Pictograms for conveying medicine instructions: comprehension in various South African language groups

The comprehension of medicine instructions is essential for the safe and effective use of medicines. In cases where low literacy constitutes a possible barrier to understanding written medicine information fully, the inclusion of pictograms may facilitate comprehension. Twenty-three internationally available pictograms and 23 corresponding locally developed images were evaluated in 304 low-literate respondents from eight different South African language groups. Demographic data were collected and an English literacy test was administered to those respondents who had stated that they could read English. Interviewees were shown the 46 pictograms in random order and were asked for their interpretation. Preference for either the international or local version was assessed. Correct interpretation of individual pictograms ranged from 14% to 97%. Images which had been developed locally were more successful in eliciting correct interpretations than those obtained from an international source (USP pictograms). Only 2 of the 23 USP pictograms achieved the 85% criterion of the American National Standards Institute compared with 12 of 23 locally developed counterparts. Local pictograms were preferred over the American ones in all cases. Standard of education had a significant influence on interpretation, whereas no significant differences in interpretation could be attributed to cultural diversity between the African language groups. Almost all respondents (98%) reacted positively to the idea of having pictograms on their medicine labels. The success of the local pictograms highlighted the value of a rigorous and consultative design and test process. Results from one African language group can reliably be extrapolated to other groups in South Africa

Development of written information for antiretroviral therapy: comprehension in a Tanzanian population

Objective To design and develop a simple, easily readable patient information leaflet (PIL) for a commonly used antiretroviral (ARV) regimen and to evaluate its readability and acceptability in a Tanzanian population. Method A PIL incorporating simple text and pictograms was designed for the antiretroviral regimen of stavudine, lamivudine and efavirenz. The PIL was designed according to established good design guidelines, modified during a multi-stage iterative testing process and piloted in a South African Xhosa population. The PIL was made available in both English and Kiswahili. Sixty Tanzanian participants who were not taking ARVs were interviewed. They were asked to read the PIL in the language of their choice and were then asked a series of two-part questions; the first part required participants to locate the information in the PIL, after which they were asked to explain the information in their own words. Acceptability was assessed through close-ended questions and open-ended feedback. The influence of selected patient characteristics on comprehension of the PIL was investigated using one-way ANOVA and t-tests for independent samples with a significance level set at 0.05. Main outcome measure Comprehension of the written information in an overall percentage understanding. Results The overall average percentage comprehension of the PIL was 95%. The target set by the EC guideline that at least 80% of participants correctly locate and understand the information was achieved for 19 of the 20 questions. Five of the six instructions illustrated by pictograms were correctly understood by all participants. The only patient characteristics significantly associated with comprehension were educational level and self-reported ease of reading the PIL. Acceptability of the PIL was high and positive comments were associated with simplicity, good design, easy readability and user-friendliness, the latter enhanced by the inclusion of pictograms. Conclusion The PIL designed for this study was shown to be effective in communicating information about ARVs. Patient characteristics must be taken into account when developing written information, and the final document must be tested for comprehension in the target population

Medicine labels incorporating pictograms: do they influence understanding and adherence?

The objective was to determine the influence of medicine labels incorporating pictograms on the understanding of instructions and on adherence. Eighty-seven Xhosa participants attending an outpatient clinic who had been prescribed a short course of antibiotics were randomly allocated to either a control group (41 participants given text-only labels), or an experimental group (46 participants given text + pictogram labels). All participants had a maximum of 10 years of formal schooling. Follow-up home visits were conducted after 3–5 days to assess understanding of instructions and to evaluate adherence. A high adherence of greater than 90% was found for 54% of the experimental group, compared with only 2% of the control group. Average percentages for understanding in the control and experimental groups were 70 and 95%, respectively, and average adherence was 72 and 90%, respectively. The presence of pictograms was found to contribute positively to both understanding of instructions and adherence

A New Course Promoting Science as a Way of Knowing

The objective of this project is to create an exciting interdisciplinary laboratory experience for a course promoting science as an objective tool for understanding the natural world. Establishing in the minds of the students a level playing field on which true science competes successfully with pseudoscience is central. The core of the project is biology, but many disciplines are introduced, providing a focused introduction to the scientific method. The primary goal is not scientific literacy per se. It is, instead, an introduction to the methodology of science. A select set of connected subjects were chosen for general interest, potential for exciting laboratories, and social relevance. Each is in an area in which pseudoscience or media sensationalism is active. We demonstrate the practical utility of critical thinking, experimental design, careful data collection, and objective analysis. Since most students are not very excited by a tube of colorless liquid, though told it is RNA, a high degree of showmanship is necessary and appropriate. Subjects introduced include: the age of the earth, origin of life, nature of light, photobiology, molecular biology, genetics and reproduction, and biological diversity. In the spring of 1995, the New York Academy of Sciences sponsored a symposium entitled The Flight From Science and Reason. Its alarming theme was that objective science is increasingly perceived as just one alternative for understanding the natural world, and that many equally (or more) valid alternatives exist (magic, crystal power, shamanism, astrology, etc.). This course demonstrates in a convincing way that the scientific method is the most objective, self-correcting way of knowing

