Archives of Design Research

Most participants facilitated accurate and safe medication administration by integrating their medication routines into their daily lives. In particular, P4, P5, and P11 utilised visual or habitual cues to take medication during their daily routines. For example, P4 aligned her medication administration with her morning tea habit. She placed her medications on the tea tray to remind herself to take them, reducing the likelihood of missed doses: “I would put all the medications for the day next to the tea tray on the coffee table so that I would see them while having tea.”

Participants also employed coloured caps to distinguish medications and optimised their strategies over time. P13 transitioned from dispensing daily doses to organising his pills weekly, using the full and empty bottles to track what he had taken: “I now fill pill bottles for the week and store them in a drawer. The bottles on the left contain medication, and those on the right are the empty ones that I have already administered.”

The participants’ behaviour showed that placing medications in prominent locations served as effective reminders. Because their daily routine included tea consumption, P3, P4, P5, P8, and P10 placed their medication near where they made tea to ensure timely administration. P8: “I come here for a cup of tea first thing in the morning after waking up, seeing the pillbox, it reminds me to take my medication (see Figure 1).” P6, P7, and P11 opted to place their medication on their kitchen table; as they spent the most time there, this made it a natural, conspicuous location for reminders.

Figure 1 P8’s medication placed in a frequently accessed area as a reminder

Some participants (P2, P10, P14, and P15) who self-medicated for minor illnesses accessed WeChat and Baidu for medication information, highlighting how self-pharmacotherapy has become an important aspect of self-management for older adults. Many participants also used online resources to find appropriate medications for minor health issues.

Family members, particularly adult offspring, are vital to older adults’ daily lives and health management, especially those with limited mobility or complex medical needs. Half of the participants (P1, P8, P9, P10, P11, P12, and P13) relied on their children to purchase OTC medications. For instance, because of his educational level, P1 relied on his daughter to purchase medications. P1: “My daughter helps me purchase all the OTC medications that I administer.”

In addition, family members assisted with reading instructions, confirming dosages and monitoring supplies. P1 and P8 said their daughters helped them with medication management. P1: “She can help me confirm the correct medication dosage and administration.” Many participants’ children helped maintain medication adherence and reduced the risk of forgetfulness by checking their parents’ medication supply and regularly reminding them to take their medicine. P9: “I would remember to take my medication only when my daughter asks if I have forgotten to administer my medication.”

Older adults often sought advice on minor ailments and medications from trusted local community clinics, whose proximity allowed the participants (except P6 and P7) to have more frequent follow-up consultations, ensuring prompt professional healthcare support. These older adults purchase OTC medications based on previous prescriptions without consulting the doctors again and many participants (P3, P4, and P10) followed the instructions or labelling on the medication. P3: “My OTC medication is based on my doctor’s previous prescription. After administering it, I simply purchase more based on their earlier advice. I do not consult my doctor again for a second purchase.”

Thus, many participants trusted their doctors’ medication information and followed the medication lists they provided, adhering strictly to the recommended dosages and timings.

Participants noted the small font sizes on medication packaging, including the outer boxes, instructions, and vial labels. Space limitations on packaging often make it difficult to present essential information in a readable format, which poses a significant challenge for older adults with visual impairments. Several participants (P1, P6, P9, P10, P11, P12, P13, P14, and P15) had trouble reading the indications, contraindications, dosage, and expiry dates, all information that must be clearly legible for safe and accurate medication use. P5 would take pictures to magnify the information: “I will take a picture and enlarge the image to view the information. If the font is too small, it will appear blurry even if a picture is enlarged. There are cylindrical pill bottles, which are difficult to photograph entirely.” Despite this solution to the issue of the small font, insurmountable difficulties remained.

Many participants (P1, P3, P4, P8, P9, P12, and P14) reported difficulties in recognising the date of manufacture and expiry on medication packaging, especially when these details were printed using steel stamps (see Figure 2). Participants expressed concern about purchasing expired medications due to this lack of clarity. P3 noted that poor lighting in pharmacies made printed dates harder to read: “When I ask pharmacy staff, I am concerned they may not provide accurate information and sell medications close to expiry.”

