ArticleLiterature Review

The Role of Pictures in Improving Health Communication: A Review of Research on Attention, Comprehension, Recall, and Adherence

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Abstract

To assess the effects of pictures on health communications. Peer reviewed studies in health education, psychology, education, and marketing journals were reviewed. There was no limit placed on the time periods searched. Pictures closely linked to written or spoken text can, when compared to text alone, markedly increase attention to and recall of health education information. Pictures can also improve comprehension when they show relationships among ideas or when they show spatial relationships. Pictures can change adherence to health instructions, but emotional response to pictures affects whether they increase or decrease target behaviors. All patients can benefit, but patients with low literacy skills are especially likely to benefit. Patients with very low literacy skills can be helped by spoken directions plus pictures to take home as reminders or by pictures plus very simply worded captions. Practice implications: Educators should: (1) ask "how can I use pictures to support key points?", (2) minimize distracting details in pictures, (3) use simple language in conjunction with pictures, (4) closely link pictures to text and/or captions, (5) include people from the intended audience in designing pictures, (6) have health professionals plan the pictures, not artists, and (7) evaluate pictures' effects by comparing response to materials with and without pictures.

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... To further enhance the understanding of the P-BAS HOP, as 29% of the Dutch population have limited health literacy, and this prevalence is higher among older people [11], also a picture version was made [12]. All items were changed into drawings by a professional illustrator. ...
... The pictures were considered helpful by the participants. A review recommended that different viewers may interpret pictures differently, so guiding is always needed with these kinds of tools [12]. The fact that many interviews were not conducted on the day of admission was potentially problematic, since the (health) status of participants changed considerably and participants had to recall their situation as it was earlier on the day of admission. ...
... This could mean that participants are more involved with the P-BAS-P because they have to place the cards on the answer sheets themselves, instead of just answering questions given by an interviewer. This is in line with other research where was found that patients were more likely to read text when pictures were added or patients were more engaged by the inclusion of pictures [12,26]. ...
Article
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Background The Patient Benefit Assessment Scale for Hospitalised Older Patients (P-BAS HOP) is a tool developed to both identify the priorities of the individual patient and to measure the outcomes relevant to him/her, resulting in a Patient Benefit Index (PBI), indicating how much benefit the patient had experienced from the hospitalisation. The reliability and the validity of the P-BAS HOP appeared to be not yet satisfactory and therefore the aims of this study were to adapt the P-BAS HOP and transform it into a picture version, resulting in the P-BAS-P, and to evaluate its feasibility, reliability, validity, responsiveness and interpretability. Methods Process of instrument development and evaluation performed among hospitalised older patients including pilot tests using Three-Step Test-Interviews (TSTI), test-retest reliability on baseline and follow-up, comparing the PBI with Intraclass Correlation Coefficient (ICC), and hypothesis testing to evaluate the construct validity. Responsiveness of individual P-BAS-P scores and the PBI with two different weighing schemes were evaluated using anchor questions. Interpretability of the PBI was evaluated with the visual anchor-based minimal important change (MIC) distribution method and computation of smallest detectable change (SDC) based on ICC. Results Fourteen hospitalised older patients participated in TSTIs at baseline and 13 at follow-up after discharge. After several adaptations, the P-BAS-P appeared feasible with good interviewer’s instructions. The pictures were considered relevant and helpful by the participants. Reliability was tested with 41 participants at baseline and 50 at follow-up. ICC between PBI 1 and PBI 2 of baseline test and retest was 0.76, respectively 0.73. At follow-up 0.86, respectively 0.85. For the construct validity, tested in 169 participants, hypotheses regarding importance of goals were confirmed. Regarding status of goals, only the follow-up status was confirmed, baseline and change were not. The responsiveness of the individual scores and PBI were weak, resulting in poor interpretability with many misclassifications. The SDC was larger than the MIC. Conclusions The P-BAS-P appeared to be a feasible instrument, but there were methodological barriers for the evaluation of the reliability, validity, and responsiveness. We therefore recommend further research into the P-BAS-P.
... In the medical field, the recall of information transmitted orally during consultation is unsatisfactory and written documents are often not adapted to patients [1]. The use of images seems to improve understanding, attention and recall of information [2]. A lot of interest has been devoted to the development and use of pictograms to improve medication adherence [3][4][5]. ...
... Participants emphasize the importance of general aesthetics and the need to catch the patient's attention. This fact validates the importance of collaboration between patients, HP and graphic designers to take into account purposes as well as visual needs [2,19,20]. ...
... The main risk of using VA described by both HP and patients is misinterpretation, especially when VA are used as a support out of consultation and without explanation or when the patient has a different cultural background. Without distinction of context, recommendations on the use of VA agree on the importance of verbal and/or written explanation to accompany graphic elements in order to reduce the likelihood of misinterpretation [2,21]. ...
Article
This study aims to explore how visual aids (VA) are used in ambulatory medical practice. Our research group (two doctors, one graphic designer and one sociologist) have led a qualitative study based on Focus Groups. A semi-structured guide and examples of VA were used to stimulate discussions. Participants were healthcare professionals (HP) working in ambulatory practice in Geneva and French-speaking outpatients. After inductive thematic analysis, the coding process was analyzed and modified to eventually reach consensus. Six focus groups gathered twenty-one HP and fifteen patients. Our study underlines the variety of purposes of use of VA and the different contexts of use allowing the distinction between "stand-alone" VA used out of consultation by patients alone and "interactive" VA used during a consultation enriched by the interaction between HP and patients. HP described that VA can take the form of useful tools for education and communication during consultation. They have questioned the quality of available VA and complained about restricted access to them. Patients expressed concern about the impact of VA on the interaction with HP. Participants agreed on the beneficial role of VA to supplement verbal explanation and text. Our study emphasizes the need to classify available VA, guarantee their quality, facilitate their access and deliver pertinent instructions for use.
... One of the science and risk communication strategies tested in other health crises (as is the case of H1N1 and H5N1, for example) is storytelling in scientific messaging (Delp & Jones, 1996;Houts et al., 2006;Kearns & Kearns, 2020). Storytelling refers to the process of developing a plot that gives rise to a narrative (Moezzi et al., 2017). ...
... Regarding language, some studies on risk communication show that using narrative language is more effective than using strictly scientific language when seeking to change perceptions of risk and promote behavioural changes (Houts et al., 2006;Shanahan et al., 2019). However, science communication is full of rules and jargon. ...
... Visual metaphors are, actually, common resources in strategic communication (e.g., advertising), namely in the health field (Lazard et al., 2016). Research shows that using narratives with visual elements is beneficial for communicating complex situations in health (Delp & Jones, 1996;Houts et al., 2006;Kearns & Kearns, 2020). Furthermore, risk literature confirms that visual communication offers creative solutions to bridge health literacy gaps, empowers communities through evidence-based information, and facilitates public health advocacy during a pandemic. ...
Chapter
This chapter discusses the emergence of the "flatten the curve" metaphor in the context of COVID-19 science communication strategies and its role in public messaging efforts that sought to inform world populations and mitigate the effects of the pandemic. Faced with the unexpected arrival and spread of the new coronavirus, governments worldwide have responded with mitigation policies to contain the dissemination of the disease. Prevention behaviours, such as washing hands frequently and maintaining social distancing, were thoroughly communicated to the public. However , despite the quality of the communication campaigns implemented, it is always hard to change people's perceptions, attitudes, and behaviours, even more so in the short term, as is required in a global health crisis. In pandemics, the literature on risk and crisis communication suggests that messages sent by authorities should enable the understanding of complex information, avoid misinformation, and promote the adoption of adequate behaviours. This assertion presumes that, ideally, communication campaigns follow a set of strategic decisions on target audiences, communication objectives, key messages, adequate channels and message format. Although the emergence of the "flatten of the curve" metaphor did not follow a classical strategic approach, it seems to have incorporated a set of valuable communicational principles that explain why it has become the defining message of about COVID-19. This well-known chart grew into a science strategic communication device, conveying complex scientific information in an engaging but also clear way to the general public. It is, therefore, a good example to advogate for a strategic science communication approach.
... A pictogram is a stylized, figurative, two-dimensional drawing intended to attract attention and convey information without language or words [13,14]. The inclusion of pictograms in health information can enhance its user-friendliness of [15][16][17][18][19] and, when used appropriately, pictograms enhance comprehension and recall of information [15,[19][20][21][22][23][24][25][26]. However, health information communicated using pictograms alone, with no accompanying verbal message or text, is open to misinterpretation, particularly in limited literacy and older populations [27][28][29][30][31]. ...
... A pictogram is a stylized, figurative, two-dimensional drawing intended to attract attention and convey information without language or words [13,14]. The inclusion of pictograms in health information can enhance its user-friendliness of [15][16][17][18][19] and, when used appropriately, pictograms enhance comprehension and recall of information [15,[19][20][21][22][23][24][25][26]. However, health information communicated using pictograms alone, with no accompanying verbal message or text, is open to misinterpretation, particularly in limited literacy and older populations [27][28][29][30][31]. ...
Article
Background: Pictograms may improve user-friendliness and comprehension of written or verbal health information. This paper describes a method to modify pictograms to improve their visual clarity, appeal and overall interpretive complexity in order to reduce the cognitive load on the viewer during comprehension. Methodology: Nine pictograms previously tested for comprehension were selected for modification. In phase 1, two participatory design workshops were conducted with (a) three limited literacy, first-language isiXhosa-speaking participants and (b) four university students. Opinions and ideas for improving interpretation were discussed. In phase 2, revised visuals were generated by the graphic artist and subsequently modified in an intensive, multistage, iterative process. Results: As no guidelines for pictogram modification exist, a modification schema was developed based on the process described in this study. Adopting a participatory approach combined with a systematic, intensive modification process enabled the opinions and preferences of the end-users to be heard, ensuring cultural relevance and contextual familiarity of the final product. Careful scrutiny of all individual visual elements of each pictogram, considerations of space, and thickness of lines all contributed to improving the legibility of visuals. Conclusions: The methodology for designing and modifying existing pictograms using a participatory process resulted in nine final pictograms that were approved by all design team members and considered good candidates for subsequent comprehension testing. The methodological schema presented in this paper provides guidance to researchers intending to design or modify pictograms.
... Seventy percent found the pictorial elements useful in understanding science concepts and felt more able to make informed choices. By linking ideas with pictures, infographics can improve reader comprehension (Houts, Doak, Doak, & Loscalzo, 2006). Though a previous study has found that pictures can also strengthen adherence to instructions as well, achieving target behaviours were dependent on two reader characteristics: literacy skills and emotional response to the nature of the picture. ...
... For example, those with low literacy skills are especially more likely to benefit from visuals. Furthermore, a picture of puppies can elicit positive responses from readers and is likely to lead to increased target behaviour (Houts et al., 2006). Another factor influencing comprehension of visual information is level of education. ...
Article
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Navigating for accurate information, especially health- and science-related content, on social media has been challenging during the COVID-19 pandemic. Although infographics are a popular medium for simplifying text-based information into visual components, their usefulness during a global health crisis has not been explored. The study aims to explore the perceptions of infographics in conveying scientific information related to COVID-19 on social media. Following a social media campaign that published COVID-19 related infographics from May to August 2020, a cross-sectional survey was administered to social media users, primarily students from Western University. Several questions asked respondents to make comparisons with written articles when reporting their perceptions of infographics. Seventy-three percent of students from 361 responses belonged to health-related academic backgrounds. Seventy-two percent felt more likely to share infographics than written articles on social media due to the visual appeal. Nearly 90% felt it was easier to navigate through complicated science and that more scientists should use infographics on social media. Educational background did not influence the perceived usefulness of infographics in understanding scientific information. Infographics are perceived favourably in conveying scientific information about COVID-19 on social media. Findings from this study can inform communication strategies during a pandemic and, more broadly, global crises.
... Research investigating patient and trial participant understanding of information materials designed for them indicates that there is often limited comprehension (Berger, Grønberg, Sand, Kaasa, & Loge, 2009;Foe & Larson, 2016;Houts, Doak, Doak, & Loscalzo, 2006). Science communication guidance advocates for using simplified language, pictures, and telling stories to break down unfamiliar concepts and terminology that characterise published scientific literature (Centers for Disease Control and Prevention, 2020;Farinella, 2018;Houts et al., 2006;McDermott, Partridge, & Bromberg, 2018;Safeer & Keenan, 2005). ...
