Evaluation of pictograms for safe medication disposal awareness campaign: a pilot study.

Improper disposal of unused and expired medications poses significant environmental and public health risks, yet awareness and appropriate disposal practices remain inadequate in Malaysia. Effective visual communication offers a sustainable approach to addressing this gap by simplifying complex medical information and improving long-term health literacy. Pharmaceutical pictograms, when designed to be simple, culturally relevant, and context- specific, can enhance message clarity, recall, and patient engagement. As low- cost and reusable educational tools, pictograms support sustainable health education by promoting informed behaviors and reducing medication-related environmental contamination. Consequently, pictogram-based educational strategies may improve public understanding and encourage responsible disposal of medication waste. This pilot study aimed to evaluate the comprehensibility of culturally localized pharmaceutical pictograms designed to promote safe medication disposal among the Malaysian population. A cross- sectional study was conducted using interviewer-administered online sessions across 14 states in Malaysia. Fourteen pictograms were evaluated among 50 participants. Comprehension was assessed before and after verbal and textual explanation, using ISO (≥66.7%) and ANSI (≥85%) standards. Demographic data were analyzed descriptively. Prior to explanation, 11 pictograms met ISO criteria and 10 met ANSI criteria. Following explanation, all pictograms met both standards. Pictograms incorporating culturally familiar symbols achieved higher recognition rates, while complex and multi-message pictograms were more prone to misinterpretation. Culturally responsive pictogram design, supported by multimodal communication, enhances comprehension of safe medication disposal practices and supports sustainable healthcare behaviors.