Figure 2 The expiration date of the steel stamp on a glossy box is not clearly visible

Several participants (P1, P2, P3, P14, and P15) reported difficulties understanding the labelling and textual information on drug packaging. Drug dosage and administration instructions were often difficult to find and had poor visibility. Moreover, when the outer packaging is lost, identifying the medication information on the medicine bottle is even more difficult for many participants (P1, P3, P5, P12, P14, and P15).

Older adults, particularly those without a medical background, often face difficulties understanding complex medical terminology. Most participants (except for P6, P7, and P13) were confused by unfamiliar medical terms on drug labels. Participants noted that chemical terms or specific medical jargon were hard to understand. P1: “I cannot understand the name Finasteride tablets.” Participants suggested clearer, more intuitive labels in drug packaging to facilitate identification and use. P11: “It would be better if there were special labels on it, such as headache, for toothache, and diarrhoea.”

Additionally, participants had difficulty understanding foreign language labels. Three participants (P2, P12, and P14) often needed to rely on family members or translation tools for assistance. P12: “I can not read labels of some medicines as they are in foreign languages. I then ask my son or daughter-in-law.”

Three participants (P10, P11, and P13) indicated that many decorative patterns on the medication packaging were unnecessary and occasionally obscured essential information. They noted that unnecessary design features occupied space that could be used for clearer drug information. P10: “The packaging contains so much information and decoration that some important drug information cannot even be read.”

However, several participants (P3, P4, P7, P8, and P14) relied heavily on visual cues, including package colours, symbols or images, to identify the type of medication or its intended use. For instance, P3 used the sizes of the medicine bottles as a visual cue, while P4 relied on their colour and shape to identify which medications to take at particular times. P4: “The long package and the green one lower blood pressure; the biggest one lowers blood lipids.” P14, who encountered health products with instructions in foreign languages, used the graphics and colours to recognise her medications: “I just looked at the surface of the package, and there was a row of little fish on the surface of the package, [...] thus, I knew that this one was a fish oil.”

P14 highlighted the usefulness of graphics on packaging in providing visual information about a medication’s intended use. She described how she recognised an ointment from the body acupuncture points printed on it, which helped her understand its application even when the packaging had been discarded (see Figure 3): “This one is an applicator ointment that my son bought from Korea (right); it has the body acupuncture points printed on it, [...] if its outer packaging is lost, I will know its efficacy and how to use it.” These findings emphasise the importance of clear and meaningful graphics and the overall readability of drug packaging for older adults. Visual cues can help older adults identify medications, especially when faced with language or terminology barriers.

Figure 3 The two packages that P14 compared

Older adults demonstrated autonomy in managing OTC medications by integrating them into their daily routines, including drinking tea, walking or cooking, thereby enhancing adherence and minimising errors. Colour-coded caps, bottle size and pictorial cues further supported rapid recognition under conditions of limited attentional resources. This reflects their adaptability and use of previous experiences and problem-solving abilities to overcome challenges (Xiao et al., 2023). However, these strategies require legible text and unambiguous graphics. Illegible expiry dates, crowded layouts or unfamiliar terminology break the perception–action loop, forcing users to engage in effortful reading or ask their family for assistance. Older adults often photograph the labels on cylindrical vials to magnify the text, but such text is easily distorted when photographed. Hence, packaging for which first-glance identification fails imposes a cognitive overload precisely where older adults seek to conserve effort.

Thus, we suggest the following design strategies:

• • Provide instantly perceptible ‘recognition keys’ (e.g. high-contrast colour bands for time of day, tactile icons for dosage), allowing users to link medicines to routine anchors without having to decode small print.
• • Position critical text so that it remains visible when bottles sit upright on trays or tables.
• • Design the labels on cylindrical bottles to display all critical information within a single flat viewing panel for one-glance reading while being undistorted when photographed with a smartphone.

