Daniel G Morrow

• University of Illinois Urbana-Champaign

Communication failures in health care are brought about by multiple challenges of communicating in this complex high stakes domain. These failures are far too common and create safety risks and contribute to sub-optimal patient outcomes. Although communication research in health care environments is not always informed by theory, existing theoretic...

The ubiquity of EHRs in healthcare means that small EHR inefficiencies can have a major impact on clinician workload. We conducted a sequential explanatory mixed methods study to: 1) identify EHR-associated workload and usability effects for clinicians following an EHR change over time, 2) determine workload and usability differences for providers...

We are developing a Computer Agent (CA), or "virtual provider", to deliver medication information to support self-care among older adults. In an initial evaluation, older and younger adults responded to CAs varying in gender, age, and level of realism that delivered medication information. Findings were consistent with the idea that CAs can engende...

Patient portals to Electronic Health Record (EHR) systems are underused by older adults because of limited system usability and usefulness, including difficulty understanding numeric information. We investigated whether enhanced context for portal messages about test results improved responses to these messages, comparing verbally, graphically, and...

To guide development of a computer agent (CA)-based adviser system that presents patient-centered language to older adults (e.g., medication instructions in portal environments or smartphone apps), we evaluated 360 older and younger adults' responses to medication information delivered by a set of CAs. We assessed patient memory for medication info...

The study of expertise, often defined as superior levels of performance on representative tasks or more broadly as improved performance with increasing task related experience, is an investigation of change, typically growth in skills, knowledge, interests, and other changes that accompany improved performance. The study of aging also focuses on ch...

Purpose of the study: Older adults' self-care often depends on understanding and utilizing health information. Inadequate health literacy among older adults poses a barrier to self-care because it hampers comprehension of this information, particularly when the information is not well-designed. Our goal was to improve comprehension of online healt...

We describe a project intended to improve the use of Electronic Medical Record (EMR) patient portal information by older adults with diverse numeracy and literacy abilities, so that portals can better support patient-centered care. Patient portals are intended to bridge patients and providers by ensuring patients have continuous access to their hea...

The study of how age-related changes in cognition influence communication and learning in safety-critical domains has important practical and theoretical implications. The work described in this chapter leveraged theories of communication and cognitive aging in order to investigate how collaboration between older adults and their health-care provid...

Older adults' medication planning and scheduling can benefit from collaborative support from healthcare providers, and through the use of cognitive support aids. In this paper, we investigate the communication strategies that older adults utilize for collaborative medication scheduling. 32 community-dwelling older adults participated in pairs, and...

When learning about a single topic in natural reading environments, readers are confronted with multiple sources varying in the type and amount of information. In this situation, readers are free to adaptively respond to the constraints of the environment (e.g., through selection of resources and time allocation for study), but there may be costs o...

Objectives To test whether a multifaceted prospective memory intervention improved adherence to antihypertensive medications and to assess whether executive function and working memory processes moderated the intervention effects. DesignTwo-group longitudinal randomized control trial. SettingCommunity. ParticipantsIndividuals aged 65 and older with...

Among patients with various levels of health literacy, the effects of collaborative, patient-provider, medication-planning tools on outcomes relevant to self-management are uncertain. Objective . Among adult patients with type II diabetes mellitus, we tested the effectiveness of a medication-planning tool (Medtable ™ ) implemented via an electronic...

Older adults make many decisions about their health, in part because they are the most frequent patients in a health-care system that places a premium on patient engagement and decision making. They face complex health-related decisions that involve receiving care from multiple providers for interacting chronic and acute conditions. Older adults wi...

Our goal is to improve understanding and use of numeric information (e.g., clinical test results) provided through portals to Electronic Health Record (EHR) systems by older adults with diverse numeracy and risk literacy abilities. We help older adults understand this information by emulating in portal environments best practices from face-to-face...

We developed and tested the Multifaceted Prospective Memory Intervention (MPMI) to improve medication adherence among older adults (≥ 65 years of age) who were prescribed at least one daily medication for the control of high blood pressure. Blood pressure control is important because high blood pressure is a leading cause of stroke, heart failure,...

Purpose of the Study: Health literacy is associated with health outcomes presumably because it influences the understanding of information needed for self-care. However, little is known about the language comprehension mechanisms that underpin health literacy. Design and Methods: We explored the relationship between a commonly used measure of heal...

