A Picture is Worth a Thousand Words: Using Pictographs to Address Limited Health Care Literacy

Monday, 9 November 2015

Elizabeth J. Winokur, PhD, MSN, BSN, RN, CEN
St. Joseph Hospital, Orange, CA, USA

Limited healthcare literacy hinders care provision and contributes to worse patient outcomes.Inability to comprehend discharge instructions can adversely affect outcomes among Emergency Department (ED) clients.  Literature has demonstrated poor comprehension of discharged instructions by emergency department patients. 

 As a result of homecare practices that were expressly different from routine discharge instructions among repeat clients, a community emergency department undertook a project to determine the cause.  Over a 3month-period, 150 emergency department clients were asked to participate in an IRB approved study.  A bilingual translator administered the Newest Vital Sign, a 6-item validated scale designed to assess healthcare literacy among English and Spanish patients. Results demonstrated statistically significant differences between the selected language and healthcare literacy (p< .001). Both English (3.82 out of 6) and Spanish speaking (2.61 out of 6) clients were assessed to be at risk for limited healthcare literacy.

 Study results demonstrated the need for an alternative form of discharge instructions.  Nurses selected pictographs, pictorial depictions, as an adjunctive method to provide home care instructions. High volume diagnosis and discharge instructions were selected to be converted to pictographs; limited text written at less than a third grade level was included to enhance illustrations. Available pictographs include fever care, abdominal pain, gastroenteritis, and orthopedic conditions. Contents of the pictographs were selected based on a review of the literature and current discharge instruction contents. 

 At visit completions clients received standard discharge instructions and the language-appropriate pictograph version. Quality and helpfulness of pictographs was determined by post-discharge phone calls by registered nurses.   Positive post-discharge client feedback supports its efficacy. More pictographs are under development.