... Research investigating patient and trial participant understanding of information materials designed for them indicates that there is often limited comprehension (Berger, Grønberg, Sand, Kaasa, & Loge, 2009;Foe & Larson, 2016;Houts, Doak, Doak, & Loscalzo, 2006). Science communication guidance advocates for using simplified language, pictures, and telling stories to break down unfamiliar concepts and terminology that characterise published scientific literature (Centers for Disease Control and Prevention, 2020;Farinella, 2018;Houts et al., 2006;McDermott, Partridge, & Bromberg, 2018;Safeer & Keenan, 2005). The medium of comics can fulfil these principles, and has been effectively used to engage patients and the general public with medical science, such as disseminating evolving scientific understanding of COVID-19, and explaining public health measures during the pandemic (Kearns, Fisher, & Chong, 2021;. ...
Article
Healthcare research is traditionally published in academic papers, coded in scientific language, and locked behind paywalls - an inaccessible form for many. Sharing research results with participants and the public in an appropriate, accessible manner, is an ethical practice directed in research guidance. Evidence-based recommendations for the medium used are scant, but science communication advice advocates principles which may be fulfilled well by the medium of comics. We report a randomised crossover study conducted online, comparing participant preferences for research results shared in the medium of a comic, a traditional lay text summary, and the control approach of a scientific abstract. 1236 respondents read all three summaries and ranked their most and least preferred formats. For the most preferred summary, the comic was chosen by 716 (57.9%), lay summary by 321 (26.0%), and scientific abstract by 199 (16.1%) respondents. For the least preferred summary the scientific abstract was chosen by 614 (49.7%), lay summary by 380 (30.7%) and comic by 242 (19.6%). Review of free-text responses identified key reasons for the majority preferring the comic over the others, which included finding this easier to read and understand, more enjoyable to consume, and more satisfactory as a medium of communication.
... Images can influence recipients' attitudes and behaviour about a specific issue to a greater extent than a purely text-based message can (Holicki 1993;Kessler et al. 2016;Nyhan and Reifler 2019). In general, images enhance cognitive processing and generate more attention, which is why they are better remembered than textual content (Holicki 1993;Houts et al. 2006). The increased comprehensibility, cognitive processing and better memory lead to images also having a stronger influence on attitudes (Arsenault et al. 2006;Lohoff 2008). ...
... Our study did not show an increased persuasion power through images. This result does not correspond with the assumptions and investigations of, for example, Holicki (1993), Houts et al. (2006) and Nyhan und Reifler (2019). Further, the results did not provide scientific evidence for the assumption that the persuasion power of the different image types differs in the correction of health myths. ...
Article
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Aim: Developing evidence-based recommendations on how to debunk health-related misinformation and more specific health myths in (online) communication is important for individual health and the society. The present study investigated the effects of debunking/correction texts created according to the latest research findings with regard to four different health myths on recipients' belief, behaviour and feelings regarding the myths. Further, the study investigated the effects of different visuali-sations (machine-technical created image, diagram, image of an expert, message without an image) in the debunking texts. Subject and methods: A representative sample of German Internet users (N = 700) participated in an anonymous online survey experiment with a 4 (myths) × 4 (picture) mixed study design. Results: The results show that receiving an online news article that refutes a widespread health myth with or without the use of an image can significantly change the attitudes of the recipients toward this myth. The most influential variable was the attributed credibility: the more credible a debunking text is for a recipient, the more corrective effectiveness it has. However, the corrective messages did not differ in their persuasive effects depending on the image types used. Conclusion: The results offer an optimistic outlook on the correction of health-related misinformation and especially health myths and insight into why and how people change their beliefs (or not) and how beliefs in health myths can be reduced. The findings can be used by journalists, scientists, doctors and many other actors for efficient (online) communication.
... Pictures will be used to link written text as they markedly increase attention to and recall of health education information as well as improving comprehension. 32 All patients benefit, however, those with low literacy skills are especially likely to benefit. 32 There may be situations where personal stories and narratives could enhance the effectiveness of PtDAs, however, given the heterogeneity of both disease process and surgical intervention it could produce bias and persuasion. ...
... 32 All patients benefit, however, those with low literacy skills are especially likely to benefit. 32 There may be situations where personal stories and narratives could enhance the effectiveness of PtDAs, however, given the heterogeneity of both disease process and surgical intervention it could produce bias and persuasion. 33 There is also insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people's informed decision-making. ...
Article
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Introduction Approximately 5%–10% of new rectal cancers are locally advanced (locally advanced rectal cancer (LARC)) at presentation with 4%–8% recurring (locally recurrent rectal cancer (LRRC)) after initial treatment. Patients with potentially curable disease have to consider many trade-offs when considering major exenterative surgery. There are no decision tools for these patients and current resources have found to not meet minimum international standards. The overall aim of this study is to produce a validated patient decision aid (PtDA) to assist patients considering radical pelvic exenteration for LARC and LRRC created in line with international minimum standards. Methods and analysis This study is a national, multicentre mixed methods project and has been designed in keeping with guidance from the International Patient Decision Aids Standard. This study is in four stages. In stage 1, we will develop the PtDA and its content using agile developmental methodology. In stage 2, we will assess the content and face validity of the PtDA using mixed-methods with key stakeholders. In stage 3, we will assess the feasibility and efficacy of the PtDA. In stage 4, we will establish the barriers and facilitators to the use of a PtDA in the outpatient setting. Questionnaires including the QQ-10, EORTC PATSAT-C33, Preparation for Decision-Making Scale and the NoMAD survey will be analysed during the study. Interviews will be analysed using thematic analysis. Ethics and dissemination Research ethics approval from North of Scotland Research Ethics Service 19/NS/0056 (IRAS 257890) has been granted. Results will be published in open access peer-reviewed journals, presented in conferences and distributed through bowel research UK charity. External endorsement will be sought from the International Patient Decision Standards Collaboration inventory of PtDAs. PROSPERO registration number CRD42019122933.
... Fortunately, ongoing research aims to improve medication instructions by incorporating illustrations or improving phrasing or formatting [2,12] The studies in this review have tested different approaches of improving quantitative medication instructions. For example, Davis tested different ways of wording information about number of pills per day [13], and Yin tested pictograms [14]. ...
Article
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Objective To develop evidence-based recommendations for improving comprehension of quantitative medication instructions. Methods This review included a literature search from inception to November 2021. Studies were included for the following: 1) original research; 2) compared multiple formats for presenting quantitative medication information on dose, frequency, and/or time; 3) included patients/lay-people; 4) assessed comprehension-related outcomes quantitatively. To classify the studies, we developed a concept map. We weighed 3 factors (risk of bias in individual studies, consistency of findings among studies, and homogeneity of the interventions tested) to generate 3 levels of recommendations. Results Twenty-one studies were included. Level 1 recommendations are: 1) use visualizations of medication doses for liquid medications, and 2) express instructions in time-periods rather than times per day. Level 2 recommendations include: validate icons, use panels or tables with explanatory text, use visualizations for non-English speaking populations and for those with low health literacy and limited English proficiency. Conclusions Visualized liquid medication doses and time period-based administration instructions improve comprehension of numerical medication instructions. Use of visualizations for those with limited health literacy and English proficiency could result in improved outcomes. Practice Implications Practitioners should use visualizations for liquid medication instructions and time period-based instructions to improve outcomes.
... A study by Houts et al. (2006) demonstrated that visual communication is an important tool when communicating health messages, as images and symbols can be comprehended easily and thus increase individuals' adherence to health instructions. The COVID-19 pandemic has exemplified this well. ...
... Mere representation of statistical data and scientifically accurate information on COVID-19 will not be of much help in leading behavioural change. Several pieces of research (Green, 2006;Houts et al., 2006) have been conducted which establish the fact that narratives have undeniable utility when it comes to imparting information or channelling any sort of communication pertaining to health. Kearns and Nethmi (2020) state that 'Comics have been used successfully in science communication during the current Covid-19 pandemic. ...
Article
Positioning this essay at intersection of comics studies, visual literacy studies, and information literacy studies, we investigate an interdisciplinary liaison between crisis in the age of COVID-19 and its awareness campaign through Indian comics. With a focus on awareness programme, Indian artists designed comics to demonstrate their vital position in social engagement through this visual medium. Following impending threats and growing concerns, people of all ages glued themselves to social media, newspapers, and television to keep them updated on the impact of COVID-19. Indian comics e.g. Nagraj Strikes: The Attack of Coronaman (2020), Priya’s Mask (2020), Kids, Vaayu, and Corona: Who Wins the Fight? (2020), and ‘Be aware of Droplets & Bubbles!!’ (2020) aimed to help children comprehend the precautionary steps to be taken to save themselves from getting infected with Coronavirus. While the first three comics showcase spit-bubbles primarily as the source of COVID-19, infusing the content with a tinge of superhero fantasy, ‘Be aware of Droplets & Bubbles!!’ (2020) unveils the microbiological evolution and mutation of the pathogen in comics format. The objective of the article is to show how Indian comics on COVID-19 can be an advantageous communicative medium to nurture knowledge and edutainment in post-infection India. Keywords: Indian comics; COVID-19; awareness programme; pathogen; graphic medicine
... To improve overall retention of the material covered, each lesson includes interactive components (e.g., writing prompts, feedback based on responses to measures), images (including animated GIFs), and diagrams. Pictures connected to text promote attention to and recollection of health education information when compared to text alone (Houts et al., 2006). Rather than simply assuming that the content has been learned, participants complete comprehension assessments at the end of each module. ...
Article
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Anxiety sensitivity, or the fear of anxiety, represents an important transdiagnostic target in the prevention and treatment of anxiety disorders, which typically emerge between childhood and early adulthood. Recent work demonstrated that single-session digital psychoeducation interventions delivered on computers in a lab setting can effectively reduce anxiety sensitivity. This evidence suggests that digital psychoeducation interventions have potential as a scalable and cost-effective approach to targeting anxiety sensitivity in emerging adults. Toward this aim, we developed the Anxiety Insight Modules (AIM), which promote insights about the function of anxiety, the activating role of thoughts, the harmless nature of sensations that often co-occur with anxiety, and the negative impact of trying to avoid anxiety. To facilitate a more accurate estimate of the potential for scalability, participants tested AIM on their personal devices at their preferred schedule and pace without the involvement of clinicians or staff. Undergraduate students with high levels of anxiety sensitivity (N = 159) were randomized to gain immediate access to AIM (n = 77) or to a waitlist control that gained access to AIM after the 2-week follow-up assessment (n = 82). All of the participants who gained immediate access to AIM, as well as 91.67% of participants in the waitlist who participated in the follow-up, completed the full set of modules, suggesting high levels of engagement. Immediate access to AIM had a medium-to-large effect on anxiety sensitivity in a 2-week follow-up comparison with waitlist control (d = 0.57–0.76). Participants that completed AIM showed acute reductions in anxiety sensitivity. Given this preliminary evidence of its effectiveness, further research is warranted to determine the factors that moderate and mediate AIM’s impact on anxiety sensitivity in order to optimize its delivery and facilitate scalability.
... Our treatment approximates the mainstream consensus found in some authoritarian regimes because respondents are exposed to only one frame and the treatment does not provide contextual information linking predisposition to the state's espoused policy position. This finding may also be influenced by the type of content-narrow and issue-specific-and the video medium of our government-controlled media treatment that activates multiple sensory channels and elicits strong emotional and physiological responses (Houts et al., 2006;Kensinger and Schacter, 2006;Lang et al., 2015). ...
Article
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Research shows that government-controlled media is an effective tool for authoritarian regimes to shape public opinion. Does government-controlled media remain effective when it is required to support changes in positions that autocrats take on issues? Existing theories do not provide a clear answer to this question, but we often observe authoritarian governments using government media to frame policies in new ways when significant changes in policy positions are required. By conducting an experiment that exposes respondents to government-controlled media-in the form of TV news segments-on issues where the regime substantially changed its policy positions, we find that by framing the same issue differently , government-controlled media moves respondents to adopt policy positions closer to the ones espoused by the regime regardless of individual predisposition. This result holds for domestic and foreign policy issues, for direct and composite measures of attitudes, and persists up to 48 hours after exposure.
