Yes, Julie, I think development of images in the classroom setting provides students with a valuable opportunity to gain valuable insight into the reality of communicating ideas and actions in a visual form rather than a text-based form. What my research students and I have done is to conduct a workshop with our undergrad pharmacy students to stimulate ideas for image development e.g. our most recent one was concerned with illustrating the side effects of ARVs. Although we are a South African university, our students come from all around Africa, so we had a wonderful melting pot of cultures, experiences and ideas to draw from. The outcomes were really useful and provided us with a great foundation from which we could further develop individual images. They are currently being tested to determine acceptability in terms of international criteria (ISO and ANSI).

Bob, I strongly agree with your opinion that all pictograms should be tested in the target patient population before being used in practice. I have seen far too many examples of cases where this has obviously not been done.

Regards
Ros

Ros Dowse
Associate Professor
Faculty of Pharmacy
Rhodes University
Grahamstown, South Africa
+27 (0)46 603 8070(w)
+27 (0)83 556 9796 (mobile)

-----Original Message-----
From: healthliteracy-bounces at nifl.gov [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Julie McKinney
Sent: 28 February 2008 11:22 PM
To: healthliteracy at nifl.gov
Subject: [HealthLiteracy 1803] Re: pill card

I think that these concerns of graphics being meaningful to any given
population is exactly the reason why this is such a good activity to do
in a classroom setting with students (whether they are health students
or literacy students). The whole point in making this with the people
who will be using it is that they can choose their own images, and the
process itself will add meaning. You could do this in a classroom and
have magazines to cut pictures out of, along with a variety of
sun/rooster/breakfast-type images. Or they could use photos of them in
their house doing what they do at certain times of day. If people are
creating this themselves, the images they choose WILL be meaningful!

Not to mention the literacy skills that can be practiced by doing and
processing such an activity...

Do people agree? Has anyone done this?

Julie

P.S. Funny this came up just now...I am working with a team on a health
literacy curriculum in Florida, and we just included an activity like
this!

Julie McKinney
Discussion List Moderator
World Education/NCSALL
jmckinney at worlded.org


>>> "Dickerson, Robert" <DICKERR2 at ihs.org> 02/28/08 1:21 PM >>>

While this tool appears to be a step in the right direction I also agree
with and share the concerns of both Laurie Anson and Marcia. Some of the
other graphics I saw on the site I would not necessarily equate with the
terms they are supposed to signify. For example the graphic that I
believe is supposed be a bag of sugar to represent diabetes did not
connect for me until I realized is was supposed to represent a bag of
sugar. I just saw a bag of something???

Of course making the connection between the graphic and intended meaning
may be influenced by context and the patient's medical conditions (the
sugar bag may make more sense to a diabetic than a non-diabetic). I'm
curious if there are truly universal graphics, symbols, pictures or
visuals that are understood by a majority of people. Of course unique
cultural difference may make even "universal" graphics meaningless in
some cases. In this event alternatives should be made available.

I'm also curious if the graphics in this application were used because
they are conveniently available clip art or if they have truly been
studied and shown effective for a variety of patient populations.

Thanks,
Bob Dickerson, MSHSA, RRT
Quality Improvement Coordinator, Clinical Quality
Iowa Health - Des Moines
Des Moines, Iowa
Phone: (515) 263-5792
Fax: (515) 263-5415
E-mail: DICKERR2 at ihs.org
Website: www.ihsdesmoines.org


-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Trenter, Marcia L
Sent: Wednesday, February 27, 2008 5:11 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 1795] Re: pill card


I agree with Ms. Anson. Considering culture/understanding ethnicity will
help us understand others' interpretations of graphics. We live in a
multi-cultural society. We need to accept that "one size does not fit
all"; one presentation will rarely be interpreted universally. Thus,
strategic targeting of visuals, cultural awareness, focus testing, and
hopefully teach-back orientation.  Here's a graphic challenge for all.

What graphic(s) would depict the following.

3x daily without food. 

Graphics for:	Morning
			Mid-afternoon
			Bedtime

3x daily with food.

Graphics for:	Breakfast
			Lunch
			Dinner

We used a rising sun with a rooster to depict "morning" and several
focus participants thought it meant, "breakfast with chicken". 

I will be very interested to hear your response and grateful.

Thanks,
Marcia

___________________
Marcia L. Trenter
Special Assistant to the Office Director Office of Training and
Communications Center for Drug Evaluation and Research U.S. Food and
Drug Administration Rm 2436, Bldg. 51
10903 New Hampshire Avenue
Silver Spring, MD 20993-0002
301-796-3172
Fax 301-847-8718
E-mail marcia.trenter at fda.hhs.gov
______________________


-----Original Message-----
From: healthliteracy-bounces at nifl.gov
[mailto:healthliteracy-bounces at nifl.gov] On Behalf Of Laurie Anson
Sent: Wednesday, February 27, 2008 5:03 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 1794] pill card

To the List -

As an RN, I recall having heard of the use of pill cards similar to the
one shown. As I remember, there were some difficulties with the symbols
used (sunrise, sunset, moon) across cultural lines. I think the use of
pill cards is an excellent idea, as long as great care is taken to
explain the symbols to the client. For instance, if there is no "sunset"
to compare to "sunrise", then there might be some confusion about the
significance of that particular symbol.


Laurie Anson
ansons at epix.net



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