Patients' preferences for visuals: Differences in the preferred level of detail, type of background and type of frame of icons depicting organs between literate and low-literate people

Objective: To evaluate icons of organs with systematic variations in design to provide directions for the development of pictograms that support patient leaflets targeted at a low-literate audience. Methods: In interview questionnaires, 191 pharmacy visitors (IJsselstein, The Netherlands), indicated for four organs in which image the organ was represented most clearly. The icons vary in level of detail of the depicted organ, in the organs that are shown in the background, and in how much of the body is shown as frame. Participants' literacy was determined through the Dutch Rapid Estimate of Adult Literacy in Medicine (REALM-D). Results: For the three internal organs, the intestines, lungs and kidneys, low-literate participants were more likely than literate participants to opt for less context in the form of the frame of the body. Conclusion: When the meaning of the visual is given, low-literate people prefer organ icons with less context of the body over a depiction of the whole body. Practice implications: Since literate and low-literate people differ in perceptual preferences, continued involvement of people with limited literacy skills in the design process is essential to target the visuals to their needs. (C) 2014 Elsevier Ireland Ltd. All rights reserved.