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% correctlyresponded 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
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