title: The development and comprehensibility of a pictorial asthma action plan.
abstract: OBJECTIVE
  Written action plans are regarded as an important part of asthma self-management education and yet they may not be understood by those with limited literacy skills. This study was designed to produce an understandable pictorial asthma action plan.
  
  
  METHODS
  With advice from a group of doctors and nurses a "standard" written action plan was translated by a medical artist into a series of pictorial images. These were assessed using the techniques of guessability and translucency by a series of adults attending a specialist asthma clinic in London and the same process was subsequently used to assess comprehensibility of the images and plans amongst a group of Somalis living in Manchester, UK and Malaysians in Seremban, Malaysia.
  
  
  RESULTS
  Guessability testing showed that the majority of pictograms were well understood by each of the study groups. Translucency testing revealed close agreement with intended meaning for the majority of the images. One image, depicting extra use of reliever medication scored less well in all populations; two other images scored less well in the Somali and Malaysian groups and reflect less use of certain inhaler devices in other countries. The overall plan was well understood by all patients who were able to adequately recount the appropriate actions to take in different clinical scenarios.
  
  
  CONCLUSIONS
  We have developed a pictorial asthma action plan understandable by 3 different populations of patients with asthma.
  
  
  CONCLUSIONS
  Pictorial representations have been shown by other studies in other situations to be an effective method of reinforcing the spoken word. The pictorial asthma action plan developed for this study has been shown to be comprehensible, personalised to the individual in the usual fashion. It is now suitable for further evaluation in clinical practice.
authors.affiliation: Department of Respiratory Medicine, NHLI at Charing Cross Hospital, Imperial College London, St. Dunstans Road, Hammersmith, London, United Kingdom.
authors.forename: Nicola J
authors.initials: NJ
authors.lastname: Roberts
authors.forename: Zeinab
authors.initials: Z
authors.lastname: Mohamed
authors.forename: Pei-Se
authors.initials: PS
authors.lastname: Wong
authors.forename: Marianne
authors.initials: M
authors.lastname: Johnson
authors.forename: Li-Cher
authors.initials: LC
authors.lastname: Loh
authors.forename: Martyn R
authors.initials: MR
authors.lastname: Partridge
mesh_terms: D000328:Adult; D001249:Asthma / Q000517:prevention & control / Q000523:psychology*; D001294:Attitude to Health / Q000208:ethnology; D001296:Audiovisual Aids / Q000592:standards*; D032882:Comprehension; D004522:Educational Status; D005260:Female; D006801:Humans; D008131:London; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D012648:Self Care / Q000379:methods / Q000523:psychology; D012998:Somalia / Q000208:ethnology; D011795:Surveys and Questionnaires