... In the study reported in this paper, signage was used to convey simplified task-related information relating to different sub-steps between a person and a robotic arm [37]. Some studies suggest that the combination of signage modalities, i.e., dynamic videos with static text-based information, helps to aid engagement and task performance [38], while other studies point to the greater benefit of new information retention via dynamic modes [39], as it can aid information transfer from concrete to abstract levels [40,41]. Furthermore, dynamic signage that is screen-based (such as billboards or road maintenance signs) is: (i) easier to adapt to changing situations (turn on and off depending on the need), (ii) less costly in terms of replication and curation, and (iii) adjustable depending on the targeted population [42]. ...
Article
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Collaborative robots offer opportunities to increase the sustainability of work and workforces by increasing productivity, quality, and efficiency, whilst removing workers from hazardous, repetitive, and strenuous tasks. They also offer opportunities for increasing accessibility to work, supporting those who may otherwise be disadvantaged through age, ability, gender, or other characteristics. However, to maximise the benefits, employers must overcome negative attitudes toward, and a lack of confidence in, the technology, and must take steps to reduce errors arising from misuse. This study explores how dynamic graphical signage could be employed to address these issues in a manufacturing task. Forty employees from one UK manufacturing company participated in a field experiment to complete a precision pick-and-place task working in conjunction with a collaborative robotic arm. Twenty-one participants completed the task with the support of dynamic graphical signage that provided information about the robot and the activity, while the rest completed the same task with no signage. The presence of the signage improved the completion time of the task as well as reducing negative attitudes towards the robots. Furthermore, participants provided with no signage had worse outcome expectancies as a function of their response time. Our results indicate that the provision of instructional information conveyed through appropriate graphical signage can improve task efficiency and user wellbeing, contributing to greater workforce sustainability. The findings will be of interest for companies introducing collaborative robots as well as those wanting to improve their workforce wellbeing and technology acceptance.
... Scientific concepts in Biochemistry, and the life sciences in general, can be hard to understand, and the use of images to better convey information is common at all levels, from very basic leaflets tailored to a lay audience to schoolbooks and the most advanced scientific papers [1][2][3][4][5][6]. In fact, no Biochemistry or Molecular Biology textbook is devoid of images (photos, graphs, diagrams, and schematics) to help guide the reader [7,8]. ...
Article
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Simple biochemical concepts can be hard to grasp by non-specialists, even when they are related to practical contexts in industry, day-to-day activities, or well-acknowledged pathological conditions. This is especially important in instances where accurate communication of biochemical aspects for different types of stakeholders may be crucial. Examples include interacting with policymakers to establish guidelines, with patients (and/or caregivers) to identify key concepts in promoting awareness and adherence to therapeutic regimens, or with teachers and students for novel approaches in critical thinking. Focusing on our own work in developing communication tools for different purposes, in this review we will focus on some examples of how biochemical concepts can be effectively translated into illustrations and graphical narratives. For this purpose, engagement with target audiences in developing the materials themselves is key. We also discuss how specific projects can be tailored for different purposes, as well as evidence that comic-book strategies are effective in conveying biochemical and biomedical knowledge.
... Through this process, we gained insight into both the areas of concern we needed to address in our tool, as well as ideas for how to approach them. Another innovative feature of our intervention was the diversity of visual content and visual aid which has been shown to increase comprehension, recall, and maintain user attention to positively influence health outcomes [25,26,42,43]. We used videos as well as real and illustrated pictures to describe the HPV natural history, the appearance of abnormal cells, reproductive anatomy, and screening guidelines. ...
Article
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Purpose Current cervical cancer screening guidelines recommend 3-year screening intervals, in contrast to the previous recommendation of annual screening, to prevent over screening and overtreatment. We evaluated the impact of viewing a tablet-based educational tool prior to seeing a clinician on young women’s knowledge and understanding of cervical cancer screening, HPV vaccination follow-up of abnormal pap smears, and comfort in communicating with their providers. Methods This cross-sectional study was part of a cluster-randomized study of fourteen primary care clinics from January 2015 to December 2016. We developed the cervical cancer education tool in English and Spanish using a community-based approach that included formative work and cognitive interviewing. Clinics were randomized to use the intervention (tablet-based patient education tool) or to participate as a control group. We administered surveys to a convenience sample of 229 English- or Spanish-speaking women aged 19 to 35 years in these clinics. We used descriptive analyses and logistic regression models with cluster-robust standard errors to compare differences among the two groups. Results Compared to women seen in control clinics, women seen in intervention clinics demonstrated greater knowledge regarding human papilloma virus (HPV (p = 0.004) and understanding (p < 0.001) of cervical cancer screening. Comfort in communicating with providers was not statistically different (p = 0.053). Women in the intervention group felt that the tool helped them understand that an abnormal Pap smear does not require immediate treatment (61.5%). Conclusion Innovative online patient education that is offered prior to patients’ interaction with their clinicians can improve their knowledge about cervical cancer prevention and treatment.
... However, complementary use of multimedia and visual aids in patient educational materials has shown to be beneficial in increasing patient comprehension and satisfaction, especially for those with low-literacy. [43][44][45][46] Pictures closely linked to written or spoken text can markedly increase comprehension, attention to and recall of health education information when compared to texts alone [43]. Delp and Jones found that mean correct recall of information was 85% with infographics and 14% without [47]. ...
Article
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Background Patients often utilize the Internet to seek information related to their care. This study assesses the readability of online patient educational materials for submental fat reduction.Methods Patient educational materials from the 12 most popular websites related to submental fat reduction were downloaded and assessed for readability grade level using 10 unique scales.ResultsAnalysis of the 12 most popular websites (and corresponding 47 articles) revealed that patient educational materials were written, on average, at an 11th grade reading level. The Flesch Reading Ease score was 48.9 (range 39.8–59.2), representing a “difficult” level of reading. Mean readability grade levels (range 9–13th grade for individual websites) were as follows: Coleman-Liau, 11.1; Flesch-Kincaid, 10.8; FORCAST, 10.8; Fry Graph, 10.1; Gunning Fog, 12.7; New Dale-Chall, 10.1; New Fog Count, 11.8; Simple Measure of Gobbledygook, 11.7; Raygor, 6.7. No website was at the 6th grade reading level for patient educational materials recommended by the American Medical Association and National Institutes of Health.Conclusions Online patient educational materials for submental fat reduction are written well above the recommended reading level. Recognition of disparities in health literacy is necessary to enable patients to make informed decisions and become active participants in their own care.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266
... Social media shareable content is content that can easily be shared on social media as a means of signposting the audience to more substantial outputs. Using visual images has been shown to be effective in increasing engagement with social media [43][44][45] which is perhaps not surprising given that the use of images to improve attention to and recall of information is a well-known approach in health education [46]. The use of visual snapshots of the findings of systematic reviews is a technique frequently used to share Cochrane evidence [47] in a dissemination product they refer to as blogshots. ...
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Background Increasing pressure to publicise research findings and generate impact, alongside an expectation from funding bodies to go beyond publication within academic journals, has generated interest in alternative methods of science communication. Our aim is to describe our experience of using a variety of creative communication tools, reflect on their use in different situations, enhance learning and generate discussion within the systematic review community. Methods Over the last 5 years, we have explored several creative communication tools within the systematic review process and beyond to extend dissemination beyond traditional academic mechanisms. Central to our approach is the co-production of a communication plan with potential evidence users which facilitates (i) the identification of key messages for different audiences, (ii) discussion of appropriate tools to communicate key messages and (iii) exploration of avenues to share them. We aim to involve evidence users in the production of a variety of outputs for each research project cognisant of the many ways in which individuals engage with information. Results Our experience has allowed us to develop an understanding of the benefits and challenges of a wide range of creative communication tools. For example, board games can be a fun way of learning, may flatten power hierarchies between researchers and research users and enable sharing of large amounts of complex information in a thought provoking way, but they are time and resource intensive both to produce and to engage with. Conversely, social media shareable content can be quick and easy to produce and to engage with but limited in the depth and complexity of shareable information. Discussion It is widely recognised that most stakeholders do not have time to invest in reading large, complex documents; creative communication tools can be a used to improve accessibility of key messages. Furthermore, our experience has highlighted a range of additional benefits of embedding these techniques within our project processes e.g. opening up two-way conversations with end-users of research to discuss the implications of findings.
... cation, Nowak et al. (2015) found that intergenerational photos of African Americans in influenza public service announcements were an important factor to garner African Americans' attention and increase their influenza vaccine uptake. Pictures of African Americans in health communication can also overcome low literacy barriers among the community (Houts et. al, 2006), increase enrollment in health programs (Goodman et. al, 2017), and improve their overall engagement with health information . ...
Article
The unveiling of the COVID-19 vaccines has sparked outward expressions of apprehension, distrust and fear. Especially among Black Americans, who have had a troubling relationship with Western medicine due to centuries of medical oppression and racist practices by health practitioners that created long-standing health disparities. Researchers have found that culturally competent and ethnic targeted health communications have worked to not only reach Black Americans but in helping Black patients adopt pro-social behaviors like vaccine uptakes. In addition, online mediums like social media have been used in health communications as the world becomes more technologically connected. This study analyzes the Twitter messaging of three minority-based health organizations – the United States Department of Health and Human Services Office of Minority Health, the National Institute on Minority Health and Health Disparities Office of Communications, and Black Women’s Health Organization – to see how they combat the vaccine hesitancy of Black Americans. As guided by the Black public sphere a content analysis of the minority organizations' tweets found that used communal frames, Black health care professionals and Black voices in their content, which aligned with the Black counter-public discourse and differed from the mainstream presentation of information. However, the minority organizations did not sufficiently address the elements and conversations distinct to Black Twitter users, which impedes their effectiveness in reaching the racial group. Evaluations of the content will be presented as guided by critical health communications recommendations and the Black public sphere.
... The use of pictograms for medical information, often referred to as pharmaceutical pictograms, is permitted, though still limited (Kanji, Xu, and Cavaco 2018). However, pharmaceutical pictograms could be an effective tool; previous research suggests that pictograms can enhance patients' ability to notice, understand, recall, and adhere to information about their medicinal treatment (Barros et al., 2014;Choi, 2011;Del Re et al., 2016;Dowse & Ehlers, 1998;Houts et al., 2006;Katz et al., 2006). ...
Article
The purpose of pharmaceutical pictograms is to help patients manage their medicinal treatment. However, the pictograms often lack perceptual clarity. While they are frequently tested for aspects such as comprehension, little attention has been paid to their legibility. This paper presents the conception and results of an experiment adapted from the ISO ‘Method for testing perceptual quality’ (ISO 9186-2:2008) to measure the visibility of pictogram elements in two sets: 15 American USP pictograms and 15 redesigned versions reduced in complexity. The statistical analysis did not show reliable significant differences, which indicates that there are more factors at stake.
... 11,12 Online visual images can improve the effectiveness of health education materials. 13 If the educational videos in youtube are well designed, scientifically correct content, adequately presented, and meet the students' learning needs may provide useful conceptual links between theory and practice. However, YouTube does not have strict regulations or standards concerning the educational aspects of the videos. ...
Article
Introduction Healthcare workers have a high risk of cross-infection during the care of Covid-19 cases. Personal protective equipment can reduce the risk. However, healthcare workers must be trained for the proper use of personal protective equipment to decrease exposure risk. This study aimed to investigate whether videos available on YouTube, presenting procedures of donning and doffing personal protective equipment, can be a useful learning resource for healthcare workers. Methods A search of YouTube was conducted using the keywords “Covid-19, personal protective equipment, donning, doffing”. Two investigators reviewed each video and collected the basic video information. Total videos were assessed independently as educationally useful and non-useful categories using a valid tool. The relationship of each video's usefulness with viewers’ preferences and the upload source were analyzed. Results A total of 300 videos were assessed; 66 (22%) fulfilled the inclusion criteria. Total video scores of educationally useful videos were higher than non-useful ones; the differences were significant. Healthcare/government agencies and hospitals mostly created educationally useful videos, e-learning platforms, and individuals mainly created non-useful videos. Significant correlations were observed between the video's usefulness and the total view and views per day. Conclusions During a pandemic, YouTube might be a resource for learning donning and doffing of personal protective equipment for healthcare workers if an appropriate selection process applied for determining educationally useful videos.
