Pictogram comprehension and medication-use literacy among undergraduate students: a cross-sectional survey study

Pictograms are widely used in pharmacy practice to enhance patient understanding, especially in contexts where language or health literacy barriers exist. However, limited data are available on the comprehension of United States Pharmacopeia Convention: Drug Information for the Health Care Professional (USP-DI) pictograms among Thai undergraduate students. This study assessed the understanding of USP-DI pictograms and medication-use literacy, and explored factors associated with pictogram comprehension.

A cross-sectional survey using a structured questionnaire was conducted among 637 university students between August 2023 and April 2024. The Medication Use Literacy Test (MULT) assessed literacy, and the USP-DI pictogram comprehension test evaluated visual understanding. Binary logistic regression was used to identify factors associated with comprehension levels.

Among the 637 participants, the MULT revealed high literacy, with over 90% of questions answered correctly. The mean score for USP-DI pictogram comprehension was 21.82 ± 3.82. Students in health sciences programmes demonstrated the highest proficiency in both tests, followed by those in social sciences and science and technology programmes, with statistically significant differences (P < 0.05). Logistic regression analysis revealed that students aged >20 years had lower pictogram comprehension than younger students (odds ratio [OR] = 0.47; 95% confidence interval [CI]: 0.25-0.88; P = 0.02). Students with a Grade Point Average <3.00/4.00 (OR = 0.55; 95% CI: 0.32-0.96; P = 0.04) and those from non-health science faculties (OR = 0.04; 95% CI: 0.02-0.08; P < 0.001) also showed significantly lower comprehension levels.

This study highlights disparities in pictogram comprehension among Thai undergraduates and affirms the influence of academic discipline, age, and academic performance. The findings support the need for targeted educational strategies to enhance medication-use literacy and pictogram understanding.