Understanding and acting on online health information is increasingly a prerequisite for patient self-care. Therefore, inadequate health literacy is a barrier to self-care among older adults with chronic illness. The goal of our study was to improve older adults' comprehension of online health information. We extracted typical health texts from mul...

We attempted to understand the latent structure underlying the systems pilots use to operate in situations involving human-automation interaction (HAI). HAI is an important characteristic of many modern work situations. Of course, the cognitive subsystems are not immediately apparent by observing a functioning system, but correlations between varia...

In this study, we used a word search puzzle paradigm to investigate age differences in the rate of information gain (RG; i.e., word gain as a function of time) and the cues used to make patch-departure decisions in information foraging. The likelihood of patch departure increased as the profitability of the patch decreased generally. Both younger a...

Communication failures in health care are brought about by multiple challenges of communicating in this high stakes domain. These failures are far too common and create safety risks and contribute to sub-optimal patient outcomes. Although communication research in health care environments is not always informed by theory, existing theoretical found...

While a training model of cognitive intervention targets the improvement of particular skills through instruction and practice, an engagement model is based on the idea that being embedded in an intellectually and socially complex environment can impact cognition, perhaps even broadly, without explicit instruction. We contrasted these 2 models of c...

Objectives This study sought to make the Brief Illness Perception Questionnaire (BIPQ) to be more informative about illness representation among older adults with hypertension. The authors developed categories for coding the open-ended question regarding cause of illness in the BIPQ – a pervasive quantitative measure for illness representation. Me...

While there is evidence that knowledge influences understanding of health information, less is known about the processing mechanisms underlying this effect and its impact on memory. We used the moving window paradigm to examine how older adults varying in domain-general crystallised ability (verbal ability) and health knowledge allocate attention t...

Cognitive engineering is an interdisciplinary approach to the analysis, modeling, and design of engineered systems or workplaces in which humans and technologies jointly operate to achieve system goals. As individuals, teams, and organizations become increasingly reliant on information technology and automation, it is more important than ever for s...

As the health care industry shifts into the digital age, patients are increasingly being provided with access to electronic personal health records (PHRs) that are tethered to their provider-maintained electronic health records. This unprecedented access to personal health information can enable patients to more effectively manage their health, but...

Human-automation interaction (HAI) takes place in virtually every high-technology domain under a variety of operational conditions. Because operators make HAI decisions such as which mode to use, and when to engage, disengage, monitor, or cross-check automation, it is important to understand their perceptions of how system and situational character...

Teamwork in many operational settings, such as air traffic control or telemedicine, involves members who are at different locations and, as in space exploration missions, may communicate under time-delayed conditions. Collaboration and coordination in distributed teams differ from face-to-face interactions in a number of important respects (Brennan...

Older adults with chronic illness have complex medication regimens that require an understanding of a wide range of information. The impact of patient characteristics (e.g., cognitive ability), health documents (language and multimedia), and the communication context (available time to communicate) in which older adults understand the information n...

This handbook collects and organizes contemporary cognitive engineering research, drawing on the original research of more than 60 contributing experts. Coverage of human factors, human-computer interaction, and the conceptual foundations of cognitive engineering is extensive, addressing not only cognitive engineering in broader organizations and c...

Understanding patient skills, abilities, and other resources related to health literacy is crucial for improvement of self-care knowledge and behaviors. The current study explored links between cognitive abilities, knowledge, and reading engagement within the framework of process-knowledge model of health literacy (e.g., Chin et al., 2011) as measu...

Adherence to prescribed antihypertensive agents is critical because control of elevated blood pressure is the single most important way to prevent stroke and other end organ damage. Unfortunately, nonadherence remains a significant problem. Previous interventions designed to improve adherence have demonstrated only small benefits of strategies that...

To assess the effect of health literacy on drug adherence in the context of a pharmacist-based intervention for patients with heart failure. Post hoc analysis of a randomized controlled trial. Inner-city ambulatory care practice affiliated with an academic medical center. The original trial enrolled 314 patients with heart failure who were aged 50...

Purpose: Describe recruitment strategies used in a randomized clinical trial of a behavioral prospective memory intervention to improve medication adherence for older adults taking antihypertensive medication. Results: Recruitment strategies represent 4 themes: accessing an appropriate population, communication and trust-building, providing comfor...

This study used a word search puzzle paradigm to examine the effects of task environment and individual differences in ability on information foraging. Younger and older adults attempted to maximize the number of items found in a set of 4 puzzles in which they were at liberty to search within a puzzle or switch between them. Younger adults demonstr...