... The American Society of Anesthesiologists supports color-coding medication labels to provide at-a-glance information that decreases human reliance on memory, vigilance, and calculations (Vender, 2019). Icons are often used for warning labels and electronic application operations across a wide variety of contexts as they allow instant recognition at an additional familiar level (Houts et al., 2006;Montagne, 2013;ANSI, 2011); convey semantic information (Hou and Hu, 2022) and facilitate noticing, recalling, and complying with information (Frienmann, 1988). Icons may serve as an additional cue as to the type, function, or dose of medications, without fully reading through labels, as the combination of pictogram and text on the icon label may enhance readability, legibility, and visual search performance of anesthesia providers (Hou and Hu, 2022). ...
Article
Misreading labels, syringes, and ampoules is reported to make up a 54.4% of medication administration errors. The addition of icons to medication labels in an operating room setting could add additional visual cues to the label, allowing for improved discrimination, visibility, and easily processed information that might reduce medication administration errors. A multidisciplinary team proposed a method of enhancing visual cues and visibility of medication labels applied to vasoactive medication infusions by adding icons to the labels. Participants were 1.12 times more likely to correctly identify medications from farther away (p < 0.001, AOR = 1.12, 95% CI: 1.02, 1.22) with icons. When icons were present, participants were 2.16 times more likely to be more confident in their identifications (p < 0.001, AOR = 2.16, 95%CI: 1.80, 2.57). Carefully designed icons may offer an additional method for identifying medications, and thus reducing medication administration errors.
... The pre-discharge education delivered by the ERAS-outpatient program helped patients take ownership of their pain control through a combination of information about opioid-sparing analgesia, previous patient feedback, and discussions on the risk of dependency. This method of self-medication, when applied appropriately, has been shown to be strongly associated with better overall pain relief [52][53][54][55][56]. ...
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Pressure to reduce healthcare costs, limited hospital availability along with improvements in surgical technique and perioperative care motivated many centers to focus on outpatient pathway implementation. However, in many short-stay protocols, the focus has shifted away from aiming to reduce complications and improved rehabilitation, to using length of stay as the main factor of success. To improve patient outcomes and maintain safety, the best way to implement a successful outpatient program would be to combine it with the principles of enhanced recovery after surgery (ERAS), and to improve patient recovery to a level where the patient is able to leave the hospital sooner. This article delivers a case for modernizing total hip arthroplasty perioperative pathways by implementing ERAS-outpatient protocols.
... This crisis calls for amplified regulatory and public health scrutiny. It is also significant to examine health related content such as tobacco use because visual social media can be easily comprehended, ignite attention, support recall, and improve adherence compared to text only [16]. Due to a strong impact on human perceptions, attitudes, and acceptance, various forms of imagery such as pictures, infographics, and pictograms have been well-recognized as highly-persuasive modalities for health communication [17,18]. ...
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Social media is rife with modifiable risky health behaviors and substance use topics, pre-cursors to peer-influence and social acceptability, which are drivers of behavioral change. With over a billion active users, Instagram is one of the leading social media platforms across the globe, especially among adolescents and young adults for obtaining, sharing, and promoting tobacco-related content. With an aim to assess the current landscape and inform future research, our review summarizes and analyzes the methodological techniques and approaches used for categorically coding Instagram-based data about tobacco. By using relevant keywords, a literature search was performed in June 2021 within three databases – Web of Science, Scopus, and PubMed – identifying 304 articles. PRISMA (Preferred Reporting Items for Systematics Reviews and Meta-Analyses) guidelines were adopted to direct further analysis and reporting. Inclusion and exclusion criteria were used by two reviewers to systematically assess the eligibility of studies resulting in 27 studies. Key characteristics (product studied, focus of the study, details about data collection, and coding and coded categories) from each study were extracted and analyzed in detail. E-cigarettes were the most frequently investigated tobacco product followed by the hookah/water pipe, cigars/cigarillos, betel nut, and Heated Tobacco Products (HTP). As the data source, Netlytic and Instagram's API/website were commonly used. The coding methods broadly encompass human coding and machine-learning techniques. As a rich and organic source, Instagram-based data is valuable for the surveillance of various forms of tobacco as well as substance use. Open and simpler data collection tools are needed as collecting Instagram data has become challenging. Blending hand-coding with machine-learning techniques may advance future research to classify broader representation and understand nuanced behaviors around tobacco portrayals on Instagram.
... While verbal communication is faster, written information is often recalled better 18 . Pictures linked to text can increase recall of health education information, compared with text alone 19 . The third component of the transactional model of communication is factors related to the patient. ...
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A patient’s comprehension and memory of conversations with their providers plays an important role in their healthcare. Adult breast cancer patients whose legal sex was female and who underwent treatment at the Center for Reconstructive Surgery at The University of Texas MD Anderson Cancer Center were asked to indicate which breast reconstruction procedures they discussed with their surgeon. We focused on the three most frequent responses: (a) participants who remembered discussing implant-based, tissue-based, and combination procedures; (b) participants who remembered only an implant-based option being discussed; and (c) participants who remember only a tissue-based option being discussed. We used multinomial logistic regression models to explore the psychosocial factors associated with patients’ recollections of their breast reconstruction options after discussions with their reconstructive surgeons, controlling for medical factors that impact surgical decision-making. Our analyses identified body mass index, body image investment, and body image as statistically significantly associated with the reconstructive options that a participant recalls discussing with their surgeon. Our findings highlight body image investment and body image as important psychological factors that may influence what patients remember from consultations about breast reconstruction options.
... One study indicate good understandability with a PEMAT score of 83% [18], illustrating results conflicting with our findings and a need for further investigation in order to draw firm conclusions. Research has shown that complementing standard information routes with non-textual media, such as relevant and clear illustrations, has the potential to increase information uptake and combat low health literacy [35]. However, only 7 (9%) of the included websites in our study utilized visual aids when possible to make content more easily understood. ...
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Background The COVID-19 pandemic has caused significant morbidity and mortality. To mitigate its spread, members in the general population were prompted to apply significant behavioral changes. This required an effective dissemination of understandable information accessible for people with a wide range of literacy backgrounds. The aim of this study was to investigate the readability, understandability and language accessibility of Swedish consumer-oriented websites containing information about COVID-19. Methods Websites were identified through systematic searches in Google.se (n = 76), and were collected in May 2020 when the pandemic spread started in Sweden. Readability and understandability were assessed with the Readability Index, the Ensuring Quality Information for Patients (EQIP) tool, and the Patient Education Materials Assessment Tool Understandability subscale (PEMAT-PU). Results The median total sample score for Readability Index was 42.0, with the majority of scores being classified as moderate (n = 30, 39%) or difficult (n = 43, 57%). Median total sample scores were for EQIP 54.0% (IQR = 17.0, Range = 8–75) and for PEMAT-PU 60.0% (IQR = 14.75, Range = 12–87). The majority of the websites did not have any texts or links containing information in an alternative language (n = 58, 76%). Conclusions Swedish websites contained information of difficult readability and understandability at the beginning of the coronavirus disease 2019 pandemic, with few providing information available in alternative languages. It is possible that these deficits contributed to the spread and impact of the virus. There is a need for studies investigating methods aiming to enhance the readability, understandability and language accessibility of web-based information at the beginning of an epidemic or pandemic.
... However, further research is necessary as these results could be domain specific. Previous work has found that medical illustrations, which opt for more cartoonistic style representations, have been found to aid in understanding while limiting the introduction of distracting details (Houts et al., 2006;Krasnoryadtseva et al., 2020). Therefore, increasing fidelity may not be the only option for improving visual cue identification. ...
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Introduction: Virtual humans have expanded the training opportunities available to healthcare learners. Particularly, virtual humans have allowed simulation to display visual cues that were not previously possible in other forms of healthcare training. However, the effect of virtual human fidelity on the perception of visual cues is unclear. Therefore, we explore the effect of virtual human rendering style on the perceptions of visual cues in a healthcare context. Methods: To explore the effect of rendering style on visual cues, we created a virtual human interface that allows users to interact with virtual humans that feature different rendering styles. We performed a mixed design user study that had undergraduate healthcare students (n = 107) interact with a virtual patient. The interaction featured a patient experiencing an allergic reaction and required trainees to identify visual cues (patient symptoms). The rendering styles explored include a 3D modeled virtual human and an AI generated photorealistic virtual human. Visual cues were applied using a Snapchat Lens. Results: When users are given a frame of reference (users could directly compare symptoms on both rendering styles), they rated the realism and severity of the photorealistic virtual human’s symptoms significantly higher than the realism of the 3D virtual human’s symptoms. However, we were unable to find significant differences in symptom realism and severity ratings when users were not given a frame of reference (users only interacted with one style of virtual humans). Additionally, we were unable to find significant differences in user interpersonal communication behaviors between the 3D and photorealistic rendering styles. Conclusion: Our findings suggest 1) higher fidelity rendering styles may be preferred if the learning objectives of a simulation require observing subtle visual cues on virtual humans and 2) the realism of virtual human rendering style does not necessarily affect participants’ interpersonal communication behaviors (time spent, questions asked).
Article
Objective: To investigate the Australian general public’s ability to identify common medical emergencies as requiring an emergency response. Methods: An online survey asked participants to identify likely medical treatment pathways they would take for 17 hypothetical medical scenarios (eight emergency and nine non-emergency). The number and type of emergency scenarios participants correctly suggested warranted an emergency medical response was examined. Participants included Australian residents (aged >18 years; n=5,264) who had never worked as an Australian registered medical doctor, nurse or paramedic. Results: Most emergencies were predominately correctly classified as requiring emergency responses (e.g. Severe chest pain, 95% correct). However, non-emergency medical responses were often chosen for some emergency scenarios, such as a child suffering from a scalp haematoma (67%), potential meningococcal disease (57%), a box jellyfish sting (40%), a paracetamol overdose (37%), and mild chest pain (26%). Participants identifying as Aboriginal or Torres Strait Islander suggested a non-emergency response to emergency scenarios 40% more often compared with non-indigenous participants. Conclusions: Educational interventions targeting specific medical symptoms may work to alleviate delayed emergency medical intervention. This research highlights a particular need for improving symptom identification and healthcare system confidence amongst Aboriginal and Torres Strait Islander populations.
Article
Purpose This study aimed to provide user-centered evidence for health professionals to make optimal use of images for the effective dissemination of health information on Facebook (FB). Design/methodology/approach Using an eye-tracking experiment and a survey method, this study examined 42 participants' reading patterns as well as recall and recognition outcomes with 36 FB health information posts having various FB post features. Findings The findings demonstrated that FB posts with text-embedded images received more attention and resulted in the highest recall and recognition. Meanwhile, compared to text-embedded images, visual only images yielded less effective recall of information, but they caught the viewers' attention; graphics tended to attract more attention than photos. For effective communication, the text features in FB posts should align with the formats of the images. Practical implications The findings of this study provide practical implications for health information disseminators by suggesting that text-embedded images should be used for effective health communication. Originality/value This study provided evidence of users' different viewing patterns for FB health information posts and the relationship between FB post types and recall and recognition outcomes.
Chapter
Under the circumstance of continuous variation of COVID-19 virus, verified the temporariness of the vaccines made by various countries. One cannot expect permanent protection by accepting only one dose of vaccine. In order to prepare and respond to the pandemic, many countries are applying different strategies to increase vaccination rates. The WHO appeals to the world to take the vaccine booster shot for community immunity. Relevant authorities then have to provide and spread visual health messages on the booster shot to keep the public informed. This study examine how unofficial organizations can guide and persuade people to adopt relevant health actions more effectively (such as continuous vaccination) by introducing emoji with different emotional valences in different message framing. An online experiment adopted a 2 (emoji: positive versus negative) × 2 (message framing: gain framing versus loss framing) design to investigate the effects of contrary emoji on people’s self-efficacy to continuously take the booster shot. In total of 240 university students were recruited to participate in this study. Within two types of message framing, the experiment simulated 4 pieces of health messages on the COVID-19 booster shot released by an unofficial organization, together with emoji of two emotional valences. The results showed that health messages with negative emoji result in stronger self-efficacy to user. Moreover, there is an interaction effect between emoji and message framing on self-efficacy. This study is intended to provide meaningful insights for health communicators, visual designers and health practitioners concerned.
