Assessment of Pictographs Developed Through a Participatory Design Process Using an Online Survey Tool

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Background: Inpatient discharge instructions are a mandatory requirement of the Centers for Medicare and Medicaid Services and Joint Commission on Accreditation of Healthcare Organizations. The instructions include all the information relevant to post-discharge patient care. Prior studies show that patients often cannot fully understand or remember all the instructions. To address this issue, we have previously conducted a pilot study in which pictographs were created through a participatory design process to facilitate the comprehension and recall of discharge instructions. Objective: The main objective of this study was to verify the individual effectiveness of pictographs created through a participatory design process. Methods: In this study, we included 20 pictographs developed by our group and 20 pictographs developed by the Robert Wood Johnson Foundation as a reference baseline for pictographic recognition. To assess whether the participants could recognize the meaning of the pictographs, we designed an asymmetrical pictograph-text label-linking test. Data collection lasted for 7 days after the email invitation. A total of 44 people accessed the survey site. We excluded 7 participants who completed less than 50% of the survey. A total of 719 answers from 37 participants were analyzed. Results: The analysis showed that the participants recognized the pictographs developed in-house significantly better than those included in the study as a baseline (P < .001). This trend was true regardless of the participant's gender, age, and education level. The results also revealed that there is a large variance in the quality of the pictographs developed using the same design process - the recognition rate ranged from below 50% to above 90%. Conclusions: This study confirmed that the majority of the pictographs developed in a participatory design process involving a small number of nurses and consumers were recognizable by a larger number of consumers. The variance in recognition rates suggests that pictographs should be assessed individually before being evaluated within the context of an application.




Kim, H., Nakamura, C., & Zeng-Treitler, Q. (2009). Assessment of Pictographs Developed Through a Participatory Design Process Using an Online Survey Tool. Journal of Medical Internet Research, 11(1).

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