Effects of pictograms in educating 3 distinct low-literacy populations on the use of postoperative cataract medication

Objective: To examine the effectiveness of pictograms in educating low-literacy patients in order to improve adherence to postoperative cataract regimens. Design: Multicenter, single-blinded, randomized controlled trial. Participants: A group of 225 patients from across India, all below a 10th-grade education level, were divided into 3 groups of 75 patients. Methods: Each group was educated differently regarding medication use and frequency of dose. The control group was given verbal instruction only. Experimental group 1 (EG1) was taught using the pictograms in the clinic. Experimental group 2 (EG2) was taught in the same way as EG1 but was given the pictograms to take home. Each group was given three 10-point oral exams: on the operative day (Test 1); on postoperative day 7 (Test 2); and on day 28 (Test 3). During the patients' final visit, medication bottles were measured to ascertain use. Results: Test 1 showed no significant difference in mean scores among groups. For Test 2, EG1 and EG2 scored similarly but significantly better than Control (control group, 5.77; EG1, 7.33; EG2, 7.62; p < 0.001). For Test 3, EG2 scored significantly better than Control and EG1 (control group, 4.37; EG1, 5.44; EG2, 7.17; p < 0.001). The only parameter significant for a higher test score was the participants' educational level. Higher test scores were significantly associated (p < 0.001) with greater medication consumption. Conclusions: Taking the pictograms home proved to be the most effective way to educate patients who had low literacy levels, and it increased adherence to regimens by 28 days or more. Education through pictograms strictly in the clinic was sufficient for short regimens ( <= 7 days).