Article
This article aims to contribute to the knowledge on product/service system (PSS) design practice as follows. First, a new rationale for why PSS design in practice often does not exploit its full potential is given based on a theory on inseparability of services. Second, a representation of the dependencies between product design parameters (DPs) and service DPs in a form of potential-dependency knowledge base is proposed as a remedy. Third, reusability of the knowledge captured from product-service integration across sectorial borders is shown with PSS design at a complex product manufacturer.
Article
Many physicians believe illustrations can be helpful in patient encounters, but fail to create such drawings due to a perceived lack of artistic ability. Digital drawing platforms, however, have the ability to compensate for the lack of artistic skills. Our study sought to evaluate how digital drawing instruction would impact the likelihood of medical students to utilise illustrations in future patient encounters. 'Draw Your Way Through Medicine' was an elective course, offered at the Icahn School of Medicine at Mount Sinai in 2020. The course instructed students how to create digital drawings using Procreate and how to depict specific surgical procedures. Students completed pre-and post-course surveys, which were analysed using paired t-tests. Thirty-six students enrolled in the course, of which 27 completed the pre-course survey and 21 completed both pre-and post-course surveys. Students' comfort level with drawing improved somewhat (3.0 to 3.5, p = .08), while their comfort level with creating medical illustrations improved significantly (2.2 to 3.7, p < .01). Qualitative responses echoed the enthusiasm for implementing digital drawing as a clinical communication tool. A digital drawing course showed considerable value in improving medical students' confidence in generating medical illustrations, making this form of visual communication a potentially valuable tool in patient care.
Chapter
The simulated patient method is becoming an increasingly popular observational method to measure practice behavior in pharmacy practice and health services research. The simulated patient method involves sending a trained individual (simulated patient among other names), who is indistinguishable from a regular consumer, into a healthcare setting with a standardized scripted request. This method has come to be accepted as being well-suited for observing practice in the naturalistic setting and has also been used as an intervention when combined with feedback and coaching. This chapter presents an overview of the method, a brief history of its use, considerations for designing, implementing, and evaluating simulated patient studies, including ethical considerations, as well as methods of analysis and mixed-methods designs.
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Pictograms have been used as a health communication tool to improve comprehension of a range of health-related information designed to inform and educate people about medicines usage, knowledge of disease states and their prevention, and healthy living. They are being used in increasingly diverse health-related applications, with many individual studies reporting an improvement in comprehension and behavioral outcomes. However, recent reviews have commented adversely on the overall quality of pictogram research, highlighting problems with the pictogram design process, and calling for improvement in both the methodology and the reporting of all aspects of pictogram research: their design, development, modification, evaluation, and application in practice. The heterogeneity in overall study design and in the outcomes measured prevents an overall conclusion of a positive impact of pictograms on comprehension and health behaviors. This chapter attempts to address some of these issues by providing a broad overview of the literature, highlighting the complexities of pictogram design, evaluation, and application, and offering guidance and guidelines. It encourages researchers to improve their reporting of pictogram studies with supporting comments for problematic areas. Last, it identifies future research direction to provide quality evidence for the impact of pictograms in practice.
Article
Two types of newly designed pharmaceutical pictograms (with and without context) were compared with an existing type of certified pictograms regarding their search efficiency. Each of the 30 participants had to search a total of 1′090 “fictitious” medical shelves for a certain box defined by the amount and type of medical instructions given (memory size) and presented among a variable number of other boxes (set size). The boxes contained the different types of pictograms mentioned above. Calculated factorial analyses on reaction time data, among others, showed that the two newly designed pictogram types make search more efficient compared to existing types of pictograms (i.e., flatter reaction time x set size slopes). Furthermore, regardless of the type of pictogram, this set size effect became more pronounced with larger memory sizes. Overall, the newly designed pictograms need fewer attentional resources and therefore might help to increase patient adherence.
Article
Background Good communication is fundamental to provision of information and patient engagement in orthodontic treatment. Images can be used to support verbal and written information, but little is known about how laypeople interpret orthodontic images. Objective To explore laypeople’s understanding and preferences for images (clinical photographs and medical illustrations) relating to orthodontic diagnoses and treatments. Design Cross-sectional survey. Setting UK. Population Laypeople aged ⩾16 years. Methods Participants were recruited through social media to complete an online questionnaire containing six pairs of images (clinical photograph and medical illustration) relating to orthodontic diagnoses and treatment. Photographs were selected from a bank with input from laypeople, then a matching medical illustration was created. Images were presented with questions relating to interpretation, preferences and reasons for preferences. Results A total of 898 people completed the questionnaire. Interpretation of images by laypeople was variable and, in some cases, normal intra-oral features and image orientation caused confusion. A combination of photograph and illustration were preferred for images representing diagnosis (by 41%–50% participants), whereas the illustration alone or both photograph and illustration together was preferred for explaining treatment (43%–48% and 35%–44%, respectively). Photographs were liked for their realism and relatability, while illustrations were often found to be clearer. Arrows aided participants’ understanding of the images, but annotations were requested to further improve the value of images. Only 26% of participants reported having previously been shown dental images, but 96% felt they would be helpful to support verbal and written information. Conclusion Laypeople may not interpret orthodontic images in the way that professionals expect, and unfamiliar intra-oral features may distract people from the intended focus of the image. A combination of photographs and illustrations together may improve the usefulness of images, alongside annotation or explanation.
Article
Background Over-the-counter (OTC) medication package inserts are vital references for healthcare professionals to make drug recommendations and influential education materials that patients commonly refer to when self-caring. However, little is known about the quality and readability of the OTC medication package inserts in China. Objectives This study aimed at evaluating the quality and readability of OTC medication package inserts. Methods Package inserts of OTC medication were selected based on the market share and pharmacological category. The quality of the package inserts was evaluated based on standards adapted separately from the Chinese National Medical Products Administration (NMPA) and European Medicines Agency's (EMA) Working Group. The readability was assessed using the Patient Education Materials Assessment Tool (PEMAT) in conjunction with the Chinese Readability Index Explorer (CRIE). Results A total of 29 OTC medication package inserts consisting of 12 Western Medicine (WM) and 17 Chinese Tradition Patent Medicine (CTPM) package inserts were included. Overall, the OTC package inserts met 92% of the NMPA standards and 54% of the EMA standards. In terms of readability assessment using PEMAT, the overall median (interquartile range) understandability score was 38% (38–45%) and for actionability score was 40% (40–55%). The overall text reading level of package inserts measured by the CRIE, after removing some medical jargon, is equivalent to the median reading level for the 12th (9.5–12th) grade reading level. Conclusions The quality of OTC medication package inserts was satisfactory under internal standards but poor under international standards. Some OTC pharmacological information is not provided due to lack of research, especially for CTPM. A more informative and comprehensive package insert may be needed to guide drug use decisions. OTC medication package inserts are not appropriate patient education materials in terms of readability. Additional materials may be developed to supplement package inserts for patient education for OTC medications.
Article
Behavior analytic interventions for people with disabilities often rely on implementation by novice caregivers and staff. However, behavior intervention documents are ineffective at evoking the level of performance needed for behavior change, and intensive training is often needed (Dogan et al., 2017; Ward-Horner & Sturmey, 2012). The cost and time requirements of intensive training may not be viable options for some clients, leading to nonadherence or attrition (Raulston et al., 2019). In addition, others may feel that prescribed interventions are not appropriate or will not work (Moore & Symons, 2011). These barriers may reflect a cultural mismatch (Rathod et al., 2018). One potential way to increase efficacy of intervention materials is to improve the cultural sensitivity and comprehensibility of these documents. Although the body of research on cultural adaptation of behavioral interventions is becoming more robust, adaptation of behavior intervention documents as a means to create effective behavior change when cultural and linguistic diversity are factors, is an area of behavior analytic practice that is not well researched and there remains a need for cultural humility. Because diversity can include expansive differences between individuals, such as race/ethnicity, socioeconomic status, religion, gender and sexuality; understanding and adapting to each of these areas may be best done through separate reviews. It is the intent of this article to focus on ethnic diversity in the United States as a starting point and frame of reference for cultural adaptation. This tutorial includes tips learned from health communication research to give step-by-step guidance on creating comprehensible, culturally adapted intervention plans through the example of training for parents of autistic children.
Article
Background: Screening immigrant mothers for postpartum depression has been shown to be challenging for health care professionals in handling cultural implications of postpartum depression, communicating through interpreter and applying translated versions of the screening scale. Aim: The aim of the study was to test the feasibility of an evidence-based educational intervention for Child Health Services nurses in screening non-native-speaking immigrant mothers for postpartum depression. Ethics: The approval was obtained from Swedish Ethical Review Authority, 2018/1063. Method: Thirty Child Health Services nurses who conducted screening with assistance of interpreter at least three times per year participated. The study was registered at ClinicalTrials.gov (NCT04167709) and a one-group pretest-posttest experimental design was applied. Data on the participants' acceptability and response to outcomes of the intervention were collected by an evaluation questionnaire, the Clinical Cultural Competency Training Questionnaire, the General Self-efficacy Scale and by self-reported data on general performance of the task. Descriptive statistics were used to present the results of the evaluation questionnaire and general performance of the task. Paired t-test were used to compare the scores on the General Self-efficacy scale, while Wilcoxon signed-ranked test was used to compare the scores on the Clinical Cultural Competency Training Questionnaire. Qualitative data were analysed by content analysis. Results: All 30 participants stated that they found the content of the intervention satisfying. The intervention was shown to provide new knowledge and improved their ability to meet the requirements linked to the screening procedure. The intervention affected their self-estimated cultural competence in some aspects but not their self-efficacy or general performance of the task. Conclusions: The intervention was found feasible but require adjustment in the design of the practical training sessions. The use of the provided material, a comic strip on parental support and interpreter information needs further evaluation.
Article
We define scientific misinformation as publicly available information that is misleading or deceptive relative to the best available scientific evidence and that runs contrary to statements by actors or institutions who adhere to scientific principles. Scientific misinformation violates the supposition that claims should be based on scientific evidence and relevant expertise. As such, misinformation is observable and measurable, but research on scientific misinformation to date has often missed opportunities to clearly articulate units of analysis, to consult with experts, and to look beyond convenient sources of misinformation such as social media content. We outline the ways in which scientific misinformation can be thought of as a disorder of public science, identify its specific types and the ways in which it can be measured, and argue that researchers and public actors should do more to connect measurements of misinformation with measurements of effect.
Article
The COVID-19 pandemic has led to a surge of information visualizations that aim to increase our scientific understanding and communicate about the ongoing health crisis with the general public. In this time, there has also been significant use of data visualization language in artefacts from online communities that provide commentary on the pandemic and create meaning through participatory digital culture. Using a qualitative approach, this paper examines over 300 memes collected from a public social media group targeted to young adults in the United States that uses the language of data visualization to discuss topics related to COVID-19. We outline four main ways that data visualization language is used in these memes-as a coarse indicator, as a visual analogy, as an opportunity for augmentation with emotion or interpretation, and as a visual pun-as well as two ways that memes leverage traditional and emerging approaches in the information visualization community. We describe the context in which these memes are socially created and interpreted in light of the political nature of online spaces and connect this work to ongoing research on participation, emotion, and embodiment in information visualization. These results aim to start a conversation about the use of data visualization language in digital culture and more casual networked environments beyond official channels.
