title: Development of an illustrated medication schedule as a low-literacy patient education tool.
abstract: OBJECTIVE
  Patients with low health literacy have difficulty understanding prescription drug labels and other medication instructions. This article describes the development, implementation, and preliminary evaluation of an illustrated medication schedule (a "pill card") that depicts a patient's daily medication regimen using pill images and icons.
  
  
  METHODS
  Participants in a randomized controlled trial who were assigned to receive the pill card intervention described their use of the card and its perceived effectiveness. Responses were analyzed by level of patient literacy and other characteristics.
  
  
  RESULTS
  Among the 209 respondents, 173 (83%) reported using the pill card when they initially received it, though use declined to 60% approximately 3 months later. Patients with inadequate or marginal literacy skills, less than high school education, or cognitive impairment were most likely to refer to the card on a regular basis initially and at 3 months (p<0.05). Most pill card users (92%) rated the tool as very easy to understand, and 94% found it helpful for remembering important medication information, such as the name, purpose, or time of administration.
  
  
  CONCLUSIONS
  Nearly all patients considered an illustrated medication schedule to be a useful and easily understood tool to assist with medication management. Patients with limited literacy skills, educational attainment, or cognitive function referred to the aid with greater frequency.
  
  
  CONCLUSIONS
  Picture-based instructions promote better understanding of prescription medications, particularly among patients with limited literacy skills or cognitive impairment, and should be used more widely in practice.
authors.affiliation: Division of General Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. skripal@emory.edu
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.forename: Rashanda
authors.initials: R
authors.lastname: Robertson
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Love-Ghaffari
authors.forename: Laura E
authors.initials: LE
authors.lastname: Henderson
authors.forename: Jessica
authors.initials: J
authors.lastname: Praska
authors.forename: Akilah
authors.initials: A
authors.lastname: Strawder
authors.forename: Marra G
authors.initials: MG
authors.lastname: Katz
authors.forename: Terry A
authors.initials: TA
authors.lastname: Jacobson
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001294:Attitude to Health; D001296:Audiovisual Aids / Q000592:standards*; D003072:Cognition Disorders / Q000523:psychology; D032882:Comprehension; D004334:Drug Administration Schedule; D004348:Drug Labeling; D011307:Drug Prescriptions; D004358:Drug Therapy / Q000523:psychology*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012646:Self Administration / Q000523:psychology; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires