Assessing the Understanding of Pharmaceutical Pictograms among Cultural Minorities: The Example of Hindu Individuals Communicating in European Portuguese

One of the sources of poor health outcomes is the lack of compliance with the prescribed treatment plans, often due to communication barriers between healthcare professionals and patients. Pictograms are a form of communication that conveys meaning through its pictorial resemblance to a physical object or an action. Pharmaceutical pictograms are often associated with a better comprehension of treatment regimens, although their use is still subject to limitations. The main goal of this study was to examine the potential understanding of pharmaceutical pictograms by a cultural minority when providing patient information while comparing the effectiveness of two reference systems (United States Pharmacopeia USP and International Pharmacy Federation FIP) for this purpose. A self-administered questionnaire was developed comprising 30 pictograms, 15 selected from the United States Pharmacopeia Dispensing Information and the equivalent from the International Pharmaceutical Federation. The questionnaire comprised plain instructions, socio-demographic data, self-reported language fluency and pictogram labels in Portuguese presented to conveniently selected members of the Hindu community of Lisbon (Portugal) until reaching a quota of 50. Participants showed difficulties in understanding some pictograms, which was related to the self-reported reduced fluency in Portuguese. Overall, the interpretation of USP pictograms was better than FIP ones, as well as for pictograms composed of multiple images, presenting a negative reading, or when conveying information unrelated to medication instructions. Even using internationally validated pictograms, added care should be taken when community pharmacists use such communication resources with cultural minorities. It is important not to disregard other forms of patient communication and information, considering pictograms as a complement to other forms of patient counselling.