“I Can See She Does Not Want to Be Pregnant”: Using Images to Inform Low-Literacy Audiences about Safe Abortion In Zambia

Theoretical Background and research questions/hypothesis: Images are often perceived as a universal language, but when communicating health messages, lack of specificity can lead to misinterpretations with potentially dangerous consequences. This study evaluates the image-based Ending Pregnancy with Pills booklet, developed by Ipas to inform low-literate women about safe abortion. To what extent do women understand the clinical directions given in the Ending Pregnancy with Pills booklet? How do women understand the visual conventions used in the booklet?

Methods: Think-aloud interviews were conducted with 20 low-literate women in Lusaka, Zambia. Analysis focused on visual techniques and structures that helped or hindered accurate understanding of the intended message.  

Results: Culturally-based visual conventions, such as thought balloons, that required symbolic interpretation strategies, contributed to misunderstanding. Iconic strategies, such as the sun and moon, to convey the passage of time increased comprehension.

Conclusions: Image-based communication relies on cultural knowledge to express meaning. Certain visual strategies, such as the use of iconic indicators to express time, are more successful at conveying the intended message across cultures. 

Implications for research and/or practice: Practitioners seeking to create image-based material for low-literacy audiences should avoid using visual strategies that rely on unfamiliar cultural knowledge. Iconic strategies, which generate meaning based on common experiences, are more likely to successfully convey the intended message.