# A Technological Framework to Support Asthma Patient Adherence Using Pictograms
## 3 Results
### First Stage of Adaptation and Design of Pictograms for Medical Indications  
Table 11 presents a comprehensive quantitative overview of the results obtained in the pictogram selection process. In a broader perspective, the indications showcase success rates in the chosen alternatives surpassing 67% across 10 indications, while 2 indications fall within the range of 60% to 66%. Notably, only one indication, labeled as number 13, registers a success rate below 50%. Moving forward, Table 12 exhibits the finalized pictograms selected from the survey, accompanied by proposed design enhancements. Further refinement was guided by professionals' valuable feedback, derived from qualitative analysis of the focus groups and the observations section of the instrument. This insightful feedback prompted the consideration of incorporating five new medical indications, each complemented by a corresponding pictogram, as outlined in Table 13. \begin{table}
\begin{tabular}{c c c c c c c} \hline \hline \multirow{2}{*}{**Indication**} & **Total Valid** & **Total** & **Percentage** & **Percentage** & **Percentage** & **Percentage** \\  & **Answers** & **Total** & **“A” in Valid** & **“B” in Valid** & **“C” in Valid** & **“A” in Total** & **“B” in Total** \\  & **Answers** & **Answers** & **Answers** & **Answers** & **Answers** & **Answers** & **Answers** \\ \hline
1 & 21 & 22 & 33\% & 0\% & 67\% & 32\% & 0\% \\
2 & 21 & 22 & 62\% & 29\% & 10\% & 59\% & 27\% \\
3 & 22 & 22 & 23\% & 68\% & 9\% & 23\% & 68\% \\
4 & 22 & 22 & 18\% & 73\% & 9\% & 18\% & 73\% \\
5 & 22 & 22 & 14\% & 86\% & 0\% & 14\% & 86\% \\
6 & 22 & 22 & 0\% & 82\% & 18\% & 0\% & 82\% \\
7 & 20 & 22 & 75\% & 25\% & 0\% & 68\% & 23\% \\
8 & 22 & 22 & 95\% & 0\% & 5\% & 95\% & 0\% \\
9 & 22 & 22 & 23\% & 64\% & 14\% & 23\% & 64\% \\
10 & 22 & 22 & 0\% & 82\% & 18\% & 0\% & 82\% \\
11 & 18 & 22 & 6\% & 72\% & 22\% & 5\% & 59\% \\
12 & 20 & 22 & 45\% & 35\% & 20\% & 41\% & 32\% \\
13 & 18 & 22 & 6\% & 11\% & 83\% & 5\% & 9\% \\ \hline \hline \end{tabular}
\end{table} 
Table 11: Results in % of pictogram selection by ARU professionals. \begin{table}
\begin{tabular}{c c c} \hline \hline \multirow{2}{*}{**Indication**} & **Selected Pictogram** & **Suggested Corrections** \\  & **Alternative** & **Suggested Corrections** \\ \hline One puff & **1**\(\times\)**\(\times\ \begin{table}
\begin{tabular}{p{113.8 pt} p{113.8 pt} p{113.8 pt}} \hline
**Indication** & **Selected Pictogram Alternative** & **Suggested Corrections** \\ \hline Every twelve hours & & Same suggestion as indication 4 \\ \hline Always use an aerocamera & & It is only suggested to include the text of the indication. \\ \hline Shake the inhaler vertically for one minute & & The numbers could be larger, and the image sharper. Additionally, ’1 minute’ should be aligned in a sentence. \\ \hline Remove the cap of the inhaler & & The arrow from Alternative B could be included between the cap and the inhaler in Alternative A. \\ \hline Insert inhaler into the air chamber & & Consider adding a socket or insertion slot to the air-chamber in Alternative A. This may make Alternative A more comprehensive than originally anticipated. \\ \hline Adjust the air chamber to the face & & The indication should use “cover” instead of “fit”, and for the nose and mouth, it should specify “face”. So, the revised indication would be: “Cover the nose and mouth with the air chamber”. \\ \hline Press the inhaler & & The indications should state ’Press the inhaler once’. To accommodate this, you can add the phrase ’press once’ to pictogram B. \\ \hline Breathe into the air chamber and perform a puff & & Include a hand and date image on the inhaler in Alternative B to illustrate the puff application process, similar to indication 10. \\ \hline \end{tabular}
\end{table} 
Table 12: Cont. Second Validation Process of Pictograms to Support Clinical Indications for Patients with Bronchial Asthma, by ARUI Professionals  
Table 14 offers an overview of the participants' characteristics in this stage of the study.