# A qualitative study to explore the perspectives of key stakeholders regarding pharmaceutical pictograms in Pakistan

## TL;DR

This study explores the views of Pakistani healthcare stakeholders on pharmaceutical pictograms and identifies barriers to their implementation.

## Contribution

The study provides new insights into stakeholder perspectives on pictogram adoption in a low-resource setting like Pakistan.

## Key findings

- Stakeholders support pictograms for improving patient safety and understanding.
- Implementation is hindered by lack of policy, training, and resources.
- Awareness of standardized pictogram systems is limited among participants.

## Abstract

This qualitative study in Pakistan aims to gather perspectives from health regulators, pharmaceutical manufacturers, and healthcare professionals regarding the implementation of pharmaceutical pictograms.

An exploratory qualitative study design was used to conduct this study across all provinces of Pakistan. The study adopted a constructivist approach to examine stakeholders’ subjective interpretations and to ensure methodological transparency, Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used as reporting guidelines. The data were collected from three main groups through in-depth, face-to-face interviews. The study participants were recruited using a purposive convenience sampling technique. Data analysis was conducted using an inductive thematic analysis approach to draw conclusions aligned with the study objectives.

A total of 57 respondents participated in the study, including 13 doctors, 15 pharmacists, 15 health regulators, and 14 manufacturers. Analysis of the data yielded five themes and sixteen subthemes. The five key themes were extracted including the current status of pharmaceutical pictograms, the impact of pharmaceutical pictograms, the significance of pharmaceutical pictograms on patients and the healthcare system, and challenges in the implementation of pharmaceuticals. The majority of the respondents demonstrated a better understanding of the term ‘pharmaceutical pictograms,’ but awareness of standardised systems (USP and FIP) was limited. However, several implementation challenges were identified, including a lack of government recognition and policy support, insufficient training and knowledge among healthcare professionals, and financial or resource constraints. Stakeholders emphasised national policy, training, and awareness to integrate pharmaceutical pictograms.

The key stakeholders strongly favoured the implementation of pharmaceutical pictograms, recognising their potential to enhance patient comprehension, adherence, and overall safety in Pakistan. However, their adoption is limited by insufficient awareness, policy support, and resources. Addressing these challenges through national policies, professional training, and awareness initiatives is essential for the successful adoption of pictograms in the healthcare system.