Leaflets performed poorly in the use of illustrations and
interactive content. Visuals such as pictures or drawings are useful
for communicating information to readers, especially when the
text and the image are closely linked [10]. There is also evidence to
suggest that pictures can enhance knowledge and comprehension
of health information [19]. Over half the leaflets focused on STIs
but few included any illustrations of a simple condom pictorial
demonstration or even written instructions. This could increase
knowledge of correct condom use.
The majority of leaflets chose to portray a culturally neutral
image or failed to use any relevant images altogether. This suggests
a reluctance to tailor information to specific cultural groups and
may mean that some populations do not perceive information to
be relevant to them. Reasons for this may include the desire to not
focus on one specific group, fear of stigmatizing audiences or lack
of consideration of alternative cultural norms. However, many
authors argue that health education is more effective if it is
culturally tailored [20].
Interaction scores were low and many leaflets neglected reader
engagement. This is supported by research that suggests reader
interaction is often absent from printed resources [21]. This
represents a missed opportunity in leaflet design especially when
interaction can promote engagement with leaflet content and may
appeal to readers with a lower literacy level.