Exploring the Role of Pictograms in the Comprehension of Pain.

Introduction: Pain is both difficult to see and to articulate and this is challenging for both patients and clinicians. The aim of this study was to develop and test pictograms to describe different pain qualities. Methods: 22 pictograms were developed for evaluation based on pain qualities of the short form McGill Pain Questionnaire, version 2 (SF-MPQ-2). An online matching survey was conducted and disseminated via social media in 2021. Results: An overall matching of 66% or higher between pictogram and pain qualities descriptors was considered a proper matching. This study was carried out internationally (males = 57, age=41y.o. ±16; females = 155, age=41y.o.±17) and in Poland (males=49, age =35y.o.±17; females = 164, age=35y.o.±16). There were 14 pictograms that did not achieve 66% matching in any country. 8 pictograms mutually in all subgroups achieved a matching score of ≥66% regardless of geographic location, sex, income, or education level. Discussion and Conclusions: These 8 pictograms can be used clinically once they have been redrawn to improve consistency, and future research in the design of pictograms representing pain qualities of the SF-MPQ-2 should focus on design improvements for the remaining 14 pain qualities with poor comprehensibility.

Pictograms for safer medication handling by health care workers: a validation study in nursing students in Poland.

BACKGROUND AND OBJECTIVE: Medication use often causes errors that are dangerous to the health of patients. Previous studies indicate that the use of pharmaceutical pictograms can effectively reduce medication errors. The purpose of this study was to determine the comprehensibility, representativeness, and recall rate of nine medication safety pictograms in a sample of nursing students in Poland in order to validate these images. METHODS: A pictogram validation study was conducted in two phases among nursing students at the Hipolit Cegielski State University of Applied Sciences, Gniezno, Poland. All experimental protocols were approved by the Children's Hospital of Eastern Ontario Research Ethics Board (REB Protocol No: 19/122X). All methods were carried out in accordance with relevant guidelines and regulations. In phase 1, the participants' first exposure to the pictograms, the students were asked to guess the meaning of the pictograms without any additional information in order to assess the pictograms' comprehensibility. To be considered valid, according to ISO standards, the pictograms had to be correctly understood by at least 66.7% of participants. After testing all pictograms, students were given explanations and meanings of the pictograms and asked to rate the representativeness of pictograms. To do so, participants were asked to select a number on a seven-point Likert-style scale to indicate the perceived strength of the relationship between the pictogram and its intended meaning for each pictogram. To be considered valid, a pictogram had to be rated at least five on this scale by at least 66.7% of participants. Phase 2 took place four weeks later, during which recall of the intended meaning and representativeness were assessed following the same procedure. RESULTS: A total of 66 third-year nursing students participated in both phases. In phase 1, of the nine pictograms, six met ISO requirements for comprehensibility and seven met ISO requirements for representativeness. In phase 2, all nine pictograms were correctly understood and rated at least 5 by at least 66.7% of participants. Therefore, all nine pictograms are considered valid. CONCLUSIONS: The nine medication safety pictograms can be deployed, but must be combined with training and a written hazard statement to improve comprehension.

Development of Pictograms to Enhance Medication Safety Practices of Health Care Workers and International Preferences.

BACKGROUND: A panel of medication management experts previously identified 9 key medication safety issues and high-alert drug classes as representing the most pressing medication-handling issues in health care. OBJECTIVE: To develop medication safety pictograms depicting medication safety issues and high-alert drug classes that represent medication-handling risks for health care personnel. METHODS: An iterative design process, including activities such as semiotic analysis, design/redesign, and evaluation, was used to develop medication safety pictograms. Nurses, physicians, pharmacists, and students listed and drew graphic elements to depict each of the 9 key medication safety issues. Graduate students in graphic design developed the preliminary pictograms for the study. A Delphi survey was then conducted with experts recruited from the International Pharmaceutical Federation to reach consensus on the pictograms and provide feedback to the graphic designers. Health care providers from around the world were invited to participate in a survey to determine a preferred pictogram for each safety warning. RESULTS: For each medication safety issue, 3 to 5 pictograms were developed on the basis of graphic elements suggested by 52 health care providers. These pictograms were then presented to 58 experts in 2 rounds of a Delphi process. For each medication safety issue, consensus on the 2 best pictograms was reached and feedback provided. A total of 799 participants from 61 countries responded to the international preference survey. Most of the participants (n = 536, 67.1%) were Canadian, and of those, 385 (71.8%) were pharmacists. In 8 categories, consensus on the preferred pictogram was reached across the health care professions; however, a difference in preference was apparent for the pictogram representing "neuromuscular blocking agent", with nurses' preferred pictogram differing from the preference of other participants. CONCLUSION: This project produced pictograms to illustrate 9 important medication safety issues, which can now be validated through comprehension and recall assessments. Further study can also determine their potential to reduce medication administration errors.

