Excellent site, thanks


Elba I. Nieves MSN, RN CE
Caribbean Healthcare System
Nursing Patient/Family Health Education Coordinator, Inpatient Diabetes
Educator
10 Casia St
San Juan, PR 00921-3201
E-Mail: Elba.Nieves at va.gov
 

-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of
paul at learningaboutdiabetes.org
Sent: Tuesday, January 09, 2007 12:56 AM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 546] Re: pictures in health education

Peter:

I'd like to share some comments supporting your observations on the
value
of alternative graphic designs in health education.

Specifically:

1) We use clip art only in very specific situations, such as
illustrating
actual sizes of food portions for people with diabetes. Clip art that
does
not support, reinforce, or relate to the topic being discussed is
ineffective at best and misleading or even harmful in some situations; 

2) I certainly agree with you and Nancy that stick figures can be very
useful with selected audiences. The key is researching a representative
sample of end-users to ensure the 'majority' of recipients understand
the
messages being conveyed and accept the simplicity of the graphic
approach.
However, as you point out later, illustrations can often be obtained at
fairly low cost in many situations, so unless it is absolutely
necessary,
try not to limit yourself to this approach.  

3) Re stick figures, the one objection you mentioned from an educator in
Africa that using thin stick figures may be problematic as very thin
people
were thought to have aids, does offer an opportunity to comment on some
issues that come up in many projects;  

a) Is a new and interesting observation valid? Input obtained in
interviews
or focus groups may sound true, real, or logical, but are they relevant
to
the majority of intended users of your program? Group interview results
often suffer from "the loudest voice in the room" problem. Unless they
are
run by a skilled facilitator, the input of one or two persons can often
dominate a group. Common sense, probing for additional information or
bias'
among a broader mix of group members, or trial and error are sometimes
the
only recourse.

2) How valuable are focus groups results?  This is a difficult question
to
answer (as Coca Cola found out when then launched their New Coke after
literally 100's of consumer focus groups and found they had made a major
strategic mistake).  Focus groups offer qualitative input on a subject
that
provides information for "further investigation" - information that is
not
necessarily projectable to the universe or audiences you are interested
in
helping.

As for budgets, culturally-neutral graphics, and other obstacles often
encountered in trying to incorporate graphics into a program, your
observation that you can do a lot with very little money have been my
experience as well. One should also not assume, without testing, that
graphics that are not culturally sensitive will not work with an
audience.
A medical missionary recently had a number of our programs tested by
native
educators working with patients in diabetes clinics in Tanzania. The
text
was simply written and the graphics were relevant, but almost all of the
graphics were of white males and females. Although different graphics
would
obviously have been better, the need for relevant materials patients
could
understand and use to improve their diabetes-self care far outweighed
the
skin color used in the graphics. 

Finally, as you point out Peter, working out what you want to achieve
with
each graphic element (drawing, illustration, photograph) before you meet
with the artist is very important. You must guide the development
process -
not the artist.

Paul Tracey
www.learningaboutdiabetes.org 

Original Message:
-----------------
From: Peter S. Houts psh2 at email.psu.edu
Date: Mon, 08 Jan 2007 16:52:33 -0500
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 541]  pictures in health education




>Hi - I'm Peter Houts - and I'm looking forward to sharing some of what

I 

>have learned while working with Ceci and Len Doak about how to best use



>pictures in health communications.  I realize that health

communications 

>is a very broad subject and my expertise is primarily in how to 

>communicate directions for managing illness - both to patients and to 

>family caregivers.

>

>The work that we did together was published as a literature 

>review:  Houts, PS, Doak CC, Doak LG, Loscalzo, MJ. "The role of

pictures 

>in improving health communication: a review of research on attention, 

>comprehension, recall and adherence" Patient Education and Counseling,

61 

>(2006) 173-190

>

>The PDF file that Julie will make available is adapted from a slide

talk 

>that I will be giving to the American Psychosocial Oncology Society in 

>March.  It is intended to spark interest in using pictures among people



>who study how patients cope with cancer.

>

>I have been reading the messages that people posted before our session 

>officially began and here are some of my thoughts in response.

>

>With respect to clip art - I have NOT found it useful to use clip art

or 

>art done for purposes other than the one I am trying to illustrate.

The 

>reason is that the art should be closely related to the text in order

for 

>the viewer to link them and in order to have maximum impact on people's



>comprehension, recall and behavior change.  Art that does not relate 

>directly to what is being said has been shown to have no effect on 

>comprehension, recall, or behavior.  Many patient education materials

do 

>use "warm fuzzy" art, but little is gained other than possibly drawing 

>attention to the document.  In the case of poor readers, they are

likely 

>to be confused by art that is unrelated to the information being

conveyed.

>

>I agree very much with the points made by Marcia - that pictures by 

>themselves, without explanatory text, are likely to be interpreted in

many 

>different ways by viewers.  That is why text - simply written - should 

>always be closely linked to art.  As I say in the slide show - the use

of 

>pictures should build on a foundation of clear, simple writing.

>

>In reply to Nancy Simpson's questions about stick figures - I have

found 

>that they work very well.  Both of our research studies used stick

figures 

>and, not only did people remember their meanings, the study

participants 

>spontaneously said they enjoyed working with them.  One advantage of

stick 

>figures is that they are culturally neutral.  (You can see examples of

the 

>stick figures we used in the pdf file of my slide show.) One objection

I 

>have heard to using stick figures was from a person who showed our 

>research drawings to health educators in Africa who said that very thin



>people were thought to have AIDS.  They suggested making the lines

thicker 

>so the figures did not seem emaciated.  My other experience with stick 

>figures was in asking people in focus groups what kind of pictures they



>preferred in the "Eldercare at Home" book that I edited.  In the focus 

>group, people said they wanted color pictures of people who look like 

>themselves.  This was not possible given the diversity of the intended 

>audience and the expense of creating the pictures.  I, personally,

think 

>that what people say they want in a focus group is not necessarily the 

>same as what works in the real world.  I suspect that those focus group



>participants would have responded positively to stick figures if they

were 

>linked to information they wanted to learn.

>

>As to the cost of creating art - there are many people who are skilled

at 

>drawing and who will work for reasonable rates.  For the Eldercare at

Home 

>book, it took about 20 minutes per drawing when I sat with the artist, 

>explained what I wanted, and responded to his draft ideas.  Once he 

>understood the kind of drawings I wanted, I was able to communicate

with 

>him by FAX which saved both of us travel time.  I believe we paid him

$50 

>an hour which meant that each drawing cost roughly $20.  This was a

very 

>reasonable rate in view of the fact that we generated over 200 drawings



>for that project.    It is important that the health educator be the 

>person who decides what should be in the drawings - not the artist.

This 

>means you will have to work out in your mind what you want the drawing

to 

>include before talking with an artist and then give feedback to his/her



>sketches until you have what you want.

>

>Peter



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