Assessment of pictographs developed through a participatory design process using an online survey tool.


Journal Article

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.The main objective of this study was to verify the individual effectiveness of pictographs created through a participatory design process.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.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%.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.

Full Text

Duke Authors

Cited Authors

  • Kim, H; Nakamura, C; Zeng-Treitler, Q

Published Date

  • February 24, 2009

Published In

Volume / Issue

  • 11 / 1

Start / End Page

  • e5 -

PubMed ID

  • 19275981

Pubmed Central ID

  • 19275981

Electronic International Standard Serial Number (EISSN)

  • 1438-8871

International Standard Serial Number (ISSN)

  • 1439-4456

Digital Object Identifier (DOI)

  • 10.2196/jmir.1129


  • eng