title: Design and validation of pictograms in a pediatric anaphylaxis action plan.
abstract: BACKGROUND
  Current anaphylaxis action plans (AAPs) are based on written instructions without inclusion of pictograms.
  
  
  OBJECTIVE
  To develop an AAP with pictorial aids and to prospectively validate the pictogram components of this plan.
  
  
  METHODS
  Participants recruited from the emergency department and allergy clinic participated in a questionnaire to validate pictograms depicting key counseling points of an anaphylactic reaction. Children ≥ 10 years of age and caregivers of children < 10 years with acute anaphylaxis or who carried epinephrine auto-injector for confirmed allergy were eligible. Guessability, translucency, and recall were assessed for 11 pictogram designs. Pictograms identified as correct or partially correct by at least 85% of participants were considered valid. Three independent reviewers assessed these outcome measures.
  
  
  RESULTS
  Of the 115 total participants, 73 (63%) were female, 76 (66%) were parents/guardians, and 39 (34%) were children aged 10-17. Overall, 10 pictograms (91%) reached ≥ 85% for correct guessability, translucency, and recall. Four pictograms were redesigned to reach the preset validation target. One pictogram depicting symptom management (5-min wait time after first epinephrine treatment) reached 82% translucency after redesign. However, it reached 98% and 100% of correct guessability and recall, respectively.
  
  
  CONCLUSIONS
  We prospectively designed and validated a set of pictograms to be included in an AAP. The incorporation of validated pictograms into an AAP may potentially increase comprehension of the triggers, signs and symptoms, and management of an anaphylactic reaction.
authors.affiliation: University of Ottawa, Ottawa, ON, Canada.
authors.forename: Garrick
authors.initials: G
authors.lastname: Mok
authors.affiliation: Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
authors.forename: Régis
authors.initials: R
authors.lastname: Vaillancourt
authors.affiliation: Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
authors.forename: Danica
authors.initials: D
authors.lastname: Irwin
authors.affiliation: University of Ottawa, Ottawa, ON, Canada.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Wong
authors.affiliation: Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Zemek
authors.affiliation: Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Waleed
authors.initials: W
authors.lastname: Alqurashi
mesh_terms: D000707:Anaphylaxis / Q000188:drug therapy / Q000453:epidemiology*; D002170:Canada; D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D058015:Health Communication / Q000379:methods* / Q000639:trends; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D010372:Pediatrics / Q000193:education*; D011795:Surveys and Questionnaires
chemical_list: D004837:Epinephrine
keywords: action plan; anaphylaxis; emergency department; pictograms