Ninik Mas Ulfa^1,2, Andi Hermansyah³ , Suharjono³, Rr. Batari Retno Minanti⁴, Dewi Ramdhani⁴

Abstract

Purpose: To develop, validate, and evaluate Indonesian-specific pictograms intended to support pharmacist-led tele-counselling for patients with T2DM. Methods: A quantitative cross-sectional study with a test–retest design was conducted over six months at a tertiary hospital outpatient clinic in Surabaya, Indonesia. Adults aged 35–65 years with T2DM, who were literate and without visual impairment, were recruited using accidental sampling. A questionnaire containing 38 pictograms addressing medication instructions, insulin timing, injection, storage, lifestyle, and diet was developed based on international guidelines and the literature. The questionnaire was reviewed by three pharmacists and one endocrinologist. Comprehension was assessed twice, with a four-month interval. Pictograms achieving comprehension rates of at least 66.7 % (ISO 9186) were accepted. Chi-square tests examined differences within pictogram sets, and Wilcoxon signed-rank tests assessed test–retest reliability. Results: Fifty-five patients completed both rounds of assessment. Most participants were female (63.6 %), aged 56–65 years (56.4 %) and had at least a senior high school education (78.2 %). Many pictograms demonstrated high comprehension, often exceeding 90 % for medication timing and insulin instructions. Lifestyle pictograms also performed well, with comprehension rates of at least 78 %. Seventeen pictograms met all criteria and demonstrated stability over time (p > 0.05). Indonesia-specific pictograms for T2DM are highly comprehensible and reliable. Conclusion: The selected pictograms support pharmacist-led tele-counselling, enhance digital communication, and address health literacy barriers.