Article
Introduction and Objectives Current models of health care are progressively migrating to more participatory models, where for treatment to achieve results that last over time, there must be effective communication between the patient, his or her caregivers, and health professionals. Although the use of pictograms in the context of medical instructions has been widely studied, in our country, there are no studies about their usefulness, or which set of symbols should be used by the systems. This work aims to present the first step towards the development of platforms that automatically suggest pictograms to supplement medical instructions for primary care settings in Chile. Materials and Methods In this pilot study, we collected and analyzed the physicians' opinions on the selection of medical instructions that later will automatically be supplemented by the software that is under construction. We designed an expert validation survey using a set of 66 medical instructions with pictograms. This survey provided three rating options for each medical instruction: Not necessary (supplementing the instruction with a pictogram does not carry any value), Useful (supplementing the instruction with a pictogram may help patients to understand and remember the instruction), and Essential (supplementing the instruction with a pictogram is essential). Seventy-one physicians responded to the survey. Results 22 out of 66 medical instructions were considered “essential” by >=51% of the experts, and 12 of the 66 were considered to be “useful but not essential” by >=51% of the experts. Conclusion Results of our survey validate the potential use of pictograms as a complement to better comprehension of medical instructions in our country.
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Introduction Chronic pain affects millions of individuals worldwide. Healthcare provider gender bias in the management of these individuals has societal and individual ramifications. Yet, a thorough and comprehensive literature summary on this topic is lacking. Therefore, this study aims to systematically: (1) identify and map the available scientific and grey literature as it relates to healthcare provider gender bias in the assessment, diagnosis and management of (chronic) musculoskeletal pain and (2) identify current gaps that necessitate further research. Methods and analysis This scoping review will be conducted in accordance with recent guidelines, and the results will be reported via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The following databases will be searched: PubMed (National Library of Medicine), Embase (Elsevier), Scopus (Elsevier), CINAHL Complete (Ovid), Academic Search Complete (Ebscohost), Pre-Prints Database (National Library of Medicine) and Rehabilitation Reference Center from inception to August 2022. Additionally, relevant grey literature will be identified. All screening will be done by two independent reviewers during two stages: first title/abstract screening followed by full-text screening. Data will be extracted from the bibliometric, study characteristics, and pain science families of variables. Results will be descriptively mapped, and the frequency of concepts, population, characteristics and other details will be narratively reported. Additionally, results will be presented in tabular and graphical form. Ethics and dissemination As this study will neither involve human subject participation nor utilisation of protected data, ethical approval is not required. This study’s methodological approach follows current recommendations. Study findings will be disseminated through conference presentations and international peer-review journal publication. In addition, infographics available in English, Spanish and German will be disseminated. Registration details This project will be registered in Open Science Framework prior to data collection.
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Objective Despite improved recognition regarding the importance and association between provision of high quality information for people affected by cancer and improved outcomes and experiences; gaps and unmet needs are still reported. As oncology health information provision increasingly moves online, understanding how service users experience or avoid misinformation is important. Determining patient and carer preferences regarding cancer provision is important to address outstanding gaps. Methods This study utilised a purpose-built national cross-sectional survey distributed via social media to assess perspectives regarding cancer information in Australia. Quantitative and qualitative (open text) items assessed respondents’ experiences with accessing information online, and current information preferences and gaps. Results A total of 491 people affected by cancer completed the survey. Respondents highlighted a preference for information that better addresses the diversity of cancer experience, and is more timely and responsive to personal situation and context. Despite increasing attention to health literacy standards, complex medical jargon and terminology remains prevalent. Many respondents have concerns about misinformation, and seek improved mechanisms or skills to assist with determining the trustworthiness and relevance of information found online. Conclusions Survey responses identified current gaps in information provision for people affected by cancer. Personalised information in formats which are more flexible, accessible, and responsive to user needs are required. Practice Implications Education and resources to target and improve digital health literacy and combat health misinformation are needed. Novel solutions co-designed by people affected by cancer will ensure that information is provided in a manner that is relevant, timely, and personalised.
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Purpose To evaluate the quality of information available in YouTube videos on the treatment of uterine fibroids. Materials and methods The DISCERN Scale Criterion was used to quantify the quality of YouTube videos on uterine fibroid embolization. The Video Power Index was used to quantify the popularity of videos on uterine fibroid embolization. Results Among the 31 videos identified in the study, the average total DISCERN score was 48.82 ± 14.48, indicative of average to poor quality. There was no correlation between a video’s popularity and its quality. Popularity, as measured by Video Power Index, was not significantly different between videos containing a board-certified physician and those that did not. Videos with a board-certified interventional radiologist had a significantly lower Video Power Index than those without a board-certified physician. Conclusion YouTube is not currently a high-quality source of information for uterine fibroid treatment options. Physicians should be aware of highly viewed material on YouTube to have informed discussions with patients about their treatment options and address misperceptions.
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The Coronavirus Disease of 2019, or COVID-19 epidemic has generated unprecedented levels of uncertainty and confusion regarding public health amongst the world population. A second “pandemic” or infodemic, exacerbated by social media, warrants just as much focus as the amplification of COVID-19 misinformation could erode trust, instigate conflict and undermine measures to control the pandemic. This chapter provides a background on the use of instant messaging platforms in Asia and discuss how these platforms are dangerous breeding grounds for misinformation. Through a content analysis of COVID-19 claims circulated via instant messaging platforms, we identified the dominant false narratives, and multimedia (image, video or audio) misinformation. We review the current legislative and non-legislative initiatives that discouraged the creation and propagation of false COVID-19 information as well as the growing body of psychological research on message cues, cognitive vulnerabilities and personality predispositions that make people susceptible to false information. This will contribute toward a more comprehensive strategy to combat misinformation in the longer term.
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The translation of scientific evidence into guidelines and advice is a fundamental aspect of scientific communication within nutrition and dietetics. For communication to be effective for all patients, health literacy (HL) must be considered, i.e. an individual's capacity to obtain, comprehend and utilise information to empower decision-making and promote their own health. HL levels are varied and difficult to judge on an individual basis and have not been quantified, thus not giving a population mean HL competency indication. It has been evidenced that most of the working age population in England cannot comprehend healthcare materials due to complexity, thereby promoting a need for agreed readability thresholds for written healthcare information. A wide range of modalities within dietetics are used to communicate to a varied audience with the primary form written, e.g. journal articles, plain language summaries and leaflets. Audio/visual and digital communications are increasing in dietetic care and welcomed by patients; however, the effectiveness of such approaches has not been studied thoroughly and digital exclusion remains a concern. Communication considering a patient's HL level leads to empowerment which is key to effective management of chronic diseases with a high treatment burden. Therefore; this review will focus on the importance of modalities used to communicate science in nutrition to ensure they are appropriate in relation to Health Literacy.
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Research conducted primarily during the 1970s and 1980s supported the assertion that carefully constructed text illustrations generally enhance learners' performance on a variety of text-dependent cognitive outcomes. Research conducted throughout the 1990s still strongly supports that assertion. The more recent research has extended pictures-in-text conclusions to alternative media and technological formats and has begun to explore more systematically the “whys,” “whens,” and “for whoms” of picture facilitation, in addition to the “whethers” and “how muchs.” Consideration is given here to both more and less conventional types of textbook illustration, with several “tenets for teachers” provided in relation to each type.
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We examined whether timeline icons improved older and younger adults' comprehension of medication information. In Experiment 1, comprehension of instructions with the icon (icon/text format) and without the icon (text-only format) was assessed by questions about information that was (a) implicit in the text but depicted explicitly by the icon (total dose in a 24 hour period), (b) stated and depicted in the icon/text condition (medication dose and times), and (c) stated but not depicted by the icon (e.g., side effects). In a separate task, participants also recalled medication instructions (with or without the icon) after a study period. We found that questions about dose and time information were answered more quickly and accurately when the icon was present in the instructions. Notably, icon benefits were greater for information that was implicit rather than stated in the text. This finding suggests that icons can improve older and younger adults' comprehension by reducing the need to draw some inferences. The icon also reduced effective study time (study time per item recalled). In Experiment 2, icon benefits did not occur for a less integrated version of the timeline icon that, like the text, required participants to integrate dose and time information in order to identify the total daily dose. The integrated version of the icon again improved comprehension, as in Experiment 1, as well as drawing inferences from memory. These findings show that integrated timeline icons improved comprehension primarily by aiding the integration of dose and time information. These findings are discussed in terms of a situation model approach to comprehension.
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Elderly patients may have limited ability to read and comprehend medical information pertinent to their health. To determine the prevalence of low functional health literacy among community-dwelling Medicare enrollees in a national managed care organization. Cross-sectional survey. Four Prudential HealthCare plans (Cleveland, Ohio; Houston, Tex; south Florida; Tampa, Fla). A total of 3260 new Medicare enrollees aged 65 years or older were interviewed in person between June and December 1997 (853 in Cleveland, 498 in Houston, 975 in south Florida, 934 in Tampa); 2956 spoke English and 304 spoke Spanish as their native language. MAIN OUTCOME MEASURE; Functional health literacy as measured by the Short Test of Functional Health Literacy in Adults. Overall, 33.9% of English-speaking and 53.9% of Spanish-speaking respondents had inadequate or marginal health literacy. The prevalence of inadequate or marginal functional health literacy among English speakers ranged from 26.8% to 44.0%. In multivariate analysis, study location, race/language, age, years of school completed, occupation, and cognitive impairment were significantly associated with inadequate or marginal literacy. Reading ability declined dramatically with age, even after adjusting for years of school completed and cognitive impairment. The adjusted odds ratio for having inadequate or marginal health literacy was 8.62 (95% confidence interval, 5.55-13.38) for enrollees aged 85 years or older compared with individuals aged 65 to 69 years. Elderly managed care enrollees may not have the literacy skills necessary to function adequately in the health care environment. Low health literacy may impair elderly patients' understanding of health messages and limit their ability to care for their medical problems.
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The first study in this series [Houts PS, Bachrach R, Witmer JT, Tringali CA, Bucher JA, Localio RA. Patient Educ. Couns. 1998;35:83-8] found that recall of spoken medical instructions averaged 14% but that, when pictographs (drawings representing the instructions) accompanied the spoken instructions and were present during recall, 85% of medical instructions were remembered correctly. Those findings suggested that spoken instructions plus pictographs may be a way to give people with low literacy skills access to medical information that is normally available only in written form. However, there were three important limitations to that study: (1) the subjects were literate and perhaps literate people remember pictograph meanings better than people with low literacy skills; (2) only short term recall was tested and, for medical information to be useful clinically, it must be remembered for significant periods of time and (3) a maximum of 50 instructions were shown in pictographs, whereas managing complex illnesses may require remembering several hundred instructions. This study addresses those limitations by investigating 4-week recall of 236 medical instructions accompanied by pictographs by people with low literacy skills. Subjects were 21 adult clients of an inner city job training program who had less than fifth grade reading skills. Results showed 85% mean correct recall of pictograph meanings immediately after training (range from 63 to 99%) and 71% after 4 weeks (range from 33 to 94%). These results indicate that people with low literacy skills can, with the help of pictographs, recall large amounts of medical information for significant periods of time. The impact of pictographs on symptom management and patient quality of life remains to be studied.
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One hundred and ninety-six patients over the age of 65 years suffering from joint pain were randomised to receive one of three patient information leaflets describing a hypothetical pain medication, a standard textual patient information leaflet (PIL) given out by a pharmaceutical chain, and two alternate-forms depicting information with icons and graphs. The results showed that patients randomised to the traditional PIL were less likely to consider taking the hypothetical medication.
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Communication is a major problem in the management of patients. Miscommunication occurs frequently in populations with low reading skills, illiteracy does not completely account for the observed low rates of recall of communicated information. Transmission of the message also plays an important role. Successful strategies to improve communication with patients include the use of videotapes, videotape modeling or cartoon illustrations. Do these products communicate effectively because they overcome illiteracy or because they also transmit a very clear message? Can good transmission of messages overcome illiteracy? In this study, we compared the effectiveness of a printed message about polio vaccinations with the same message converted into a production of animated cartoons using marketing and advertising techniques. The production that resulted from using this strategy showed that in the setting of this study, a well-designed animated cartoon is more effective in delivering a message than the same information provided in written instructional materials.
