The role of pictograms in improving patients’ medication adherence: a systematic review

BACKGROUND: Poor medication adherence remains a significant public health issue. Although pictograms are established as intuitive visual aids for medication guidance, a current evidence synthesis is lacking, particularly regarding their role in the rapidly advancing digital health landscape. OBJECTIVE: To systematically evaluate the potential effect of pictograms on patients' medication adherence and exploring implications for the digital health era. METHODS: We searched PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang Data Knowledge Service Platform, VIP Network, and CBM databases for relevant studies on the effect of pictograms on patients' medication adherence, from the inception of each database to April 27, 2025. RESULTS: A total of 21 articles were included, comprising 19 English and 2 Chinese publications, all of which were randomized controlled trials. These studies varied in terms of study background, sample size, and drug regimens tested. All studies had methodological limitations, with pictographic interventions differing in complexity, duration, and adherence outcomes measured. Twelve studies (57.1%) reported statistically significant effects of pictographic interventions on patient adherence. CONCLUSION: Pictograms serve as an effective adjunct to enhance medication adherence, particularly among patients managing complex medication regimens or possessing limited health literacy. Future efforts should focus on developing standardized, evidence-based pictogram libraries and integrating them into multimodal medication education systems. Incorporating pictograms into digital health platforms, such as those using AI and smart devices, represents a promising direction for enhancing their reach and impact.