The evaluation of pharmaceutical pictograms in a low-literate South African population

An inability to read and understand written medication instructions may be a major contributory factor to non-compliance in certain patient populations, particularly in countries with a high illiteracy rate such as South Africa. Twenty three pictograms from the USP-DI and a corresponding set of 23 locally developed, culturally sensitive pictograms for conveying medication instructions were evaluated in 46 Xhosa respondents who had attended school for a maximum of 7 years. Respondents were tested for their interpretation of all 46 pictograms at the first interview and again 3 weeks later. The correct meaning of each pictogram was explained at the end of the first interview. Preference for either the Local or USP pictograms was determined. At the follow-up interview, 20 of the Local pictograms complied with the ANSI criterion of ≥85% comprehension, compared with 11 of the USP pictograms. Respondents indicated an overwhelming preference for the Local pictograms

Design and evaluation of a new pharmaceutical pictogram sequence to convey medicine usage

Pictorials may be used to augment textual instructions in the depiction of safety and warning information on medicines. The objective of this study was to design, develop and evaluate a simple and culturally appropriate pictogram sequence for using nystatin suspension, and to assess its understandability in low-literate Xhosa participants. A new pharmaceutical pictogram sequence was designed through focus group discussions and evaluated in a 2-phase process. The results of Phase 1 (30 participants) identified various problems associated with the new pictogram sequence. It was modified accordingly and re-evaluated in Phase 2 with 20 participants. All participants belonged to the Xhosa group, had between 0 and 7 years of formal schooling and had English as their second language. Acceptance of the new pictogram sequence was based on international standards (ANSI and ISO criterion) for evaluating the comprehensibility of pictograms. In Phase 1, the new pictogram sequence was correctly interpreted by 66.7% of the participants and this complied with the ISO criterion of 67% correct. In Phase 2, 95% of the participants were able to correctly interpret the new pictogram sequence. This result complied with the ANSI criterion of 85% correct, therefore, this new pictogram sequence was considered to be acceptable. This study has illustrated the success of using a consultative approach in the design of new pictograms

Work Life Balance of IT Managers: Finding Time for a Life

As the IT ship continues its odyssey, we spend a moment to consider the condition of the crew. We interviewed eleven IT mangers concerning their working hours, the effects of these hours on their families and their health, and how they dealt with problems of work life balance. These managers are working harder than is healthy, and are aware of the consequent problems, but a combination of industry attitudes, personal ambition and practical difficulties of arranging time off means that they mostly deal with their problems through stress alleviation techniques rather than attempting to bring their life back into balance

Qualifying the Definition of Dispositions

The National Council for Accreditation of Teacher Education (NCATE) Standards are in place to ensure teacher preparation programs produce candidates who meet the high standards of the field and who work to help all students learn. NCATE dictates that teacher preparation programs must provide assessment data which demonstrates the knowledge, skills, and professional dispositions of candidates in the program. While teacher preparation programs have historically assessed the areas of knowledge and skills in candidates, the same programs are struggling to understand the concept of dispositions and how to assess the professional dispositions of candidates. The purpose of this research study was to describe how one teacher preparation program attempts to document candidate concerns in the areas of knowledge, skills and professional dispositions. The research looks at the students who are considered to be at-risk of successfully completing the teacher preparation program and reveals some of the themes which emerged from analyzing one college\u27s conference record forms

“A hundred times we learned from one another” Collaborative learning in an academic writing workshop

Using Design Research as methodology and research design type, this article reports on a research proposal writing workshop conducted with Education postgraduate students, with the aim of ascertaining the roles that conversation, collaboration and feedback play in constructing meaning and supporting writing. It was found that through conversation, as part of a general discourse within a community that students whose first language may differ from that of others, but for whom the language of learning is English, are able to share with tutors and other students, and to negotiate meaning. The construction of knowledge is consequently dependent on conversation between students, their peers and the tutors within a collaborative community, such as a writing centre, in which feedback on writing is offered and received in order to support student writing.Key words: academic writing; academic writing support; collaborative learning; feedback tutoring; writing centre