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To design, develop, and evaluate a simple, understandable medicine label and patient information leaflet (PIL) for nystatin suspension, and to assess the effect of incorporating pictograms on understanding in low-literate participants. Patient information materials were designed and pretested in a pilot study (n = 20), and were subjected to the Fry's readability test. The final evaluation was conducted with 60 low-literate participants who had a maximum of 7 years of formal schooling and for whom English was their second language. Demographic data were collected. Participants were randomly allocated to a control (text-only information) or experimental (text + pictogram information) group, shown the medicine label and PIL, and asked to read them. A series of questions was asked about the instructions and an understanding level was calculated in each case. A second series of questions assessed patient acceptability of the materials. Differences in understanding were determined by chi(2) tests. Both sets of these simple written materials were generally well understood. However, the presence of pictograms was shown to improve the comprehension of more complex information, resulting in significantly more participants in the experimental group obtaining a score for understanding >80% for both the medicine label and PIL. A clear preference for the materials incorporating pictograms was expressed. The presence of pictograms had a positive effect in the acquisition and comprehension of drug information.
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This review examines the use of pictograms in health care. Well designed pictograms are simple, clear, graphic symbols able to convey their intended meaning to all patients, including those who are illiterate, elderly or visually impaired. Although some research on the effectiveness of pictograms has not supported the hypothesis that pictograms are beneficial for the acquisition and comprehension of information, most studies investigating health-related applications of pictograms have shown them to be of benefit in the comprehension and recall of instructions on prescription and over-the-counter medicines. However, the success of pictograms as a communication aid in pharmacy depends first on a rigorous design process, followed by well-designed, randomised, controlled trials using an appropriate method of evaluation. The final stage is to investigate the optimal way of using pictograms in practice and to assess their effect on behavioural outcomes, such as compliance. We discuss methodological issues associated with the design process of pictograms, the evaluation of pictograms in practice, reasons for their use in pharmacy and their potential in improving medication compliance. We also report on the positive and negative aspects of various pictograms that have been developed and tested in pharmacy.
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For which readers and texts are different types of Pictures and/or Titles ‘worth a thousand words'? Pictures and Titles are extensively used in reading materials under the assumption that they enhance individuals’ motivation for reading, and that they also facilitate reading. This paper presents findings from studies into the effects of Pictures and/or Titles on the reading and comprehension of continuous printed text.The transfer‐appropriate processing hypothesis encourages the specification of conditions under which Pictures and/or Titles enhance or interfere with children's text‐processing skills. Such studies contribute to an evolving theory of the cognitive conditions required for meaningful learning from materials comprising continuous text, Pictures and Titles.Four groups of researches are summarized. The first considers the effects of Pictures on Reading Comprehension (17 studies). The second summarizes work on effects of Pictures on both Reading Accuracy and Reading Comprehension (three studies). Turning to Titles, their effects on comprehension are presented (five studies). The fourth section summarizes studies into the effects of both Pictures and Titles on Reading Comprehension (four studies). Finally, one study that simultaneously examines the effects of both Pictures and Titles in relation to Reading Accuracy and Reading Comprehension is presented.Three main points emerge from the Picture and Title research reviewed. The first is that Pictures and Titles are not uniformly effective in all prose‐reading situations. The second is that not all types of Pictures and Titles are equally effective for children with differing reading abilities. Both of these points are, in part, a consequence of methodological variations between researches, coupled with their respective limitations. Despite such limitations, an appreciation of such work suggests that teachers and textbook producers could increase slightly the likelihood of Pictures and Titles being effective in facilitating Reading Accuracy and Reading Comprehension for particular groups of readers. The third point raised by this survey is the challenge inherent in the first two. Can Pictures and/or Titles that systematically and differentially affect the accessibility of running text be constructed for children with different reading attainments and learning styles working with text of various genres?
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Overall findings of the analysis of published studies reveal small effects of adjunct pictures on reading comprehension. No advantage was found when traditional vs nontraditional text settings were compared. Generally small effects were found for nontraditional text settings at both public school and university levels. On the other hand, a large effect was noted for university-level subjects in traditional text settings. Additionally, line drawings seem to facilitate comprehension more than do shaded drawings or photographs, and color pictures seem to have a greater effect than black and white pictures. Only a slight difference between immediate vs posttests was found. (40 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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It is estimated that 1 out of 5 American adults lacks the literacy skills needed to function effectively in todays society and as patients they present a challenge to health instruction. This book provides teaching strategies to aid in making self-help and self-management a reality for the patient with low literacy skills. The magnitude of the problem is explored and myths about illiteracy are exemplified. Two chapters deal with comprehension of written materials from theory to practical proven testing techniques including the cloze technique and the word-recognition test. Another chapter offers 2 formulas for testing the readability of written materials: the SMOG formula and the Fry index. Once a problem is identified a 4-step teaching strategy gives tips on teaching the low-literacy patient. For those pamphlets and booklets commonly given to patients suggestions for writing and rewriting to simplify the text are given along with examples of comprehension level. The use of audiotapes for teaching is explored in depth for those who learn better by listening. A chapter on the use of visuals stresses simplification to reduce the amount of text reading to emphasize instruction and to motivate and appropriate examples are given. Where written material audiotapes and visuals are drafted and produced according to the guidelines in the book the last chapter is devoted to pretesting to determine whether intended concepts are coming through. It defines the components of pretesting describes procedures discusses possible stages for production and provides examples of results. Although the book is aimed at providing teaching methods for the low-literate patient the suggestions also apply to the learning disabled.
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One of us had agreed to participate in the “Mothers' March” (on Birth Defects) of the March of Dimes. The collecting packet arrived without an identification badge, however. Much of the March of Dimes literature bears the picture of a handicapped child, but some does not. The question facing us as we set out to collect for the “Mothers' March” was whether or not to include a picture of a handicapped child on the identifying poster which we would present to potential donors as we made our rounds, door-todoor. A picture is worth a thousand words, they say. But what would be the effect of a thousand words when collecting door-tedoor on behalf of a charity such as the March of Dimes?
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People's level of erotophobia influences their acceptance of sexually related situations, including the likelihood of engaging in sexually related health care such as breast self-examinations (BSE). Female college students (n= 61) completed a measure of erotophobia and read a BSE brochure that either did or did not contain instructional photographs showing a woman's breasts. As hypothesized when the brochure contained photographs, women high in erotophobia felt less competent in giving themselves BSE and were less likely to claim that they did things to improve their health. When the brochure contained no photographs, women low in erotophobia thought that the information was easier to understand and that BSE was more important.
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This paper reports two studies on comprehension of pharmaceutical texta containing pictorial and written instructions by mothers in rural Kenya. The subjects were asked to read and recall instructions for preparing and administering a solution for the treatment of dehydration due to diarrheal disease in children. A set of pictures describing the preparation procedure, together with written text instructions under two conditions, (a) original, as in the commercial product, and (b) revised, to include familiar terminology and explanations of some procedures, were presented to two groups of Kenyan mothers. The verbal protocols generated were transcribed and analyzed using propositional representation of instructional procedures. The results showed that mothers recalled the procedures for the preparation as in the pictures but not those presented in the written instructions. The written instructions were generally found to be difficult, with the original text being more difficult than the revised text. Any conflicting information between the written and pictorial instructions was resolved by selecting the familiar procedure. The information recalled from the revised text that was recalled was that which supported the procedures in the pictures. The results have implications for writing adequate pharmaceutical texts for users such that little room is left for misinterpretation.
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Can illustrations aid learning of text material? These authors review the results of 55 experiments comparing learning from illustrated text with learning from text alone. They go on to look at research in closely related fields (involving, for example, nonrepresentational pictures, graphic organizers, learner-produced drawings) and conclude by offering guidelines for practice.
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There is broad acceptance of the philosophic foundations of health education as grounded in the collaborative model of client and professional partnership. In practice, however, this partnership is largely dominated by the professional side. Workers may be particularly sensitive to professional domination as issues associated with health promotion vs. safety and health programs at the workplace are often politicized. This polarization is particularly evident in the area of asbestos-related hazard prevention, reduction, and education. Using asbestos hazards as the unifying theme, we participated in a program to facilitate active participation of workers in the production of their own occupational health education materials through the use of the photonovel. Representatives from some seven building trade locals worked with a staff to produce a twenty-four-page photonovel for their co-workers. A random sample of 500 members of building trades locals received either a copy of the photonovel or a popular NCI asbestos pamphlet with an evaluation questionnaire. Differences between the groups were evident in favor of the photonovel in readability, factual recall, general credibility, and attitudes toward future involvement in health and safety issues.
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A sample of 50 consecutive patients with gout was tested by means of a multiple-choice knowledge-testing questionnaire based on the Arthritis and Rheumatism Council's Gout: A Handbook for Patients. Patients were divided into two groups: (a) those tested with an illustrated booklet containing 89 cartoons, and (b) those tested with an unillustrated booklet with text exactly the same as in the illustrated booklet. No significant difference was observed in either the overall test scores between the two groups or between individual question scores. It was concluded that increasing the number of illustrations in the Arthritis and Rheumatism Council's handbook on gout had not significantly increased the value of this material as a communication aid. Certain sources of error have been discussed including the possibility of an 'interest factor' due to the inevitable interest patients have in reading about their own disease, and also the possibility that technical factors to do with page layout and picture/text imbalance might be responsible for failing to show differences between the two groups.
Article
Research suggests that much of the available health education literature requires a level of reading ability that makes it inaccessible to a large proportion of the population in greatest need of health information. The present study tested the value of illustrations and a narrative text style as means of improving the readability of a brochure designed to provide information on cervical cancer and condyloma. Two versions of the brochure were designed, one that had only text presented as simple sentences in bullet-type format (SMOG reading level score of 7.7), and a second version that had somewhat more difficult text formatted in a narrative style (SMOG grade level score of 8.4) together with drawings designed to complement the text. A randomized study design was used to test for comprehension, perceived ease of understanding, and overall rating of the two brochures. Women selected from one private and three public health primary-care clinics were randomly assigned to read one of the two brochures. The brochure with illustrations and narrative text was given a significantly higher overall rating than the one with bullet-type text and no illustrations, while no difference was found in perceived ease of reading. Among poor readers, comprehension was significantly greater for women who read the brochure with illustrations and narrative text, with no difference in comprehension of the two brochures for better readers. The results suggest that the use of aids such as illustrations and text style can make health education literature more accessible to high-risk populations, while remaining interesting enough to appeal to individuals at all levels of reading ability.
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This study investigated the reading level estimates of cancer clinical trial consent forms from actively accruing studies at the Medicine Branch and the Clinical Pharmacology Branch of the National Cancer Institute. Forty-four consent forms were analyzed using the SMOG formula. Readability levels ranged from grade 12 to grade 17.5 (mean = 14.3). The conclusion was that these consent forms were written above most subjects' reading levels. The usefulness of consent forms could be improved significantly by using readability formulas, applying rewriting techniques, and being aware of subjects' comprehension levels. This paper suggests a number of strategies that nurses can use to enhance comprehension of the information contained in informed consent documents.
Article
American Cancer Society (ACS) literature commonly used to inform patients about cancer-detection methods, life-style risks, and treatment modalities was examined for readability. Fifty-one booklets obtained from a regional ACS office were evaluated. According to the SMOG formula, the reading level estimates of the booklets ranged from grade 5.8-15.6 (SD = 2.2), with a mean reading level of grade 11.9. The sampled cancer materials may be too difficult for many Americans to read and understand since most of the booklets (55%) were written for individuals with grade 12 or higher reading skills. Only one booklet was written at less than a grade six reading level. Booklets produced since 1985 were written at significantly lower reading levels (p less than 0.05) than those published in earlier years. The nurse's role in cancer education encompasses awareness of patients' diverse reading skills and formulation of a systematic method to develop materials that meet the needs of low-literacy groups.
Article
We conducted a study to determine the effects of presenting prescription information in a pictorial compared to a verbal format on comprehension and memory in young and old adults. Both comprehension and memory for drug information were studied as a function of age and presentation method. Participants received prescription instructions on actual medicine bottles in one of two formats: verbal instructions only, or verbal instructions mixed with pictorial representations. Results indicated that (a) younger adults' memory for prescription information was facilitated by the mixed instructions, but that mixed instructions appeared to hamper older adults' memory for prescription information; (b) younger adults recalled more information overall relative to older adults across both presentation conditions; and (c) older adults were less able to comprehend prescription information relative to younger adults. Results suggest that well-organized verbal prescription labels are more facilitative for the elderly and that additional efforts must be undertaken to improve the clarity of labeling on prescription drugs.