Family members, especially adult children, play a crucial role in helping older adults manage their medications by providing reminders, reading instructions and obtaining medications. In our study, half of the participants depended on adult children to purchase their medicine or remind them to take it and nearly all of them trusted the advice they had previously received from local clinicians. Trust in healthcare providers affects older adults’ medication adherence, as many of them continue to buy OTC medications based on earlier prescriptions. In the rural area where our study was conducted, pharmacies are often close to patients’ residences and communicate with patients’ family members upon request. Therefore, packaging should be designed so as to support distributed care work. Participants frequently used video calls or texts to communicate with their family members living at a distance for assistance with their medication. Additionally, although many of the caregivers are familiar with smart devices, some elderly patients find barriers to using the same technology. At the same time, many elderly individuals want to maintain their independence, as shown by participants who managed their medications on their own.

Thus, appropriate packaging design would aid to older users and intermittent helpers who may have various literacy levels or reside elsewhere. Accordingly, we suggest the following design strategies.

• • Encode dosage instructions in plain language and pictograms that family members can conveniently access remotely via video calls.
• • Print a scannable QR code linking to an audio-visual guide; this accommodates presbyopia and allows caregivers to verify instructions quickly.
• • Include writable zones on the bottles where helpers can mark custom reminders (e.g. ‘after breakfast’) once the outer cartons have been discarded.

Homes are visually and physically heterogeneous. Participants are notified of the expiration dates of their medicine in the pharmacy, but typically struggle to read the steel-stamped dates in dim kitchen lighting or shadowed corners.

Taking medication is a part of older adults’ everyday life, so the pill boxes and medicine bottles reside among other household items. At the same time, small packages are easily lost.

We found that older adults often place certain medications in a specific order where they can be easily found. Research on situated visibility indicates that information must remain readable under the actual luminance and orientation conditions of use. We suggest the following design strategies to overcome these constraints.

• • Use matte, low-glare substrates and dark-on-light typography with a minimum height ≥3 mm to preserve contrast in sub-optimal lighting.
• • Reserve sufficient space on the package faces most likely to be exposed on crowded shelves for the essential triad: drug name, purpose icon and expiry date.

The prevalence of abstract terminology and dense textual instructions for CPMs underscores the need for intuitive visual cues. To address this challenge, this study proposes a packaging design concept that externalises human bodily features by presenting the treatment site for the drug in three-dimensional relief on the exterior of the medicine bottle (see Figure 4).

Figure 4 Prototype medicine bottle packaging design

The label area thus combines text with a model of the respective area of the body to reinforce the association between diseases, medications and body parts, thereby reducing the risk of errors due to difficulty in understanding the information. This strategy leverages visual-tactile associations to minimise reliance on text and support recognition among users with low literacy or visual impairments. It also preserves culturally relevant terminology for the body and health while simplifying its interpretation.

This study found that CPM labels often specify vague ranges for dosage frequency, creating uncertainty among elderly users. To translate this abstract information into actionable guidance, following Lin and Luo (2024) on the application of emojis in health information, we designed ‘emoji-style dosage frequency diagrams’ on the labels: Using two emotion icons—‘😖’ and ‘😐’—to represent different levels of physical discomfort, users are guided to select the appropriate dosage frequency based on their condition (e.g. ‘😖’ indicates severe discomfort requiring 3 doses daily, while ‘😐’ corresponds to 2 times daily). This approach bridges cultural symbolism and standardised visual communication by using emotive icons to convey the severity of symptoms and recommended dosing frequency, thereby enhancing comprehension and recall.

Limited information on vials remains a challenge even in standardised Western OTC packaging. This issue is even more pronounced for CPMs, where dense traditional labelling further restricts accessibility. To address this limitation, we propose a visual assistance system for medication time and dosage integrated into the bottle cap (see Figure 5) in which colour coding is used to distinguish medication times—yellow for morning, orange for noon and dark blue for evening. The number of circles in the centre corresponds to the number of tablets. Rather than replacing the instruction manual, this system functions as a compact embedded reminder that both optimises the use of the limited surface area of small CPM containers and compensates for the cognitive demands of dense text instructions, balancing regulatory requirements with the needs of elderly users.

Figure 5 Color-coded cap design to enhance medication adherence