Background: Appropriate communication towards patients using driving impairing medicines about risk on fitness to drive can be supported by the use of pictograms. To evaluate and compare the effectiveness of various pictograms and warnings (e.g. a French, a Dutch and a newly developed EU rating model) in communicating risk, several experiments were conducted.

Methods: Structured interviews (experiment 1) and written questionnaires (experiment 2) were used respectively among drivers (n = 270) visiting one out of four community pharmacies in Groningen (n = 4) and patients who were drivers (n = 298) and starting a new treatment with a driving impairing medicine visiting community pharmacies (n = 38) in the Netherlands, to compare various pictograms and warnings.

Results: Compared to general warnings and pictograms, the EU rating model allowed patients to better understand the potential risk estimate when using impairing medicines. Addition of a side-text to the rating model resulted in a significantly higher estimated level of driving risk and a significant increase in intention to change driving behaviour. Age was the strongest predictor influencing participants’ preference for pictograms to express a warning message and levels of impairment.

Conclusions: Implementation of the rating model in clinical practice should be considered, but factors such as age and education of patients need attention in designing and implementing new pictograms.