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Using pictures and drawings

Home Guideline Using pictures and drawings

Introduction

Pictures often say more than words. For this reason, easily understood and often self-explanatory symbols have been used for a long time on signs in public places such as railway stations, airports or sport venues. At a glance they show what is meant. Symbols or pictograms as well as anatomical images, cartoons, drawings or photos are being used increasingly in health information, making the statements and their contents easier for the readers to understand. The aim is for the contents to be understood better and quicker, to enable the written explanations to be remembered more easily and to contribute to making the information more satisfactory (1). Pictures may have an affective and/or cognitive effect and may be applied accordingly. Cognitive pictures such as pictograms or anatomical images are meant to supplement and explain the text. Affective pictures, such as photos of physicians or patients, should on the other hand evoke emotions and increase the attractiveness and credibility of the information given (1).

Supplementing information with pictures can contribute to better understanding (2). This is especially so for instructions (e.g. administering medications or measuring blood pressure). However, the presentation must always be clear and simple so that particularly people with a low standard of education or older people might profit from this (1-5).

Pictograms (also called icons or symbols) are very simple, often schematic illustrations that are often used to ensure the correct dosage is given during drug treatment. In 2007 the Institute of Medicine (USA) issued a standard for labeling medications (6), which in the meantime is also being studied in Europe. With regard to the pictograms, a standardized, uniform presentation should be aimed for (6).

Apart from being used in health information, pictograms are also seen in occupational healthcare and safety as well as in public institutions with the intention of preventing accidents or as information about work protection measures. The efficacy of pictograms in particular with regard to medication intake has been scientifically investigated.

The following explanation show which recommendations can be given for using pictures in health information. The various formats have been categorized as follows: anatomical pictures, cartoons, photos, pictograms and illustrative drawings (cf. Table 16).

Questions

  1. What effects do anatomical images in health information have compared with text only?
  2. What effects do cartoons in health information have compared w with text only?
  3. What effects do photos in health information have compared with text only?
  4. What effects do pictograms in health information have compared with text only?
  5. What effects do illustrative drawings in health information have compared with text only?
Recommendation 1-5
Evidence tables 1-5
Full text
References
  1. Bol N, Smets EM, Eddes EH, de Haes JC, Loos EF, van Weert JC. Illustrations enhance older colorectal cancer patients’ website satisfaction and recall of online cancer information. European journal of cancer care. 2015;24(2):213-23. Epub 2015/01/24.
  2. Bunge M, Mühlhauser I, Steckelberg A. What constitutes evidence-based patient information? Overview of discussed criteria. Patient Education and Counseling. 2010;78(3):316-28. Epub 2009/12/17.
  3. King SR, McCaffrey DJ, 3rd, Bentley JP, Bouldin A, Hallam J, Wilkin NE. The influence of symbols on the short-term recall of pharmacy-generated prescription medication information in a low health literate sample. Journal of Health Communication. 2012;17 Suppl 3:280-93. Epub 2012/10/04.
  4. Liu CJ, Kemper S, McDowd J. The use of illustration to improve older adults’ comprehension of health-related information: Is it helpful? 2009; http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/160/CN-00754160/frame.html (Zugriff am 12.10.2016)
  5. Mansoor LE, Dowse R. Effect of pictograms on readability of patient information materials. The Annals of pharmacotherapy. 2003; http://onlinelibrary.wiley.com/o/cochrane/ clcentral/articles/903/CN-00558903/frame.html (Zugriff am 12.10.2016).
  6. Roundtable on Health Literacy: Board on Population Health and Public Health Practice, Institute of Medicine. In: Hernandez LM (ed). Standardizing medication labels: confusing patients less Workshop summary. Washington DC: National Academies Press; 2008.
  7. Hollands GJ, Marteau TM. The impact of using visual images of the body within a personalized health risk assessment: an experimental study. British Journal of Health Psychology. 2013;18(2):263-78. Epub 2013/01/03.
  8. Delp C, Jones J. Communicating information to patients: the use of cartoon illustrations to improve comprehension of instructions. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine. 1996;3(3):264-70. Epub 1996/03/01.
  9. Sahm LJ, Wolf MS, Curtis LM, Behan R, Brennan M, Gallwey H, et al. What’s in a label? An exploratory study of patient-centered drug instructions. European Journal of Clinical Pharmacology. 2012;68(5):777-82. Epub 2011/12/01.
  10. Thompson AE, Goldszmidt MA, Schwartz AJ, Bashook PG. A randomized trial of pictorial versus prose-based medication information pamphlets. Patient Education and Counseling. 2010; http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/944/CN-0078 1944/frame.html (Zugriff am 12.10.2016).
  11. Yin HS, Mendelsohn AL, Fierman A, Schaick L, Bazan IS, Dreyer BP. Use of a pictographic diagram to decrease parent dosing errors with infant acetaminophen: a health literacy perspective. Academic Pediatrics. 2011; http://onlinelibrary.wiley.com/o/cochrane/ clcentral/articles/830/CN-00801830/frame.html (Zugriff am 12.10.2016).
  12. Austin PE, Matlack R, Dunn KA, Kesler C, Brown CK. Discharge instructions: Do illustrations help our patients understand them? Annals of Emergency Medicine. 1995;25(3):317-20. Epub 1995/03/01.
  13. Brotherstone H, Miles A, Robb KA, Atkin W, Wardle J. The impact of illustrations on public understanding of the aim of cancer screening. Patient Education and Counseling. 2006;63(3):328-35. Epub 2006/10/03.
  14. Kools M, van de Wiel MW, Ruiter RA, Kok G. Pictures and text in instructions for medical devices: effects on recall and actual performance. Patient Education and Counseling. 2006;64(1-3):104-11. Epub 2006/02/14.
  15. Henry E, Brown T, Bartlett C, Massoud E, Bance M. Informed consent in otologic surgery: prospective randomized study comparing risk recall with an illustrated handout and a nonillustrated handout. Journal of otolaryngology – head & neck. 2008;37(2):273-8. Epub 2009/01/09.

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