The impact of illustrated side effect information on understanding and sustained retention of antiretroviral side effect knowledge

Background: Prompt management of side effects is critical to supporting adherence to antiretroviral (ARV) medication. Objective: This study examines the impact of presenting side effect information using simple text combined with pictograms on sustained knowledge of ARV side effects over three months. Method: Previously designed side effect pictograms, combined with simple text, were incorporated into a side effects panel within an ARV information leaflet. In a randomised controlled study, 116 limited literacy HIV patients taking ARVs were randomly allocated to either control (standard care) or intervention groups (standard care plus illustrated information). Side effect knowledge was assessed at baseline, and intervention patients received the illustrated leaflet. Knowledge was re-tested at one and three months. Interpretation of side effect pictograms was evaluated at one month. Results: In intervention patients, mean side effect knowledge increased from 45.9% (baseline) to 95.7% (three months; p<0.0001), and pictogram interpretation was good. Knowledge did not change significantly in the control group. All found the pictograms clear and useful, and endorsed their routine use. Conclusions: Providing patients with simple written information containing pictograms on ARV side effects significantly improved side effect knowledge, sustained over time, in limited literacy, rural South African HIV patients.