title: Crowdsourcing participatory evaluation of medical pictograms using Amazon Mechanical Turk.
abstract: BACKGROUND
  Consumer and patient participation proved to be an effective approach for medical pictogram design, but it can be costly and time-consuming. We proposed and evaluated an inexpensive approach that crowdsourced the pictogram evaluation task to Amazon Mechanical Turk (MTurk) workers, who are usually referred to as the "turkers".
  
  
  OBJECTIVE
  To answer two research questions: (1) Is the turkers' collective effort effective for identifying design problems in medical pictograms? and (2) Do the turkers' demographic characteristics affect their performance in medical pictogram comprehension?
  
  
  METHODS
  We designed a Web-based survey (open-ended tests) to ask 100 US turkers to type in their guesses of the meaning of 20 US pharmacopeial pictograms. Two judges independently coded the turkers' guesses into four categories: correct, partially correct, wrong, and completely wrong. The comprehensibility of a pictogram was measured by the percentage of correct guesses, with each partially correct guess counted as 0.5 correct. We then conducted a content analysis on the turkers' interpretations to identify misunderstandings and assess whether the misunderstandings were common. We also conducted a statistical analysis to examine the relationship between turkers' demographic characteristics and their pictogram comprehension performance.
  
  
  RESULTS
  The survey was completed within 3 days of our posting the task to the MTurk, and the collected data are publicly available in the multimedia appendix for download. The comprehensibility for the 20 tested pictograms ranged from 45% to 98%, with an average of 72.5%. The comprehensibility scores of 10 pictograms were strongly correlated to the scores of the same pictograms reported in another study that used oral response-based open-ended testing with local people. The turkers' misinterpretations shared common errors that exposed design problems in the pictograms. Participant performance was positively correlated with their educational level.
  
  
  CONCLUSIONS
  The results confirmed that crowdsourcing can be used as an effective and inexpensive approach for participatory evaluation of medical pictograms. Through Web-based open-ended testing, the crowd can effectively identify problems in pictogram designs. The results also confirmed that education has a significant effect on the comprehension of medical pictograms. Since low-literate people are underrepresented in the turker population, further investigation is needed to examine to what extent turkers' misunderstandings overlap with those elicited from low-literate people.
authors.affiliation: School of Information Studies, Syracuse University, Syracuse, NY 13244, USA. byu@syr.edu
authors.forename: Bei
authors.initials: B
authors.lastname: Yu
authors.forename: Matt
authors.initials: M
authors.lastname: Willis
authors.forename: Peiyuan
authors.initials: P
authors.lastname: Sun
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
mesh_terms: D003142:Communication; D063045:Crowdsourcing; D003625:Data Collection; D057220:Health Literacy; D006801:Humans; D020407:Internet; D011786:Quality Control
keywords: Amazon Mechanical Turk; crowdsourcing; health literacy; medical instruction; participatory design; patient communication; pictogram; readability