
Ever think about how pictures affect what you do in your
daily life? Have you ever tipped a waiter a little more because he drew a
smiley face on the bottom of your check? Or donated money to a local humane
society when you saw pictures of puppies in its literature? Studies have shown that the
frequency and size of a waiter’s tips were greater when a smiley face was
present. And that showing pictures of puppies alongside a charity solicitation increased the amount of money donated, versus text-only materials.
Pictures can play an important part in all communications,
and especially in health education.
The Fry formula, the Flesch-Kincaid test, the SMOG. These
are all health literacy assessment tools. According to experts, some of
these are better than others. But whether better or best, all of these tools do
only 1 thing—calculate the
grade reading level of materials in question.
HealthEd applies health
literacy guidelines to all of its patient materials. We understand that written health education plays a major role in helping patients
comprehend and apply positive behaviors to their treatment. And with 50
percent of all Americans reading below the eighth-grade level,
using the appropriate grade reading level for the written word becomes even more important.
But the grade reading level of health education materials
alone is only one guideline of many that help in the creation of effective patient
education. According to the US Department of Health and Human Services, we
must “use measures of reading grade
level only in combination with other factors to judge ease of reading.” As
a creative director, and one who speaks frequently on the role of design in
creating materials that comply with health literacy guidelines, I am well aware that pictures and visuals are among those “other factors.”
Do pictures really
affect comprehension of health education materials?
In a recent study involving 60 respondents with low literacy, researchers assessed how employing pictures affected patients' understanding of medication instructions. Of patients who received a leaflet with
pictures, 93% correctly responded to
the question “How must you take this
medicine?” versus 47% for those who received text-only instructions. And
when asked, “What are the actual times?” 73% who had been given the text plus pictures answered correctly, versus 3%
of those who received the text-only version.
Many other health education studies have reached similar conclusions. Incorporating pictures into health education
materials helps patients better understand the information. But as health
educators, we know it’s not just about patients’ ability to comprehend the
information. We want them to act on the information as well.
Do pictures influence
people’s intentions and behavior in response to medical instructions?
A study
of 234 emergency room patients compared 2 groups of patients given instructions for managing lacerations. Not surprisingly, 77% of those whose instructions were accompanied by pictures did what was recommended, versus 54% of those whose instructions were text only. A different study involved 78 nonliterate women. On average, women who received picture instructions took 90% of
the pills prescribed for the affected time period, versus 78% for the women who
received only spoken instructions.
So, it seems logical to assume that incorporating pictures
into health education can not only enhance comprehension but also
help patients accept the message as something they should act on. With that in
mind, here are some recommendations for using pictures in health education:
Look for ways to include
pictures
Think visually and ask,
“How can I use pictures to support key points?”
Use the simplest drawings
or photographs possible
This helps viewers with
low literacy skills to understand the intended message without being distracted by irrelevant details.
Guide viewers' perception and interpretation of pictures
Use captions that
describe what is happening in the picture and that link to text through
proximity.
Be sensitive to the
culture of the intended audience
Readers want to see
themselves and their concerns related in the piece. If they don’t, chances
are they will not fully understand the information.
Evaluate the effect of
pictures
If possible, conduct follow-up interviews that assess attention, understanding,
recall, and adherence as it pertains to the inclusion of pictures in
the pieces. We understand that the grade reading level of health education
materials can be a make-it-or-break-it point for patient comprehension.
Writing copy at a lower grade reading level can certainly help readers understand the information. But words alone won’t do the trick. As referenced above, pictures along with copy allow for better comprehension, better recall, and ongoing adherence to treatment regimens than does just plain text with no visuals.
And can also lead to higher tips. Just ask the waiter with
the smiley face.

Ken Thorlton
SVP, Creative Director
HealthEd