Using pictographs to enhance recall of spoken medical instructions II

The first study in this series [Houts PS, Bachrach R, Witmer JT, Tringali C A, Bucher JA, Localio RA. Patient Educ. Couns. 1998;35:83-8] found that rec all of spoken medical instructions averaged 14% but that, when pictographs (drawings representing the instructions) accompanied the spoken instruction s and were present during recall, 85% of medical instructions were remember ed correctly. Those findings suggested that spoken instructions plus pictog raphs may be a way to give people with low literacy skills access to medica l information that is normally available only in written form. However, the re were three important limitations to that study: (1) the subjects were li terate 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 fo r significant periods of time and (3) a maximum of 50 instructions were sho wn in pictographs, whereas managing complex illnesses may require rememberi ng several hundred instructions. This study addresses those limitations by investigating Lt-week recall of 236 medical instructions accompanied by pic tographs by people with low literacy skills. Subjects were 21 adult clients of an inner city job training program who had less than fifth grade readin g skills. Results showed 85% mean correct recall of pictograph meanings imm ediately 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 skil ls can, with the help of pictographs, recall large amounts of medical infor mation for significant periods of time. The impact of pictographs on sympto m management and patient quality of life remains to be studied. (C) 2001 El sevier Science Ireland Ltd. All rights reserved.