Doodle Health: A Crowdsourcing Game for the Co-design and Testing of Pictographs to Reduce Disparities in Healthcare Communication

Supplementing patient education content with pictographs can improve the comprehension and recall of information, especially patients with low health literacy. Pictograph design and testing, however, are costly and time consuming. We created a Web-based game, Doodle Health, for crowdsourcing the drawing and validation of pictographs. The objective of this pilot study was to test the usability of the game and its appeal to healthcare consumers. The chief purpose of the game is to involve a diverse population in the co-design and evaluation of pictographs. We conducted a community-based focus group to inform the game design. Game designers, health sciences librarians, informatics researchers, clinicians, and community members participated in two Design Box meetings. The results of the meetings were used to create the Doodle Health crowdsourcing game. The game was presented and tested at two public fairs. Initial testing indicates crowdsourcing is a promising approach to pictograph development and testing for relevancy and comprehension. Over 596 drawings were collected and 1,758 guesses were performed to date with 70-90% accuracies, which are satisfactorily high

Doctor of Philosophy

dissertationHospital discharge instructions are critical for a patient's posthospitalization recovery. When patients are discharged to home they frequently have to manage wound/incision care, change dressings, take medications, modify activities, follow specialized diets and recognize signs or symptoms that require medical attention. Unfortunately, conditions of hospitalization, effects of illness on cognition, and low health literacy impact a patient's ability to understand discharge instructions. Two studies were completed for this dissertation research. The first was conducted to understand how discharge instructions are created and used by healthcare professionals and by patients. Semistructured interviews were conducted with 5 nurses and 5 doctors who work at the University of Utah Hospital Cardiovascular Medical Unit and 5 patients recently hospitalized on this unit. Coded interview segments were analyzed to reveal themes, which converged with discharge instruction literature, that were then developed as strategies to improve discharge instructions. Strategies included the modification of content through text simplification to improve patient comprehension, the enhancement of readability with logical formatting, the use of discharge instructions to provide consistent information to the patient and the inclusion of pictures or illustrations. The second study was a randomized controlled trial with aims to evaluate the effect of standard versus pictograph-enhanced discharge instructions on immediate and delayed patient recall of the content of and patient satisfaction with their discharge instructions. Participants were randomly assigned to receive standard (n = 71) or pictograph-enhanced (n = 73) discharge instructions and were asked to recall the content of their instructions at discharge and 1 week post discharge. Patients who received pictograph-enhanced discharge instructions recalled more of their instructions at discharge than those who received standard discharge instructions, (t(142) = -3.1, p < .01), and were also more satisfied with the ease of understanding discharge instructions one week after hospital discharge than those who received standard discharge instructions (z(142) = -2.4, p = .016). A multifaceted, comprehensive approach is essential to assist patients through the transition from hospital to self-care. The results of these studies, to improve discharge instruction creation and enhance their understandability, provide interventions that can serve an important role in such an approach

A brief intervention to improve patient satisfaction scores

"Background: Patient-centered care is the future of hospital services. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is the first of its kind, national, publicly available standardized survey. Although the overall score has been improving over the years, the aspect of physician-patient communication still lags far behind. We conducted a pilot study to evaluate a new method to improve communication. We assessed the changes in perception of patients if their provider initiated the post-discharge follow-up. ... Discussion: Improved communication outcomes require increased physician effort along with the efforts of the other staff and hospital resources. Patients' perception of physician communication can be enhanced by a post-discharge phone call from the provider."Vinod Nookala (1), Pratiksha Singh (1), Manbeer Singh Sarao (1), Sravanthi Ennala (2); 1. UPMC Pinnacle. Department of Internal Medicine ; 2. The Cleveland ClinicIncludes bibliographical reference

A study designed to explore trends in 30-day readmission rates of patients with congestive heart failure after implementation of new patient education tools

Congestive heart failure (CHF) is a major problem in the United States today. So many aspects to the disease process exist that creating and implementing interventions to manage symptoms during the progression of the disease presents a challenge. Providing effective patient education to patients with this chronic disease process is a challenge due to the high frequency of readmissions to the hospital for these patients. Recently a CHF discharge class and visual educational tool were implemented at a hospital in Northwest Arkansas in an attempt to improve knowledge retention of patient education material. The purpose of this study was to identify “gaps in knowledge” in CHF patients readmitted to the hospital within 30 days following discharge. The study examined knowledge about their chronic illness and identified gaps of knowledge provided by the discharge education process in CHF patients who were readmitted within 30 days of discharge

Design and Development of a Patient-Centered E-Health System to Improve Patient Understanding at Discharge

E-health systems are often designed without considering user-centered design principles. Past research on the topic of patient-centered e-health (PCEH) has lacked focus on the design and development of a PCEH artifact and the process for its development. In this study, information systems design theory (ISDT) is applied to design, develop, and evaluate an e-health system based on PCEH principles. The goal of the artifact in this study is to improve patient understanding of diagnoses, procedures, medications, and post-discharge instructions and empower patients with the information needed pre- and post-discharge to make informed healthcare decisions. The artifact justification, meta-requirements, meta-design, development, and evaluation are presented in multiple iterations—beginning with a simple picture book, and ending with a Web-based, mobile, multimedia system. Findings indicate that a PCEH approach can be useful for achieving multiple design goals. The artifact illustrates achievement of an important organizational quality improvement goal for the case study organization involved, a key physician goal to improve patient-physician engagement, and an important patient goal—to improve understanding about patient-specific diagnoses and health conditions prior to discharge from a hospital visit and initiation of home health care

The extent and effects of patient involvement in pictogram design for written drug information : a short systematic review

This short review provides insight into the extent and effectiveness of patient involvement in the design and evaluation of pictograms to support patient drug information. Pubmed, CINAHL, Cochrane Library, Embase, PsycINFO, Academic Search Premier and Web of Science were searched systematically; the 73 included articles were evaluated with the MMAT. We see that, usually, non-patient end-users are involved in the design of pharmaceutical pictograms - patients are more commonly involved in the final evaluation of pictogram success. Repeated involvement of (non-)patients aids the design of effective pharmaceutical pictograms, although there is limited evidence for such effects on patient perception of drug information or health behaviour.Publisher PDFPeer reviewe

Education and Decision Making at the Time of Triptan Prescribing: Patient Expectations vs Actual Practice

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106941/1/head12308.pd

What factors affect patients' recall of general practitioners' advice?

