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Patient Educ Couns. 1997 Mar;30(3):257-70.

Design, development, and evaluation of visual aids for communicating prescription drug instructions to nonliterate patients in rural Cameroon.

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  • 1College of Pharmacy, Ferris State University, Big Rapids, Ml 49307-2740, USA.


In this study, culturally sensitive visual aids designed to help convey drug information to nonliterate female adults who had a prescription for a solid oral dosage form of antibiotic medications were developed and evaluated. The researchers conceptualized the educational messages while a local artist produced the visual aids. Seventy-eight female ambulatory patients were evaluated for comprehension and compliance with antibiotic prescription instructions. The study was conducted in three health centers in Cameroon, West Africa and followed a pre-test, post-test, and follow-up format for three groups: two experimental, and one control. All participants were randomly assigned to either experimental or control groups, 26 patients to each group. Subjects in the experimental groups received visual aids alone or visual aids plus an Advanced Organizer. A comparison of the three groups showed that subjects in the experimental groups scored significantly higher than the control group in both the comprehension and compliance measures.


A study in rural Cameroon evaluated culturally sensitive visual aids designed to convey instructions for use of prescription antibiotics to illiterate women. The study, conducted in 3 health centers, used a pre-post test and follow-up format in 3 random groups (2 experimental and 1 control) of 26 patients each to test compliance with short-term prescriptions of antibiotics (ampicillin, sulfamethoxazole, trimethoprim, metronidazole, and tetracycline). The introduction to this report reviews the literature on use of essential drugs by ambulatory patients and the problems of communicating directions for use to patients, especially illiterate patients in developing countries. Visual aids can use pictorial, graphic, or verbal symbols and must get the audience's attention, be culturally appropriate, and be relevant to the population to be served. The theoretical framework for the use of visual aids is found in Albert Bandura's Social Learning Theory of Identificatory Processes, which explains how to achieve behavior modification using modeling. This study involved use of a literacy test, visual aids, and an "advanced organizer." The advanced organizer (introductory information used to explain why the drug is needed) used farming as an analogy and described a body as a crop field, disease as weeds, and antibiotics as a farmer. Visual aids were developed through a conceptual and a design phase and were field tested. It was found that the experimental groups (1 with only visual aids, 1 with visual aids and the advanced organizer) scored significantly higher than the controls in measures of comprehension and compliance and that use of the advanced organizer improved scores significantly. It is concluded that, to be effective, visual aids must be population-specific but that their preparation and use contributes significantly to achieving desired results in patients.

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