Pharmaceutical pictograms: From fragmented evidence to accessible care

Understanding medication-related messages is a core requirement of pharmaceutical care. Pharmaceutical pictograms, as visual aids complementing verbal and written communication, have long been proposed as a strategy to improve comprehension and promote the rational use of medicines. However, despite decades of research, their integration into routine pharmaceutical practice remains limited. This commentary argues that the limited application of pharmaceutical pictograms is primarily related to systemic fragmentation within the research landscape rather than to an absence of evidence. Diagnostic and implementation studies have largely evolved in parallel, without being articulated into coherent methodological pathways capable of generating cumulative evidence and supporting effective translation into practice. As a result, pictograms are frequently validated without progressing toward implementation, or implemented without prior cultural validation. Building on this critical analysis, we position pharmaceutical pictograms as a health literacy strategy and propose an integrative and replicable multistage protocol grounded in organizational health literacy and cultural competence principles. The model incorporates multidimensional diagnosis, iterative co-design and cultural validation, an essential educational intervention, and implementation with evaluation in real-world settings. By integrating educational, health care, and regulatory dimensions within a single methodological framework, the proposed model seeks to strengthen evidence accumulation and support the effective implementation of pharmaceutical pictograms in pharmaceutical care.