title: The effect of illustrations on patient comprehension of medication instruction labels.
abstract: BACKGROUND
  Labels with special instructions regarding how a prescription medication should be taken or its possible side effects are often applied to pill bottles. The goal of this study was to determine whether the addition of illustrations to these labels affects patient comprehension.
  
  
  METHODS
  Study participants (N = 130) were enrolled by approaching patients at three family practice clinics in Toronto, Canada. Participants were asked to interpret two sets of medication instruction labels, the first with text only and the second with the same text accompanied by illustrations. Two investigators coded participants' responses as incorrect, partially correct, or completely correct. Health literacy levels of participants were measured using a validated instrument, the REALM test.
  
  
  RESULTS
  All participants gave a completely correct interpretation for three out of five instruction labels, regardless of whether illustrations were present or not. For the two most complex labels, only 34-55% of interpretations of the text-only version were completely correct. The addition of illustrations was associated with improved performance in 5-7% of subjects and worsened performance in 7-9% of subjects.
  
  
  CONCLUSIONS
  The commonly-used illustrations on the medication labels used in this study were of little or no use in improving patients' comprehension of the accompanying written instructions.
authors.affiliation: Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada. hwangs@smh.toronto.on.ca
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
authors.forename: Carolyn Q N
authors.initials: CQ
authors.lastname: Tram
authors.forename: Nadia
authors.initials: N
authors.lastname: Knarr
mesh_terms: D000328:Adult; D000368:Aged; D032882:Comprehension; D004348:Drug Labeling / Q000379:methods*; D004522:Educational Status; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D009864:Ontario; D010351:Patient Discharge; D010353:Patient Education as Topic / Q000379:methods*