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Effective illustrations can greatly enhance patient education materials, yet many illustrations do not aid instruction as much as they could. By following the above recommendations, patient education materials developers and illustrators can together accomplish their objectives.
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This article reports the results of an analysis of the readability levels and content of 38 print cholesterol education materials available from government, health agency, professional association, university and industry sources. Each item was characterized according to the primary intended audience (general public, public and screening participants, or those identified with elevated cholesterol and patients in treatment), size, length and appearance. Readability analysis was done using the SMOG and Fog Grading formulas and content analysis examined the presence of messages in each of nine key areas. The readability assessment revealed that the average reading grade level was close to Grade 11, which is too difficult for many adults. Content analysis suggested a need to better address other heart disease risk factors, portion size and the use of brand name food recommendations. Further practice and research needs are identified.
Article
This paper describes the methods used to develop and evaluate diabetes education material for American Indians and Alaska Natives living in Washington, Oregon, and Idaho. Reading skills of individuals and readability of a sample of existing diabetic education material were measured. Using the Wide Range Achievement Test to measure reading skills, the authors found that 66% of the sample read at a 5th "grade" or higher level. Readability of a sample of available diabetic education material was found to be, on average, at the 10th "grade" level. Diabetes education booklets targeted to a 5th to 7th "grade" level were developed and assessed for acceptability and comprehension. Final evaluation, using the close procedure, showed that 62% of the target audience understood the messages in the booklets. A comprehensive assessment process was found to be useful in developing effective diabetes education material for Indian communities.
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Patients (n = 404) with osteoarthrosis and control subjects (n = 233) were studied to examine the communicational value of five styles of illustration (cartoon (C), matchstick (M), representational (R), symbolic (S), photographic (P) and two levels of text ('easy', 'hard'), presented as educational booklets about osteoarthrosis. Booklet comprehension was tested with a multiple choice questionnaire (MCQ) scored by two raw score and two, more sensitive, weight-of-evidence methods. Further studies assessed perception of image detail, tone, and colour by ranking, rating, latency, and questionnaire methods. A subgroup was tested psychometrically. The main findings were: pictures in booklets enhance communication; perception of pictorial style depends on its vehicle of presentation, cartoons being most effective in booklets, photographs overall; simplifying text does not significantly enhance communication; certain picture-text 'interactions' appear to increase comprehension (e.g. 'hard' text with 'easy' pictures); several 'endogenous' factors are associated with increased comprehension: 'psychological' (e.g., intelligence, memory, reading skill); 'demographic' (e.g., the young, males, higher social grades, higher educational levels); 'disease' (e.g., longer disease duration, previous information about the disease).
Article
One recurrent theme in the literature on aging and memory is that the decline of memory for nonverbal information is steeper than for verbal information. This research compares verbal and visual encoding using the picture superiority effect, the finding that pictures are remembered better than words. In the first experiment, an interaction was found between age and type of material; younger subjects recalled more pictures than words while older subjects did not. However, the overall effect was small and two further experiments were conducted. In both of these experiments, the picture superiority effect was found in both age groups with no interaction. In addition, performing a semantic orienting task had no effect on recall. The finding of a picture superiority effect in older subjects indicates that nonverbal codes can be effectively used by subjects in all age groups to facilitate memory performance.
Article
The literature on communication, compliance, and patient satisfaction is selectively reviewed. As in earlier reviews, it is concluded that dissatisfaction with communication remains widespread, as does lack of compliance with medical advice. Related factors include poor transmission of information from patient to doctor, low understandability of communications addressed to the patient, and low levels of recall of information by patients. There does not appear to be any evidence that provision of additional information leads to adverse reactions by patients. Theoretical approaches to communication and compliance are described, and it is concluded that these should be used to direct future research.
Article
A consent to treatment form provides required information that a patient may use to give intelligent, informed consent to proposed treatment. This study applied two standard techniques to assess the degree to which 60 informed consent forms from five national cancer clinical trial groups were readable and understandable by patients. The forms were found slightly less difficult to comprehend than medical journals but substantially more difficult than comparable materials from the popular press. Three of four passages describing treatment methods, procedures, discomforts, and risks required a college level or greater reading ability to comprehend. Informed consent documents may not be understood by a substantial portion of patients who sign them. The very regulations designed to ensure a patient's informed cooperation with treatment may inadvertently lead to forms that are so complex as to make informed cooperation virtually impossible.
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To determine whether the addition of illustrations to discharge instructions improves patient comprehension. Randomized, blinded, prospective study. A blinded investigator asked a series of questions designed to test the participant's comprehension of the discharge instructions. There were 10 possible correct responses. Emergency department of a rural Level I trauma center. Convenience sample of 101 patients discharged with the diagnosis of laceration. Patients were randomly assigned to receive discharge instructions with (n = 54) or without (n = 47) illustrations. The median number of correct responses was five. Patients with illustrations were 1.5 times more likely to choose five or more correct responses than those without illustrations (65% versus 43%; P = .033). The effect of illustrations varied by demographic group. Among nonwhites (n = 51), patients with illustrations were more than twice as likely to choose five or more correct responses (P = .032). Among patients with no more than a high school education (n = 71), patients with illustrations were 1.8 times more likely to choose five or more correct responses (P = .038). Among women (n = 48), patients with illustrations were 1.7 times more likely to chose five or more correct responses (P = .006). The addition of illustrations to discharge instructions for patients who have sustained lacerations improves patient comprehension. There is a large effect among patients who are nonwhite, female, or have no more than a high school education.
Article
Medical information pamphlets often are written using language that requires a reading level higher than parents of many pediatric patients have achieved. Anecdotal reports suggest that many parents may not readily understand the federally mandated Public Health Service vaccine information pamphlets prepared by the Centers for Disease Control and Prevention (CDC) in 1991. The level at which the pamphlets need to be written for low-reading-level parents is undetermined, as is whether parents reading at higher levels will accept low-reading-level materials. To determine whether a simple pamphlet prepared at a low reading level using qualitative and adult education techniques would be preferable to the available CDC polio vaccine information pamphlet, we conducted an integrated qualitative-quantitative study. We compared the parent reading time and comprehension of a simplified pamphlet (Louisiana State University, LSU) comprising 4 pages, 322 words, 7 instructional graphics, and a text requiring a 6th grade reading ability with the equivalent 1991 CDC vaccine information pamphlet comprising 16 pages, 18,177 words, no graphics, and a text requiring a 10th grade reading level. We measured the reading ability of 522 parents of pediatric patients from northwest Louisiana seen at public clinics (81%) and in a private office (19%). Of the entire group, 39% were white, 60% African-American, and 1% Hispanic; the mean age was 29 years; the mean highest grade completed was 12th grade 3 months; and the reading level was less than 9th grade in 47% of parents and less than 7th grade in 20%. After parents were given one of the pamphlets to read, their reading time, comprehension, and attitude toward the pamphlet were measured. Mean comprehension was 15% lower for CDC than for LSU (56% vs 72% correct; P < .001) and reading time was three times longer for CDC than for LSU (13 minutes 47 seconds vs 4 minutes 20 seconds; P < .0001). These trends were significant for parents reading at all but the lowest levels. Mean comprehension and reading time did not differ among parents reading at the third grade level or less. However, mean comprehension was greater and reading time lower for LSU among parents at all reading abilities greater than the third grade. Parents in the private practice setting took the longest time to read the CDC (20 minutes 59 seconds vs 5 minutes 46 seconds, LSU), yet their comprehension on the LSU was significantly higher than on the CDC (94% vs 71%; P < .0001). Two focus groups of high-income parents were unanimous in preferring the LSU. A short, simply written pamphlet with instructional graphics was preferred by high- and low-income parents seen in private and public clinics. The sixth grade reading level appears to be too high for many parents in public clinics; new materials aimed at third to fourth grade levels may be required. The new 1994 CDC immunization materials, written at the eighth grade level, may still be inappropriately high. The American medical community should adopt available techniques for the development of more effective patient-parent education materials.
Article
To evaluate the effect of cartoon illustrations on patient comprehension of and compliance with ED release instructions. A prospective, randomized, controlled study of consecutive patients who presented to the ED of a community teaching hospital with lacerations necessitating wound repair during a three-month study period. At ED release, the patients were randomly assigned to receive wound care instructions with or without cartoon illustrations. Three days later, the patients were followed up by telephone. A blinded investigator asked a series of questions designed to test the patient's recall of, understanding of, and compliance with wound care instructions. A total of 234 patients were successfully contacted by telephone; 105 (45%) had been given ED release instructions with cartoons, 129 (55%), without cartoons. There was no significant difference in age, gender, level of education, or satisfaction with the ED visit between the two groups. The patients given cartoon instructions were more likely to have read the instructions (98% vs 79%, p < 0.001), were more likely to answer all wound care questions correctly (46% vs 6%, p < 0.001), and were more compliant with daily wound care (77% vs 54%, p < 0.01). Subset analysis of those patients who had less than a high school education (n = 57) demonstrated even larger differences between the two treatment groups in terms of comprehension of and compliance with ED release instructions. Cartoon illustrations are an effective strategy for conveying information and may improve patient compliance with ED release instructions.
Article
In this study, culturally sensitive visual aids designed to help convey drug information to nonliterate female adults who had a prescription for a solid oral dosage form of antibiotic medications were developed and evaluated. The researchers conceptualized the educational messages while a local artist produced the visual aids. Seventy-eight female ambulatory patients were evaluated for comprehension and compliance with antibiotic prescription instructions. The study was conducted in three health centers in Cameroon, West Africa and followed a pre-test, post-test, and follow-up format for three groups: two experimental, and one control. All participants were randomly assigned to either experimental or control groups, 26 patients to each group. Subjects in the experimental groups received visual aids alone or visual aids plus an Advanced Organizer. A comparison of the three groups showed that subjects in the experimental groups scored significantly higher than the control group in both the comprehension and compliance measures.
Article
Pictographs have been used in nonliterate societies to help people remember spoken instructions and, today, they could be used to help nonliterate people remember spoken medical instructions. This study tested the hypothesis that pictographs can improve recall of spoken medical instructions. Twenty-one junior college subjects listened to lists of 38 actions for managing fever and 50 actions for managing sore mouth. One of the action lists was accompanied by pictographs during both listening and recall while the other was not. Subjects did not see any written words during the intervention and, therefore, relied entirely on memory of what they heard. Mean correct recall was 85% with pictographs and 14% without (P < 0.0001) indicating that pictographs can enhance memory of spoken medical instruction--often to a very high level. For this technique to be clinically useful, further research is needed on how to achieve accurate recall of large amounts of medical information for long periods of time by nonliterate patients. By viewing illiteracy as a memory problem, the large body of research on learning and memory can be utilized in designing education materials for this group.
Article
The present research explored the effectiveness of a picture and the phrase "even a penny will help" on contributions to charity. Two experiments were conducted, one in the laboratory and one in the field. In both experiments the manipulation of a pleasant picture and the phrase created four types of signs: (1) picture-no phrase, (2) phrase-no picture, (3) picture-phrase, and (4) no picture-no phrase. In the field experiment patrons of local business anonymously put money in a donation box that displayed one of the four signs. In the laboratory experiment, 129 undergraduate students were randomly assigned to view one of the four signs placed on a donation box for a local charity. Analyses for both studies showed that more money was donated when the boxes displayed pictures. The phrase "even a penny will help" had no significant effect on donations.
Article
Previous research has demonstrated that a pleasant drawing (a smiling face) on a restaurant bill increased the number of tips left by clients. A similar experiment was carried out using a drawing of the sun since it is known that tips increase on sunny days. The experiment was carried out in local bars and involved clients who have ordered an espresso coffee. Analysis showed that the drawing of the sun led clients to leave a tip more frequently than when this drawing is not present. The size of the tip left was also higher. The hypothesis of the creation of a positive frame of mind by this stimulus is discussed.