The authors explored knowledge effects on comprehension of multimedia health information by older adults (age 60 or older). Participants viewed passages about hypertension, with text accompanied by relevant and irrelevant pictures, and then answered questions about the passage. Fixations on text and pictures were measured by eye-tracking. Participa...

Background Health literacy is the ability of patients to obtain, process, and understand information needed to make health decisions. Health literacy is a stronger predictor of a person's health than is age, income, employment status, educational level, or race. The Medtable is a paper-based tool that is designed to support comprehension of medicat...

Patients with type II diabetes often struggle with self-care, including adhering to complex medication regimens and managing their blood glucose levels. Medication nonadherence in this population reflects many factors, including a gap between the demands of taking medication and the limited literacy and cognitive resources that many patients bring...

Why do some groups succeed where others fail? We hypothesise that collaborative success is achieved when the relationship between the dyad's prior expertise and the complexity of the task creates a situation that affords constructive and interactive processes between group members. We call this state the zone of proximal facilitation in which the d...

The authors explore the role of technology in supporting collaboration between health care providers and older adults. They focus on two technologies that help link patients to their providers by giving them access to health information and services: 1) patient portals to Electronic Health Records, and 2) Personal Health Record systems. Theories of...

We investigated the effects of domain-general processing capacity (fluid ability such as working memory), domain-general knowledge (crystallized ability such as vocabulary), and domain-specific health knowledge for two of the most commonly used measures of health literacy (S-TOFHLA and REALM). One hundred forty six community-dwelling older adults p...

While there is much evidence that health knowledge supports understanding of health texts, little is known about the processing mechanisms underlying this effect. We used the moving window paradigm to examine attentional allocation to reading health and domain-general texts among older adults with hypertension who varied in verbal ability (general...

Medtable™ is an Electronic Medical Record (EMR)-integrated tool designed to address the significant problem of medication nonadherence, especially barriers related to patients’ limited cognitive resources and ineffective patient-provider communication. Medtable™ supports the patient-provider collaboration needed to create effective medication sched...

Research that addresses human factors issues in health care has made good progress since the landmark 1999 Institute of Medicine report on medical error (Kohn, Corrigan, & Donaldson, 1999), yet patient safety remains a persistent challenge for the health care system. While this challenge reflects many factors, we focus on the need for research that...

Medication adherence—taking medication as prescribed—is critical for successful self-care, especially among older adults. Adherence depends on developing and implementing plans for taking medications. Age-related cognitive declines that affect adherence may be mitigated using external tools that support patient-provider collaboration needed to deve...

Medication adherence is an essential activity for successful self-care, particularly for older adults who take multiple medications. Adherence depends on understanding how to take medication, which in turn depends on effective communication with providers. Unfortunately, physician and patient communication is often substandard and ineffective. Furt...

We studied hypertensive older adults' processing of multimedia (text and picture) displays of hypertension information, and how reading patterns related to hypertension knowledge and passage comprehension. Eye movements of 23 older adults were tracked as they studied 4 text-picture passages. Eye movements were analyzed during and after participants...

Patient adherence is defined as the extent to which patients follow prescribed treatment regimens (Haynes et al., 2008). Adherence supports health promotion (e.g., exercise and diet), treatment of disease, symptom management, and efficient health care delivery. The term adherence is used rather than compliance because its meaning is more consistent...

We investigated how cognitive abilities and illness experience relate to illness knowledge. One hundred and forty-eight community-dwelling older adults including hypertensive patients and healthy adults completed a battery that measured illness knowledge, fluid cognitive abilities, crystallized abilities, and health history. Results suggested that...

We investigated interrelationships between the predisposition toward approaching experiences in a mindful and creative way, participation in specific activities, and cognition among older adults. Participants were administered a battery measuring cognition (i.e., working memory, processing speed, divergent thinking, inductive reasoning, visuo-spati...

We determined the factors associated with exacerbation of heart failure, using a cohort (n = 192) nested within a randomized trial at a university-affiliated ambulatory practice. Factors associated with emergency or hospital care included left ventricular ejection fraction, hematocrit and serum sodium levels, refill adherence, and the ability to re...

The effect of expertise on collaborative memory was examined by comparing expert pilots, novice pilots, and non-pilots. Participants were presented with aviation scenarios and asked to recall the scenarios alone or in collaboration with a fellow participant of the same expertise level. Performance in the collaborative condition was compared to nomi...

