The effect of a visual aid on the comprehension of cataract surgery in a rural, indigent South Indian population

Abstract

Purpose-To determine whether a visual aid improves the understanding and retention of information presented during informed consent for rural, indigent patients presenting for cataract surgery.Materials and Methods-This was a randomized, unmasked, interventional study. We recruited patients who presented to the Hande Surgical Hospital in Chennai, India, for cataract surgery. Patients were randomized into two groups: verbal consent alone (group A) and verbal consent plus a poster (group B). Both groups completed an 11-question true/false quiz immediately before and after informed consent and one day after surgery.Results-A total of 60 patients were recruited for the study, with 30 randomly assigned to each group; 23 patients from group A and 17 from group B completed the study. Informed consent improved patient scores in both groups; however, group B had significantly higher mean scores on postoperative day 1 (7.4 vs 8.7, P = 0.005) and significantly greater improvement in mean scores from pre-informed consent to postoperative day 1 (1.3 vs 3.6, P = 0.002).Conclusions-Informed consent improves patient understanding of cataract surgery. Using a visual aid during informed consent for cataract surgery improves understanding and retention of information more than verbal consent alone in a rural South Indian population.Multiple barriers to high-quality care exist for millions of indigent patients with pressing medical conditions. [1][2][3][4] Ineffective communication between health care providers and patients is a major factor in reduced care. [5][6][7] Roadblocks to effective communication can include limited formal education, illiteracy, and misinformation or misunderstanding among the population being served regarding medical interventions. 5,7 Informed consent is a critical component of invasive medical procedures, helping to establish a healthy doctor-patient relationship by educating patients about the methods, risks, and benefits of procedures. 8 Moseley et al 9 examined the use of a poster and video presentation combined with a verbal informed consent in a highly educated population and demonstrated a significant increase in patient understanding of cataract surgery. In another study, the use of written pamphlets in addition to verbal discussion prior to cataract surgery showed an increase in information retention among patients. 10 Methods used to communicate with patients in developed countries such as graphic tools and electronic multimedia-based programs may not be applicable to indigent populations in the developing world. 11,12 In addition, written pamphlets and electronic programs can be prohibitively expensive in financially limited clinics. We aimed to determine whether a poster presentation combined with a verbal informed

Assessment of the Readability of Genetic Counseling Patient Letters

“…Letters written by genetic counselors that included images had, on average, a lower reading level than those that did not include images. This finding is consistent with previous research (Delp and Jones 1996;Karan et al 2011) that found including images improves comprehension. Because images have been shown to have a correlation with increasing readability, it is concerning that 20 % of respondents had never thought about including images in patient letters and 14 % believed it would not be helpful.…”

“…Readability of patient letters can also be increased by including images. Images have been shown to increase comprehension (Delp and Jones 1996;Karan et al 2011). For example, Delp and Jones (1996) found that patients who were given medical information with visual aids were not only more likely to read the information, they were also more likely to understand the information.…”

Patient education strategies in cataract surgery: A systematic review

“…Other reasons for exclusion included: incompatible study population (not cataract surgery patients) ( n = 4), no relevant study intervention (patient education about cataract surgery) ( n = 3), language of publication other than English ( n = 2), and no available full‐text ( n = 1). From reference lists of the located articles, we identified two additional RCTs eligible for systematic review, yielding 16 studies in this review …”

“…includes Austrian patients). Most studies employed multiple inclusion criteria, though six (38%) studies did not specify any inclusion criteria aside from the status of cataract surgery patient. In addition, only three (19%) studies reported the type of anesthesia employed during surgery (local anesthesia in two and topical anesthesia in one).…”

TELBS robust linear regression method

“…In the analysis of gene microarrays, Ahdesmäki et al 15 proposed use of robust M estimation of regression when dealing with biological time series models. Karan et al 16 assessed the use of visual aids when obtaining informed consent for cataract surgery, using linear regression model as their model of choice. The study of van Vliet et al 17 used robust linear regression to demonstrate that low plasma apolipoprotein E gene levels in midlife are associated with increased risk of Alzheimer's disease in later life.…”