Communicating Information to Patients: The Use of Cartoon Illustrations to Improve Comprehension of Instructions

Abstract

Objective:To evaluate the effect of cartoon illustrations on patient comprehension of and compliance with ED release instructions.Methods: A prospective, randomized, controlled study of consecutive patients who presented to the ED of a community teaching hospital with lacerations necessitating wound repair during a three-month study period. At ED release, the patients were randomly assigned to receive wound care instructions with or without cartoon illustrations. Three days later, the patients were followed up by telephone. A blinded investigator asked a series of questions designed to test the patient's recall of, understanding of, and compliance with wound care instructions.Results: A total of 234 patients were successfully contacted by telephone; 105 (45%) had been given ED release instructions with cartoons, 129 (55%), without cartoons. There was no significant difference in age, gender, level of education, or satisfaction with the ED visit between the two groups. The patients given cartoon instructions were more likely to have read the instructions (98% vs 7996, p c 0.001), were more likely to answer all wound care questions correctly (46% vs 6%, p < 0.001), and were more compliant with daily wound care (77% vs 54% p c 0.01). Subset analysis of those patients who had less than a high school education (n = 57) demonstrated even larger differences between the two treatment groups in terms of comprehension of and compliance with ED release instructions. Conclusion:Cartoon illustrations are an effective strategy for conveying information and may improve patient compliance with ED release instructions.Key words: illustrations; patient instructions; patient follow-up; compliance; discharge instructions; cartoons.Acad. Emerg. Med. 1996; 3:264-270.I The outcome of minor illness and injury managed in the ED is largely dependent on care rendered after release from the ED. However, the ED team has little control over what patients do after they leave. Many patients follow up with their own physicians or clinics, usually at a time related more to convenience than to necessity. Some patients choose their own follow-up care. Others completely ignore ED release and follow-up instructions, often with serious results. Only a fraction of patients recall everything they are told and follow instructions exactly. Identifying which patients will heed ED release and follow up instructions and which ones will not is never an easy task for the emergency physician (EP).'Studies indicate that patient satisfaction and compliance with the aftercare plan are related to the amount and quality of information given to the patient and the ability of the patient to comprehend it.'-' Efforts to improve ED release and follow-up instructions include verbal teaching techniques, behavior modification, emergency care clinics, postal notification and reminder systems, and ED follow-up While these methods have significant effects on compliance rates, each method has cost-related drawbacks.

A patient information booklet about anesthesiology improves preoperative patient education

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“…Combining written material with appropriate images has been shown to be significantly more effective than text alone in enhancing comprehension. 5 This study was designed to determine the key topics that anesthesiologists routinely discuss with patients in a preadmission clinic, and to test the effectiveness of a graphically illustrated booklet specifically written at a Grade 6 reading level in improving patient's knowledge about the perioperative period.…”

The potential of comics in science communication

“…When compared to traditional text-based material, comics appear to significantly improve understanding and recollection of medical conditions [Diamond et al, 2016;Tekle-Haimanot et al, 2016], compliance with medical instructions [Delp and Jones, 1996;Tjiam et al, 2013], promote informed consent [Furuno and Sasajima, 2015;Kraft et al, 2016], facilitate interactions between patients and doctors [Anderson, Wescom and Carlos, 2016] and between patients and their communities [McNicol, 2014;McNicol, 2017], and generally improve community engagement with medical issues [Leung et al, 2014;Wang, Acevedo and Sadler, 2017]. However, the health-related information presented in these comics clearly has a different emotional value than generic scientific knowledge.…”

Health Literacy and Quality: Focus on Chronic Illness Care and Patient Safety

“…Pictorial-enhanced written materials have been shown to improve comprehension, adherence, and dosing accuracy, 93,98,[107][108][109][110] particularly for patients with low literacy skills. [111][112][113][114] The use of illustrated schedules to assist patients with medication selfmanagement 108,115 can be especially beneficial for patients who take multiple medications. These picture-based scheduling tools seem to aid in the integration of dose and time information, 108 have been well accepted by patients, and are particularly beneficial for those with limited literacy or decreased cognitive function.…”