pictograms:
- Initial pictogram set of 40 “local” pictograms: drawn by Tina Ehlers
- Graphic artist: Susan Abraham
- Postgraduate students: Betty Mwingira, Leila Mansoor, Thato Ramela, Kirsty Barford, Ida Okeyo, Sonal Patel
- Undergraduate students: Perpetua Chikwande, Fadzai Munedzimwe, Mary Chidanyika, Mbali Mashiya, Mufaro Muzondo, Sam Okeyo, Simise Sikhondze, Nosihle Khumalo.
- Collaborator: Sara Browne, Division of Infectious Diseases, UCSD (HIV pictograms)