Refining teratogen warning symbols for diverse populations

Comprehension of Pictograms Demonstrating the Risk of Medication Use During Pregnancy: A Systematic Review

OBJECTIVE

This study aimed to summarize the comprehension of a pictogram about the risk of medication use during pregnancy.

METHODS

A systematic review was performed using the PRISMA checklist of the PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycInfo, LILACS, Academic Search Premier, Scopus, and Web of Science databases, grey literature (Google Scholar and OpenAIRE), ClinicalTrials.gov website, and design journals and congresses. The search was performed since the database inception, without language or year of publication restrictions.

RESULTS

Twelve studies met the inclusion criteria for this review, 2 of which were randomized clinical trials. The pictograms and methods used varied widely among studies. The comprehension of the pregnancy pictograms had a complex communication outcome with a variation of 21-96%.

CONCLUSIONS FOR PRACTICE

The lack of a standard pictogram and uniform methods to evaluate the comprehension of the pregnancy pictogram made it challenging to reach a conclusion with the studies available to date on the safety and efficacy of the pregnancy pictogram to alert the risk of medication use.

Health literacy in an orthopaedic trauma patient population: improving patient comprehension with informational intervention

OBJECTIVES

This study aims to evaluate the change in comprehension of diagnoses, treatment plans, and discharge instructions after orthopaedic trauma patients are given an informational document that includes pictorial representations at the time of discharge. It also seeks to determine if the intervention has a greater impact on patients with lower educational backgrounds.

DESIGN

Prospective comparative cohort study.

SETTING

Academic level 1 trauma center.

PATIENTS

From April to December 2011, 529 orthopaedic trauma patients with an operatively fixed isolated fracture were eligible for inclusion. Two hundred ninety-nine eligible questionnaires were collected (56.5% response rate).

INTERVENTION

Patients were administered a questionnaire regarding their treatment and discharge instructions during their first postoperative clinic visit before being seen by a physician. The questionnaire included demographic information and questions regarding: (1) which bone was fractured, (2) type of implanted fixation, (3) weight-bearing status, (4) expected recovery time, and (5) need for deep vein thrombosis prophylaxis. All patients had received verbal instructions outlining this information at postoperative hospital discharge. During the second half of the study, patients were given an additional informational sheet with both text and pictorial representations at discharge. Multivariable log-binomial regression analyses were used to examine the impact of this intervention.

RESULTS

One hundred forty-six patients were given only the standard discharge instructions, whereas 153 patients were also administered the additional information document. The mean score for patients who received the intervention was 2.90 (out of 5) compared with the mean score of 2.54 for patients who did not receive the intervention (P = 0.013). Patients who received the intervention were 1.3 times more likely to know which bone was fractured (P = 0.007) and 1.1 times more likely to be able to correctly name the medication(s) they were prescribed for deep vein thrombosis prophylaxis (P = 0.03).

CONCLUSIONS

Overall performance on comprehension questionnaires in orthopaedic trauma patients was significantly improved via a text and pictorial intervention. The intervention did not preferentially aid patients with lower education backgrounds. Future studies should evaluate long-term postoperative results to determine if improved patient comprehension has an effect on surgical outcomes and patient satisfaction.

On Warning Symbols, Text, and ‘getting it right’: The Iterative Refinement of a Teratogenic Pharmaceutical Label

Several birth defects warning symbols identified as most successful in an earlier study (Mayhorn & Goldsworthy, 2007) were further modified and then evaluated within a nationally distributed field trial (n = 2773). A total of 11 warning labels were examined: 4 new symbols plus the existing baseline symbol, each in versions with and without text, plus a text-only condition. Participant interpretation accuracy and preferences were assessed. For symbol-only conditions, several candidate symbols outperformed the existing symbol, one substantially so. The effect of adding text to symbols varied significantly by symbol. Symbol+text and text-only conditions performed equivalently, generally exceeded symbol-only conditions, and often surpassed the ANSI benchmark of 85% accurate interpretation. Implications are drawn from the process and outcomes in relation to warning design, warning evaluation, and future research.

Interpretation of pharmaceutical warnings among adolescents

PURPOSE

Warnings are an important component of pharmaceutical risk mitigation efforts, yet very little research attention has been directed toward adolescent interpretation of such warnings. This study examined adolescents' interpretations of and preferences for warning symbols and statements related to pharmaceuticals with teratogenic properties.

METHODS

A total of 200 adolescents interpreted one of four warning symbols and four warning statements. Responses were coded using an established three-tier coding system. Symbol preferences were elicited. Interpretation accuracy and symbol preferences were analyzed by symbol and statement.

RESULTS

The symbol in use on medication labels at the time of the study elicited nearly goal levels of interpretation accuracy; however it exceeded allowable levels of critical confusion. An alternative symbol elicited more fully correct responses than the existing symbol and was preferred to the existing symbol by a margin of 2 to 1. Yet another symbol was most preferred despite eliciting fewer correct interpretations. The impact of warning statements on overall warning interpretation varied by statement and statement-symbol combinations. At least one statement appeared to lessen the overall message of caution, and few adolescents expressed an awareness of risk if one "may become pregnant" until explicitly informed of this risk.

CONCLUSIONS

Comprehension of medical warning symbols and statements among adolescents is an important public health issue. Those involved in adolescent health education and research have considerable theoretical and practical tools for approaching the development and evaluation of such warning messages. Understanding how warnings are interpreted can lead to more effective communication efforts and reduce risk.