Table 2 Recommendations for layout and typography (summarised from Hartley [14]) and the use of images (summarised from Houts et al. [15]) in patient information leaflets

Margin spacing

The top, bottom and outer margins should be at least 10 mm, where inner-right and inner-left margins should be at least 25 mm.

Column format

Consistent number of columns per page should be used. Double or multiple column formats used for landscape designs. Varying column formats may confuse the reader.

Consistent spacing

Systematic spacing should be used (such as one line separating a heading from the main text or two lines separating page titles from sub-headings). Horizontal spacing (unjustified text) is also recommended.

Appropriate font size

A font size of at least 10, 12, or 14 pt is recommended for the main text, and 14, 18, or 24 for headings. Line spacing of 1.5 lines is also recommended.

Capital letters

Paragraphs of text in capital letters are hard to read, and capitals should be limited in headings.

Italicized text

Continuous italicized text is hard to read and should be limited to signalling important words or points.

Bold text

Bold text loses its effect when over-used, so should be used sparingly.

Bullet points

Should be used appropriately in outlining a series of points within a paragraph

Use of graphics to support key points

Pictures are linked with text frequently

Use of simple graphics

Simple graphics are used to understand the intended message which prevents the reader from being distracted by irrelevant details. Minimize the use of abstract symbols. When using a sequence of images explain the connection between them in simple terms

Simplified language accompanying graphics

Appropriate text should be used to accompany the images to avoid ambiguity. Language should be clear.

Closely link graphics and text

Link images and text through close proximity. Captions to describe images where possible should be written at a low literacy level, thereby aiding people with limited reading skills understand any images presented to them

Graphics should be culturally sensitive

Consider the culture of the target audience, which may affect whether people attend to the education materials. Particularly for audiences who may not have been exposed to western medicine

Involve healthcare professionals in designing the graphics

Health professionals should design the images or be involved in guiding the design of the images. This is done to successfully communicate complex information through images.

Evaluate the effects of graphics

Systematically evaluate the effects of graphics through follow interviews which can be implemented to assess: attention, understanding, remembering and adherence