Development of a Communication Intervention for Older Adults With Limited Health Literacy: Photo Stories to Support Doctor–Patient Communication

Abstract

Successful doctor-patient communication relies on appropriate levels of communicative health literacy, the ability to deal with and communicate about health information. This article aims to describe the development of a narrative- and picture-based health literacy intervention intended to support older patients with limited health literacy when communicating during their primary care consultations. We performed a formative evaluation that included a review of the literature and interviews with stakeholders on relevant health literacy issues, qualitative studies with the target group, intervention planning, and a small-scale evaluation. Cocreation with the target group was a major component. Seven photo stories were developed incorporating principles from narrative and social learning theory and covering communication themes and strategies identified during focus group discussions and role-play exercises. The intervention was developed in 3 different formats: 1-page photo stories, narrated video clips using the original photo story pictures, and interactive video clips covering participation and communication during primary care consultations. In our small-scale evaluation, older adults considered the cocreated intervention appealing and comprehensible. The intervention shows promise for improving the health of older adults but needs further evaluation. This study provides a rigorous template for the participatory development of health literacy interventions.

A visual content analysis of vaccine coverage in the print media

“…television. However, we agree with Meyer et al 24 that newspapers can be a rather good indicator, thereby providing insight into what could be felt elsewhere. Nevertheless, the findings in this study are a starting point for developing a more comprehensive portrait of the visual contents used in the media coverage of health issues.…”

Testing a Photo Story Intervention in Paper Versus Electronic Tablet Format Compared to a Traditional Brochure Among Older Adults in Germany: Randomized Controlled Trial

“…Photo Story is an alternative tool in a comic layout with modeled pictures and bubble conversation [6], which is considered to be one of the most useful health literacy strategies to engage people in effective communication through the process of reflection and critical thinking [7]. This tool has been used in several contexts; for example, to promote healthy eating in a Latino community [8], to support older adults with limited health literacy during doctor-patient communication [9], and to improve depression literacy and help-seeking behaviors [6]. Moreover, a previous study highlighted the value of comic strips, which share similar characteristics with photo stories, as a format for health information [10].…”

Storybridging: Four steps for constructing effective health narratives

“…Some researchers have provided concrete strategies and writing techniques for constructing narratives ( Gesser-Edelsburg and Singhal, 2013 ; Thompson and Kreuter, 2014 ). Several studies have described the development of their narrative health materials, including a HIV prevention video for company workers in Ecuador ( Del Carmen Cabezas et al, 2015 ), a depression fotonovela for Latinos with limited English proficiency ( Cabassa et al, 2012 ), photo stories for older adults with limited health literacy ( Koops Van ‘t Jagt et al, 2016 ), stories on obesity prevention ( Zwald et al, 2013 ), and narratives for the African American community on breast cancer screening ( Kreuter et al, 2008 ), HIV prevention ( Berkley-Patton et al, 2009 ), smoking cessation ( Houston et al, 2011 ), and hypertension management ( Fix et al, 2012 ). The majority of these studies focused on minority groups and, either implicitly or explicitly, addressed the health disparities gap.…”