Julia A. Bucher

Using pictographs to enhance recall of spoken medical instructions II

The first study in this series [Houts PS, Bachrach R, Witmer JT, Tringali CA, Bucher JA, Localio RA. Patient Educ. Couns. 1998;35:83-8] found that recall of spoken medical instructions averaged 14% but that, when pictographs (drawings representing the instructions) accompanied the spoken instructions and were present during recall, 85% of medical instructions were remembered correctly. Those findings suggested that spoken instructions plus pictographs may be a way to give people with low literacy skills access to medical information that is normally available only in written form. However, there were three important limitations to that study: (1) the subjects were literate and perhaps literate people remember pictograph meanings better than people with low literacy skills; (2) only short term recall was tested and, for medical information to be useful clinically, it must be remembered for significant periods of time and (3) a maximum of 50 instructions were shown in pictographs, whereas managing complex illnesses may require remembering several hundred instructions. This study addresses those limitations by investigating 4-week recall of 236 medical instructions accompanied by pictographs by people with low literacy skills. Subjects were 21 adult clients of an inner city job training program who had less than fifth grade reading skills. Results showed 85% mean correct recall of pictograph meanings immediately after training (range from 63 to 99%) and 71% after 4 weeks (range from 33 to 94%). These results indicate that people with low literacy skills can, with the help of pictographs, recall large amounts of medical information for significant periods of time. The impact of pictographs on symptom management and patient quality of life remains to be studied.

Exploring New Dimensions of an Old Role for Chaplaincy: Community Liaison

Chaplaincy has the opportunity to help local religious communities develop their healing ministries. This article describes one such program. The Prepared Family Caregiver Program provides resources and study guides for chaplains to use in training clergy and other community leaders in how to help family members be better caregivers to persons with cancer. It also provides the resources for the local clergy to use with family members in the training. The material, however, is easily adapted for other chronic diseases. The program provides a way for chaplaincy departments to reach out to their communities and for local religious communities to train volunteers. Materials and training are now available over the Internet.