<p>Abstract</p> <p>Background</p> <p>In order for patients to adhere to advice, provided by family doctors, they must be able to recall it afterwards. However, several studies have shown that most patients do not fully understand or memorize it. The aim of this study was to determine the influence of demographic characteristics, education, amount of given advice and the time between consultations on recalled advice.</p> <p>Methods</p> <p>A prospective survey, lasting 30 months, was conducted in an urban family practice in Slovenia. Logistic regression analysis was used to identify the risk factors for poorer recall.</p> <p>Results</p> <p>250 patients (87.7% response rate) received at least one and up to four pieces of advice (2.4 ± 0.8). A follow-up consultation took place at 47.4 ± 35.2 days. The determinants of better recall were high school (OR 0.4, 95% CI 0.15-0.99, p = 0.049) and college education (OR 0.3, 95% CI 0.10-1.00, p = 0.050), while worse recall was determined by number of given instructions three or four (OR 26.1, 95% CI 3.15-215.24, p = 0.002; OR 56.8, 95% CI 5.91-546.12, p < 0.001, respectively) and re-test interval: 15-30 days (OR 3.3, 95% CI 1.06-10.13, p = 0.040), 31-60 days (OR 3.2, 95% CI 1.28-8.07, p = 0.013) and more than 60 days (OR 2.5, 95% CI 1.05-6.02, p = 0.038).</p> <p>Conclusions</p> <p>Education was an important determinant factor and warrants further study. Patients should be given no more than one or two instructions in a consultation. When more is needed, the follow-up should be within the next 14 days, and would be of a greater benefit to higher educated patients.</p

Effect of Primary Care Follow Up on Hospital Readmissions

Hospital readmission rates are costly; nearly 1 in 5 hospital patients covered by Medicare are readmitted to the hospital within 30 days of discharge, accounting for $15 billion a year in health care spending (Jencks et al., 2009). The emergency department (ED) is the biggest cost driver for hospital readmissions. The research conducted implemented new protocols with an ED-based research study team that came in at the time of the patient discharge and assist with the transition of care for the patient, scheduling next day follow-ups with their Primary Care Provider. Analysis of this data will include readmission rates for patients demographic variables, comparison of patients with scheduled follow-up versus no follow-up, and barriers to follow up care. The goal of this thesis is to evaluate hospital readmissions and identify potential interventions to reduce them

A Visual Approach to Improving the Experience of Health Information for Vulnerable Individuals

Many individuals with low health literacy (LHL) and limited English proficiency (LEP) have poor experiences consuming health information: they find it unengaging, unappealing, difficult to understand, and un-motivating. These negative experiences may blunt, or even sabotage, the desired effect of communicating health information: to increase engagement and ability to manage health. It is imperative to find solutions to improve poor experiences of health information, because such experiences heighten vulnerability to poor health outcomes. We aimed to address a gap in the health literacy literature by studying the patient experience of health information and how visualization might be able to help. Our four studies involved patients presented with health information in various settings to improve understanding and management of their care. We used semi-structured interviews and observations to understand patient experiences of receiving personal health information in the hospital. We learned that the return of results is desired and has the potential to promote patient engagement with care. We developed a novel method to analyze LHL, LEP caregiver experience and information needs in the community setting. The novel method increased our understanding and ability to detect differences in experiences within the same ethnic group, based on language preference. Next, we interrogated the literature for a solution to easily communicate complicated health information to disinterested, LHL, LEP individuals. We found that visualizations can help increase interest, comprehension, support faster communication, and even help broach difficult topics. Finally, our findings were used to develop a novel prototype to improve experiences of consuming genetic risk information for those having LHL and LEP. Unlike traditional approaches that focus on communicating risk numbers and probabilities, the novelty of our approach was that we focused on communicating risk as a feeling. We achieved this by leveraging vicarious learning via real patient experience materials (e.g., quotes, videos) and empathy with an emotive relational agent. We evaluated and compared the prototype to standard methods of communicating genetic risk information via a mixed methods approach that included surveys, questionnaires, interviews, observations, image analysis, and facial analysis. Main outcome variables were perceived ease of understanding, comprehension, emotional response, and motivation. We employed t-tests, ANOVAs, directed content analysis, correlation, regression, hierarchical clustering, and Chernoff faces to answer the research questions. All variables were significantly different for the prototype compared to the standard method, except for motivation as rated by 32 LHL, LEP community members. Findings revealed that LHL, LEP individuals have difficulty appropriately processing standard methods of communicating risk information, such as risk numbers supported by visual aids. Further, appealing visuals may inappropriately increase confidence in understanding of information. Visualizations affected emotions, which influenced perceived ease of understanding and motivation to take action on the information. Comprehension scores did not correlate with perceived ease of understanding, emotional response, or motivation. Findings suggest that providing access to comprehensible health information may not be enough to motivate patients to engage with their care; providing a good experience (taking into account the aesthetics and emotional response) of health information may be essential to optimize outcomes