Print materials for audiences with low levels of literacy usually include illustrations. This is particularly true of health education materials designed to raise awareness of serious diseases like the Human Immuno-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and Tuberculosis (TB). When people cannot read well, it is often assumed illustrations will communicate information more clearly than written text. Theories of visual communication, however, suggest that visuals are ambiguous and more likely to be misinterpreted than written text, especially by under-educated viewers in environments where visuals and print materials are scarce. Moreover, the traditional guidelines on illustrating educational materials for adults with limited literacy are dated and often anecdotal. Due to South Africa’s high HIV/AIDS and TB infection rates, effective health education is important. The lack of basic literacy skills among millions of adults presents a challenge. It is important to understand the communicative potential and limitations of illustrations in health education materials in order to maximise their success. This qualitative research analyses how visual meaning is structured in illustrations from health education print materials from a semiotic perspective. A mixed method approach known as hybridised semiotics (Penn, 2000) is used, which in this case combines the semiotic analysis of the illustrations with data collected through interviews. Audience interpretations of the illustrations are contrasted with the producer’s intended meanings. 23 individual interviews were conducted with Zulu-speaking adult participants from ABET Level 1 Zulu literacy classes in two rural and two urban literacy centres in KwaZulu-Natal. The research instrument for the interviews included illustrations in different illustrating styles and with different approaches to content. The content of the illustrations included HIV/AIDS; the digestive system, safety for caregivers, and TB. The illustration styles included artistic techniques, levels of stylization, pictorial depth and background detail. The participants frequently misinterpreted the illustrations, or were able to describe the basic appearance of what was depicted without interpreting the complexities of the intended messages. Reported education levels seemed to influence participants’ abilities to interpret pictures, but not as significantly as expected. Findings suggest that rural participants were more likely to misinterpret illustrations containing symbols and unfamiliar objects, and tended to focus on describing surface details. Even though urban participants were more likely to discuss the connotations of illustrations, they often misinterpreted the intended message. Previous background knowledge and experience of the subject matter of the illustrations seemed to be the factor that enabled participants to infer the intended meanings of illustrations. This study demonstrates the use of a semiotic approach to analysing illustrations, which may help to predict and avoid sources of confusion for audiences with low literacy. It also confirms that certain guidelines remain relevant while others do not, and provides specific recommendations on how to enhance the effectiveness of visual communication in this context. Illustrations have many beneficial roles, and remain essential components of reading material for audiences with low levels of literacy. It is therefore important to understand their complexity, and the reasons why they may be misinterpreted, so that their educational potential can be maximised. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2014.