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. 2023 Oct 5;23(1):1926.
doi: 10.1186/s12889-023-16856-5.

Comprehension of prescription orders with and without pictograms: tool validation and comparative assessment among a sample of participants from a developing country

Nisreen Mourad  1   2 , Samar Younes  3   4 , Lidia Mourad  3 , Iqbal Fahs  5 , Shatha Mayta  3 , Racha Baalbaki  3 , Wassim El Basset  3   6 , Mariam Dabbous  5 , Marwan El Akel  4   5   7   8 , Jihan Safwan  4   5 , Faraj Saade  5   9 , Mohamad Rahal  3 , Fouad Sakr  4   5   10   11
Affiliations

Comprehension of prescription orders with and without pictograms: tool validation and comparative assessment among a sample of participants from a developing country

Nisreen Mourad et al. BMC Public Health. .

Abstract

Background: Medication errors can often occur due to the patient's inability to comprehend written or verbal medication orders. This study aimed to develop pictograms of selected medication orders and to validate the comprehension of prescription orders index and compare the comprehension scores with and without pictograms. In addition to determine the predictors that could be associated with a better or worse comprehension of prescription orders with pictograms versus that of their written counterparts.

Methods: A cross-sectional study was conducted using a snowball sampling technique. Six pictograms were developed to depict specific medication orders. The comprehension of prescription orders index was constructed and validated. The study then compared the comprehension scores of prescription orders with and without pictograms, and identified the predicting factors score difference.

Results: A total of 1848 participants were included in the study. The structure of the comprehension of prescription orders index was validated over a solution of four factors, with an adequate Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.711 and a significant Bartlett's test of sphericity (P < 0.001). The construct validity of the index was further confirmed by highly significant correlations between each item and the full index (P < 0.001). The study also found a significant association between the difference in comprehension scores for prescription orders with and without pictograms and several factors, including age, level of education, area of residence, number of children, and smoking status with the difference of comprehension scores (P < 0.001).

Conclusion: Pictogram-based instructions of medication orders were better understood by the Lebanese population than written instructions, making the incorporation of pictograms in pharmacy practice paramount to optimize medication use by the patient and thus yielding better health outcomes.

Keywords: Comprehension; Health literacy; Healthcare; Medication errors; Medication orders; Medication safety; Patient education; Pictograms.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Pictograms illustrating selected medication orders
Fig. 2
Fig. 2
Comparison of prescription orders comprehension scores with and without pictograms
See this image and copyright information in PMC

References

    1. rxr@usp.org. NCC MERP. 2014 [cited 2023 Feb 25]. About Medication Errors. Available from: https://www.nccmerp.org/about-medication-errors.
    1. Aspden P, Wolcott J, Bootman L, Cronenwett LR. Institute of Medicine. Preventing medication errors. Washington, DC: National Academies Press; 2006.
    1. Vaillancourt R, Zender MP, Coulon L, Pouliot A. Development of Pictograms to enhance Medication Safety Practices of Health Care Workers and International Preferences. Can J Hosp Pharm. 2018;71(4):243–57. - PMC - PubMed
    1. Malhotra R, Bautista MAC, Tan NC, Tang WE, Tay S, Tan ASL, et al. Bilingual text with or without Pictograms improves Elderly Singaporeans’ understanding of prescription medication labels. Gerontologist. 2019;59(2):378–90. doi: 10.1093/geront/gnx169. - DOI - PubMed
    1. Kim M, Suh D, Barone JA, Jung SY, Wu W, Suh DC. Health literacy level and comprehension of prescription and nonprescription drug information. Int J Environ Res Public Health. 2022;19(11):6665. doi: 10.3390/ijerph19116665. - DOI - PMC - PubMed

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