title: Assessment of pictographs developed through a participatory design process using an online survey tool.
abstract: BACKGROUND
  Inpatient discharge instructions are a mandatory requirement of the Centers for Medicare and Medicaid Services and Joint Commission on Accreditation of Healthcare Organizations. The instructions include all the information relevant to post-discharge patient care. Prior studies show that patients often cannot fully understand or remember all the instructions. To address this issue, we have previously conducted a pilot study in which pictographs were created through a participatory design process to facilitate the comprehension and recall of discharge instructions.
  
  
  OBJECTIVE
  The main objective of this study was to verify the individual effectiveness of pictographs created through a participatory design process.
  
  
  METHODS
  In this study, we included 20 pictographs developed by our group and 20 pictographs developed by the Robert Wood Johnson Foundation as a reference baseline for pictographic recognition. To assess whether the participants could recognize the meaning of the pictographs, we designed an asymmetrical pictograph-text label-linking test. Data collection lasted for 7 days after the email invitation. A total of 44 people accessed the survey site. We excluded 7 participants who completed less than 50% of the survey. A total of 719 answers from 37 participants were analyzed.
  
  
  RESULTS
  The analysis showed that the participants recognized the pictographs developed in-house significantly better than those included in the study as a baseline (P< .001). This trend was true regardless of the participant's gender, age, and education level. The results also revealed that there is a large variance in the quality of the pictographs developed using the same design process-the recognition rate ranged from below 50% to above 90%.
  
  
  CONCLUSIONS
  This study confirmed that the majority of the pictographs developed in a participatory design process involving a small number of nurses and consumers were recognizable by a larger number of consumers. The variance in recognition rates suggests that pictographs should be assessed individually before being evaluated within the context of an application.
authors.affiliation: Clinical Informatics Research and Development, Partners Healthcare System, Boston, MA, USA.
authors.forename: Hyeoneui
authors.initials: H
authors.lastname: Kim
authors.forename: Carlos
authors.initials: C
authors.lastname: Nakamura
authors.forename: Qing
authors.initials: Q
authors.lastname: Zeng-Treitler
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001296:Audiovisual Aids; D003710:Demography; D004358:Drug Therapy / Q000379:methods; D004522:Educational Status; D034742:Electronic Mail; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008484:Medicaid; D006278:Medicare; D009862:Online Systems; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011932:Reading; D021641:Recognition, Psychology; D012648:Self Care; D014481:United States