We investigated expertise differences in pilot decision making by examining a hypothesized attention-action link. During simulated flight we measured the accuracy and latency of more and less expert pilots' decision outcomes and used eye tracking to measure their attention. We also examined whether decision outcomes and attentional strategies were...

We examined the influence of age and expertise on pilot decision making. Older and younger expert and novice pilots read at their own pace scenarios describing simpler or more complex flight situations. Then in a standard interview they discussed the scenario problem and how they would respond. Protocols were coded for identification of problem and...

Experimental studies on cognitive training have suggested that the effects of experience are narrow in augmenting or maintaining cognitive abilities, while correlational studies report a wide range of benefits of an engaged lifestyle, including increased longevity, resistance to dementia, and enhanced cognitive flexibility. The latter class of evid...

In this qualitative review, we develop an integrative framework to bring coherence to the concept of environmental support (ES) in the fields of human factors and cognitive aging. The ES hypothesis, originally formulated to explain effects of retrieval support on age-related differences in memory by reducing need for self-initiated processing, has...

Taking medication requires developing plans to accomplish the activity. This planning challenges older adults because of age-related cognitive limits and inadequate collaboration with health providers. The authors investigated whether an external aid (medtable) supports collaborative planning in the context of a simulated patient/provider task in w...

While much is known about differences in decision making outcomes related to pilot expertise, less is known about the processes that underlie these differences. We explored expertise differences in decision making processes by simultaneously measuring expert and novice pilots' attention, using eye-tracking, and their decision outcomes in a realisti...

Approximately half of the US population has marginal or inadequate health literacy, a measure highly associated with health outcomes. This measure is often linked to age and education, but recent evidence from patients with chronic heart failure suggests that much of age-related variability in health literacy can be explained by cognitive abilities...

Voice communication with air traffic control (ATC) taxes pilots' cognitive abilities, contributing to errors that reduce safety. External aids such as note-taking help pilots manage communication demands, and may especially benefit older pilots. Emerging technologies provide new opportunities for external aids that are integrated with other systems...

Older adults' medication nonadherence is an important patient safety issue. Adherence depends on plans that instantiate treatment guidelines in the context of patients' daily lives, but the ability to create successful plans is often undercut by poor collaboration between providers and patients. We investigated whether external aids can support the...

Objective: We developed a pharmacist-based patient education intervention to improve older adults' adherence to chronic heart failure (CHF) medications, which included written patient-centered instructions. The study evaluated these instructions by examining whether patients preferred them to standard pharmacy instructions. Method: Elders diagnosed...

The Senior Odyssey was developed to promote social and intellectual engagement among older adults. Modeled after the Odyssey of the Mind program, Senior Odyssey teams meet for one hour weekly over the course of 20 weeks to engage in creative and collaborative problem solving. Within the larger context of the Senior Odyssey research program, qualita...

The engagement hypothesis suggests that social and intellectual engagement may buffer age-related declines in intellectual functioning. At the same time, some have argued that social structures that afford opportunities for intellectual engagement throughout the life span have lagged behind the demographic shift toward an expanding older population...

Patients with heart failure who take several prescription medications sometimes have poor adherence to their treatment regimens. Few interventions designed to improve adherence to therapy have been rigorously tested. To determine whether a pharmacist intervention improves medication adherence and health outcomes compared with usual care for low-inc...

This study investigated age differences in the way in which attentional resources are allocated to expository text and whether these differences are moderated by content preexposure. The organization of the preexposure materials was manipulated to test the hypothesis that a change in organization across two presentations would evoke more processing...

groups, respectively (difference, 10.9 percentage points (95% CI, 5.0 to 16.7 percentage points)). However, these salutary effects dissipated in the 3-month postintervention follow-up period, in which adherence was 66.7% and 70.6%, respectively (difference, 3.9 percentage points (CI, 5.9 to 6.5 percentage points)). Med- ications were taken on sched...

The purpose of this study was to investigate the association between cognitive processes and medication adherence among community-dwelling older adults. Ninety-five participants (M = 78 years) completed a battery of cognitive assessments including measures of executive function, working memory, cued recall, and recognition memory. Medication adhere...

Communication taxes pilots' cognitive resources. External aids such as note-taking help pilots manage these demands. Morrow et al. (2003) found that note-taking eliminated age differences among pilots on a readback task compared to a no-aid condition. However, we investigated communication-only rather than multi-task environments typical of pilotin...

