title: Development and pilot test of pictograph-enhanced breast health-care instructions for community-residing immigrant women.
abstract: Current written text-based health-care instructions are not suitable for presenting lengthy, complex breast health-care instructions and are difficult for immigrant women with limited literacy skills. The aims of this study were to develop breast health-care instructions enhanced by pictographs (simple line drawings representing health-care actions) and pilot test the instructions in a sample of six immigrant women with limited literacy skills. Based on the Mayer's Cognitive Theory of Multimedia Learning, pictographs were developed in addition to low-literacy text. The text and the pictographs were then pilot tested with six immigrant women in community health centres for clarity, comprehension and acceptability through face-to-face interviews. Participants perceived that the drawings were engaging and enhanced clarity of the intended health-care messages. The black and white simple line drawings were well received by participants of varying race and ethnicity. The pictograph-based approach might be an effective tool in developing health-care instructions for immigrant women with limited literacy skills. Future research is needed to compare the effect of pictograph-enhanced instructions with written text-based instructions on adherence to instructions and health outcomes.
authors: School of Nursing, University of Massachusetts Amherst, Amherst, MA 01003-9304, USA. jeungokc@nursing.umass.edu
authors: Jeungok
authors: J
authors: Choi
mesh_terms: D016504:Breast Self-Examination; D004522:Educational Status; D054242:Emigrants and Immigrants; D005260:Female; D057220:Health Literacy; D006801:Humans; D008488:Medical Illustration; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010865:Pilot Projects