This site is intended for health professionals only

Study: Pictures on prescriptions could help illiterate patients

9 May 2014

Share this article

Using pictures and symbols, rather than handwritten words, on prescriptions helps illiterate patients take their medicines correctly, doctors have claimed. 

The idea was first tested in a Pakistan hospital using pictures of the sun, moon and stars to help patients understand when and how long to take their medication for.

Dr Matthew Clayton and colleagues, working in outpatient clinics at Services Hospital in Lahore, noticed very poor levels of adherence to patients’ “take home” discharge medication, particularly among the 48% of illiterate patients at the hospital.

Analysis revealed that only 5% of illiterate patients understood their handwritten discharge prescription when leaving hospital. Even with counselling, only 12% understood the discharge prescription correctly.

Non-adherence can have serious health implications, such as relapses, drug resistance from under-dosing and possible accidental overdosing.

The team designed a new discharge prescription form, using pictures and symbols rather than words to convey the necessary information. 

For example, instructions like ‘bd’ (twice a day) and ‘tds’ (three times a day) were replaced by pictures of a sun rising over the mountains to represent morning, and a moon and stars to represent night time.

Doctors hope that the idea, which has been published as a BMJ Quality Improvement Report, will soon be adopted in the UK, where a recent survey estimated that one in five adults is ‘functionally illiterate.’

Mobasher Butt, clinical lead at BMJ Learning and Quality Improvement, said: “On average it takes 17 years for clinical research to become routine practice. By rapidly publishing projects that have made a real improvement to clinical practice in a fully searchable open access format, BMJ Quality Improvement Reports is a fantastic vector for sharing improvement knowledge.”

He added: “Having fast, detailed access to what has, and hasn’t, worked in other healthcare settings as well as the ability to contact other improvers directly is an invaluable tool to organisations who wish to research and improve a clinical problem.”

The full report is available online, as are supporting images