CONTEXTE: Un groupe d'experts en gestion des médicaments avait auparavant établi neuf principales questions de sécurité des médicaments ou classes de médicaments de niveau d'alerte élevé qui méritaient l'attention la plus urgente en santé du point de vue de la manipulation des médicaments. OBJECTIF: Concevoir des pictogrammes de sécurité des médicaments qui illustrent adéquatement les questions de sécurité des médicaments et les classes de médicaments de niveau d'alerte élevé représentant des risques pour le personnel en santé lors de la manipulation des médicaments. MÉTHODES: Un processus de conception itératif (comprenant des activités comme l'analyse sémiotique, la conception et la rectification, et l'évaluation) a été employé pour créer des pictogrammes de sécurité des médicaments. Du personnel infirmier, des médecins, des pharmaciens et des étudiants ont dressé une liste d'éléments graphiques qu'ils ont dessinés afin d'illustrer chacune des neuf principales questions de sécurité des médicaments. Des étudiants diplômés en graphisme ont conçu les ébauches de pictogrammes destinées à l'étude. Un sondage Delphi a ensuite été mené auprès d'experts recrutés au sein de la Fédération internationale pharmaceutique afin de dégager un consensus quant aux pictogrammes et de fournir des commentaires constructifs aux graphistes. Des fournisseurs de soins de santé de partout dans le monde ont été invités à répondre à un sondage pour déterminer quel pictogramme privilégier pour chacune des mises en garde. RÉSULTATS: Pour chaque question de sécurité des médicaments, entre trois et cinq pictogrammes ont été conçus à partir d'éléments graphiques proposés par 52 fournisseurs de soins de santé. Ces pictogrammes ont ensuite été présentés à 58 experts au cours d'un processus Delphi à deux phases. Pour chacune des questions de sécurité des médicaments, un consensus sur les deux meilleurs pictogrammes a été atteint et des commentaires constructifs ont été émis. Au total, 799 participants de 61 pays ont répondu au sondage international sur leurs préférences. La majorité des participants (n = 536, 67,1 %) étaient Canadiens et parmi eux, 385 (71,8 %) étaient pharmaciens. Dans huit catégories, l'ensemble des professions ont atteint un consensus quant au pictogramme à privilégier. Cela n'a pas été le cas pour le pictogramme représentant les « bloqueurs neuromusculaires ¼, car le personnel infirmier a privilégié un pictogramme différent de celui préféré par les autres professions participantes. CONCLUSIONS: Ce projet a produit des pictogrammes pour illustrer neuf importantes questions de sécurité des médicaments. Ces pictogrammes peuvent maintenant être validés à l'aide de tests de compréhension et de mémoire. De plus amples études pourront aussi déterminer dans quelle mesure ces pictogrammes aident à réduire les erreurs d'administration de médicaments.

Shared decision-making to improve attention-deficit hyperactivity disorder care.

OBJECTIVE: To examine the effect of a shared decision-making intervention with parents of children newly diagnosed with attention-deficit/hyperactivity disorder. METHODS: Seven pediatricians participated in a pre/post open trial of decision aids for use before and during the office visit to discuss diagnosis and develop a treatment plan. Encounters pre- (n=21, control group) and post-intervention implementation (n=33, intervention group) were compared. We video-recorded encounters and surveyed parents. RESULTS: Compared to controls, intervention group parents were more involved in shared decision-making (31.2 vs. 43.8 on OPTION score, p<0.01), more knowledgeable (6.4 vs. 8.1 questions correct, p<0.01), and less conflicted about treatment options (16.2 vs. 10.7 on decisional conflict total score, p=0.06). Visit duration was unchanged (41.0 vs. 41.6min, p=0.75). There were no significant differences in the median number of follow-up visits (0 vs. 1 visits, p=0.08), or the proportion of children with medication titration (62% vs. 76%, p=0.28), or parent-completed behavior rating scale to assess treatment response (24% vs. 39%, p=0.36). CONCLUSIONS: Our intervention increased shared decision-making with parents. Parents were better informed about treatment options without increasing visit duration. PRACTICE IMPLICATIONS: Interventions are available to prepare parents for visits and enable physicians to elicit parent preferences and involvement in decision-making.