Objectives: Comprehension by the patient is often difficult due to varying levels of health literacy, language differences, and cultural variations. The authors worked collaboratively with six First Nation communities to develop pictographic instructions for the labelling of medications that were meaningful and sensitive to First Nation culture. Methods: Focus groups composed of community members and healthcare providers were conducted in six communities. They were presented with current

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... ion labelling pictograms and asked to provide feedback and revisions required to be best understood by members of their community. The redesigned pictograms were then communicated back to the communities through several iterations until agreement was reached. Results: Focus group discussions identified modifications to pictograms to reduce interpretation errors based on cultural characteristics. The focus groups agreed that the majority of the original pictograms were not culturally adequate so 16 new or modified pictograms were created and validated for use in First Nation communities. This project also discovered that pictograms are not only culture specific but context specific. Conclusion: Developing culturally and contextually meaningful pictograms can be used as a tool to improve patients' understanding and may help with remembering complex medical instructions and reduce the risk of taking medications incorrectly, thereby contributing to patient safety.