Thanks for mentioning Judy's work, Sue. 
 
If you want to read a short summary of the article that appeared in AHRQ's "Research Activities" go to http://www.ahrq.gov/research/jun05/0605RA40.htm and scroll down to Shea.

________________________________

From: healthliteracy-bounces at nifl.gov on behalf of Sue Stableford
Sent: Mon 3/3/2008 9:55 AM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 1818] Re: pill card



Just to add one more great article to suggested reading about how adults understand pictures, check this article:
Shea Judy et al. Developing an Illustrated Version of the Consumer Assessment of Health Plans (CAPHS). Joint Commission on Accreditation of Healthcare Organizations. January 2005;31(1):32-42. This is an excellent article about how line drawings to explain important health survey issues were designed and tested with an American audience. While not "icons," the drawings had to be simple representations of complex concepts. I often recommend this article to help people learn about the importance of audience testing.

Best,
Sue Stableford



Sue Stableford, MPH, MSB, Director
Health Literacy Institute
Center for Health Policy, Planning & Research
University of New England
716 Stevens Ave.
Portland, Maine 04103
Tel: 207-221-4567
email: sstableford at une.edu
fax: 207-523-1914
www.HealthLiteracyInstitute.net
www.ClearLanguageGroup.com



>>> Joan Medlen <joan at ipns.com> 2/29/2008 9:55 AM >>>

This is absolutely spot on. You will also find good information on creating
visual materials within the autism community - take a look at Visual
Strategies for Improving Communication by linda Hodgdon and "Teaching by
Design" by Kimberly Voss. I have used all these techniques in my work
adapting nutrition education materials for people with intellectual
disabilities and find that it crosses over to ESOL work and work in health
literacy very nicely.  It's all about being understood and your target
audience/individual being able to show you that.

I would highly recommend background free images if you are using
photographs. Many tools for people with autism have a lot of these images.
The owner of Silverlining Multimedia may be willing to create some of these
images for you if photographs are preferable. You can reach her at
www.silverliningmm.com . I use her Visual Foods CD all the time.

You can also download some of the symbol-based communication programs for a
free trial. Boardmaker has a great library of symbols, but is also a bit
expensive. you can find it, and pix writer, here: www.mayerjohnson.com

Take care,

Joan

-------
Joan E Guthrie Medlen, R.D., L.D.
Clinical Advisor, Health Literacy & Communications
Special Olympics Healthy Athletes
joan at DownSyndromeNutrition.com

At 06:30 AM 2/29/2008, you wrote:

>One place that you will find a large body of knowledge about icons for

>language is in the field of alternative and augmentative

>communication.  Many communication systems use pictographic symbols to

>store message components.  You will find that this is a very complex

>area.  While you would think that photographic images are easiest to

>associate, they can be too complex to process easily.  Line drawings

>are easiest to identify and discriminate, but the association can be

>hard to establish.  And, as you've noted, as soon as the ideas become

>even a little bit abstract, the images can be complicated.

>

>Do you use the same symbol for a Papillon and a Great Dane?  Both are

>dogs, but sure don't look alike.  What do you use to indicate

>"justice" or "faint?"  In AAC, people have been wrestling with this

>for some time, and I recommend at least looking at the body of work as

>an aid to literacy work.

>

>Denis Anson, MS, OTR

>Misericordia University

>Dallas, PA

>

>On Feb 29, 2008, at 2:34 AM, Ros Dowse wrote:

>

> > 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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