We investigated whether patient-centered instructions for chronic heart failure medications increase comprehension and memory for medication information in older adults diagnosed with chronic heart failure. Patient-centered instructions for familiar and unfamiliar medications were compared with instructions for the same medications from a chain pha...

Although precise definitions and models of human error in medicine remain elusive, there is little doubt that adverse events, sometimes involving human error, threaten patient safety and can be addressed by human factors approaches to error. In this chapter, we combine an information-processing framework that identifies perceptual, cognitive, and b...

We investigated whether expertise mitigates age differences on pilot communication tasks when experts rely on environmental support. Pilots and nonpilots listened to air traffic control messages describing a route through an airspace, during which they referred to a chart of the airspace. The routes were high (waypoint routes anchored to navigation...

We examined age/expertise trade-offs in a laboratory pilot decision-making task. Expert and novice pilots read at their own pace brief scenarios that described simpler or more complex flight situations, then in a standard interview discussed the problem in the scenario and how they would respond if they were pilot-in-command. Decision making was me...

Younger and older adults read a series of expository and narrative passages twice in order to answer comprehension questions. Reading time was used to index attentional allocation to word, textbase, and situation model processing and to assess shifts in the allocation policy from the first to the second reading. Older readers' comprehension was at...

Chronic heart failure (CHF) is associated with reduced functional capacity and quality of life, particularly among older adults. Complex medication regimens for CHF challenge older patients' ability to adhere to them, in part because of age-related cognitive decline and poor communication about medications. This article describes patient-centered i...

Medications can improve the functioning and health-related quality of life of patients with chronic heart failure (CHF) and reduce morbidity, mortality, and costs of treatment. However, patients may not adhere to therapy. Patients with complex medication regimens and low health literacy are at risk for nonadherence. The primary goal of this project...

Adults aged > or =50 years often have multiple chronic diseases requiring multiple medications. However, even drugs with well-documented benefits are often not taken as prescribed, for a variety of reasons. The objective of this article was to provide background information about medication adherence and its measurement, the development of the conc...

Vision and reading comprehension would seem to be important determinants of medication adherence. We assessed whether vision, reading, and health literacy predict medication adherence in 242 adults (> 18 years of age) with cardiovascular disease. Adherence was assessed as the percent of drug taken during six months to one year using electronic moni...

We investigated whether expertise reduced age-related declines in pilot communication, using multiple expertise measures and laboratory tasks varying in domain relevance. Younger, middle-aged, and older pilots and nonpilots listened to air traffic control messages that described an aircraft's route through an airspace, while they referred to a char...

Chronic heart failure (CHF) is associated with reduced functional capacity and quality of life among older adults. Complex CHF medication regimens challenge older patients' ability to adhere to these regimens, in part because of cognitive declines and poor communication. We developed patient-centered instructions for CHF medications as part of a ph...

improve appointment adherence. Geron technology 2003;2(3):247-254. Objectives. Appointment nonadherence increases health care costs and reduces treatment efficacy. Nonadherence not only involves failure to show up for appointments, but failure to follow preappointment procedures. We examined the impact of ~utomated telephone messages on adherence t...

The authors investigated whether expertise is more likely to mitigate age declines when experts rely on environmental support in a pilot/Air Traffic Control (ATC) communication task. Pilots and nonpilots listened to ATC messages that described a route through an airspace, while they referred to a chart of the airspace. They read back (repeated) eac...

... Login to save citations to My List. Citation. Database: PsycINFO. [Journal Article]. Expertise , cognitive ability and age effects on pilot communication . Morrow, Daniel G.; Menard, William E.; Ridolfo, Heather E.; Stine-Morrow, Elizabeth ...

The influence of the air traffic control (ATC) message format and message length was investigated on the ability of general aviation pilots to read back ATC instructions. While flying a simulator, 12 pilots heard altitude and radio frequency instructions spoken in grouped format ("forty-one-hundred"), and 12 heard them sequentially ("four-thousand-...

Age differences in the construction of the situation model during text understanding were investigated. Situation model processing was measured in terms of the distance effect, the tendency for readers to process information about objects in a narrative more quickly when the objects are spatially closer to the protagonist than when they are farther...

The influence of expertise and task factors on age differences in a simulated pilot–Air Traffic Control (ATC) communication task was examined. Young, middle-aged, and older pilots and nonpilots listened to ATC messages that described a route through an airspace, during which they referred to a chart of this airspace. Participants read back each mes...