In what ways does user experience design improve printed educational materials?

We report on a series of four studies that investigated how user experience design (UXD) can improve printed educational materials (PEMs). We examined the perceived usability of an existing PEM for breast cancer screening and observed the usability problems associated with it (Study 1). We then compared a breast cancer screening PEM created by user experience designers with two other breast cancer screening PEMS, finding that the PEM based on UXD had higher perceived usability, and lower mentions of usability problems, than the other two PEMs (Study 2). We next examined the impact of individual differences in design expertise on perceived usability, this time including a PEM on cervical cancer screening as well as one on breast cancer screening (Study 3). Our concluding study (Study 4) then examined the impacts of UXD on learnability of PEM content as defined by answers to a knowledge questionnaire about screening administered before and after reading the PEM, and by intention to screen for cancer after reading the PEM. The first three studies showed that the involvement of UXD improved the perceived usability of PEMs, and Study 3 showed that designers differ in their ability to create useable PEMs. Study 4 failed to find a corresponding improvement in learnability or intention to screen when UXD was used to improve perceived usability. We conclude that a user experience design approach that incorporates graphic design can improve the perceived usability of PEMs in some situations (e.g., when the PEM material is not too lengthy or complex, and when the graphic designer is sufficiently skilled). However, we found no evidence that lack of perceived usability accounted for the failure of PEMS (found in previous research) to improve knowledge or intention to screen.

Educational material for social marketing and behaviours linked to early detection of breast cancer.

BACKGROUND: Social marketing is an effective tool to ensure a populationbased behaviour change for a healthy lifestyle. AIM: The aim was to investigate the effects of breast cancer-related printed educational materials on women's behaviours related to early detection and diagnosis of breast cancer within the framework of social marketing. METHOD: This pre-post test one-group study was conducted with 80 women in a family health centre. An interview form, printed educational materials and follow-up form were used to collect the study data. The data were collected at the baseline and through phone calls at the third month. RESULTS: Of the women, 36% had never performed breast self-examination (BSE), 55% had never had clinical breast examination (CBE), and 41% had never had mammography. There were no differences between the measurements made at the baseline and at the third month in terms of performing BSE, and having CBE and mammography. CONCLUSION: The importance of expanding social marketing approaches in terms of global health investments is emphasised. Adoption of positive health behaviours will lead to improvements in health status, as assessed through measures of morbidity and mortality status in cancer.

Printed educational materials directed at Ontario family physicians do not improve adherence to guideline recommendations for diabetes management: a pragmatic, factorial, cluster randomized controlled trial [ISRCTN72772651].

BACKGROUND: Printed educational materials (PEMs) have long been used to inform clinicians on evidence-based practices. However, the evidence for their effects on patient care and outcomes is unclear. In Ontario, despite widely available clinical practice guidelines recommending antihypertensives and cholesterol-lowering agents for patients with diabetes, prescriptions remain low. We aimed to determine whether PEMs can influence physicians to intensify prescribing of these medications. METHODS: A pragmatic, 2 × 2 factorial, cluster randomized controlled trial was designed to ascertain the effect of two PEM formats on physician prescribing: a postcard-sized message ("outsert") or a longer narrative article ("insert"). Ontario family physician practices (clusters) were randomly allocated to receive the insert, outsert, both or neither. Physicians were eligible if they were in active practice and their patients were included if they were over 65 years with a diabetes diagnosis; both were unaware of the trial. Administrative databases at ICES (formerly the Institute for Clinical Evaluative Sciences) were used to link patients to their physician and to analyse prescribing patterns at baseline and 1 year following PEM mailout. The primary outcome was intensification defined as the addition of a new antihypertensive or cholesterol-lowering agent, or dose increase of a current drug, measured at the patient level. Analyses were by intention-to-treat and accounted for the clustering of patients to physicians. RESULTS: We randomly assigned 4231 practices (39% of Ontario family physicians) with a total population of 185,526 patients (20% of patients with diabetes in Ontario primary care) to receive the insert, outsert, both, and neither; among these, 4118 practices were analysed (n = 1025, n = 1037, n = 1031, n = 1025, respectively). No significant treatment effect was found for the outsert (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.98 to 1.04) or the insert (OR 0.99, 95% CI 0.96 to 1.02). Percent of intensification in the four arms was similar (approximately 46%). Adjustment for physician characteristics (e.g., age, sex, practice location) had no impact on these findings. CONCLUSIONS: PEMs have no effect on physician's adherence to recommendations for the management of diabetes-related complications in Ontario. Further research should investigate the effect of other strategies to narrow this evidence-to-practice gap. TRIAL REGISTRATION: ISRCTN72772651 . Retrospectively registered 21 July 2005.

Randomized Trial of a Children's Book Versus Brochures for Safe Sleep Knowledge and Adherence in a High-Risk Population.

OBJECTIVE: Sleep-related infant deaths have plateaued in the past decade, disproportionately affecting low socioeconomic status (SES) families. Printed materials are widely used for anticipatory guidance, yet none for safe sleep has been studied. We tested the efficacy of a specially designed children's book compared to brochures for safe sleep knowledge and adherence, which we hypothesized would be greater due to superior readability and engagement. METHODS: This randomized controlled trial involved low-SES mothers (n = 282) enrolled in a home visiting program. Home visitors (n = 56) were randomly assigned to perform safe sleep teaching and assessments during 3 visits: third trimester, 1 week old, and 2 months old, exclusively utilizing a specially designed children's book or brochures, and surveys incorporating the American Academy of Pediatrics' safe sleep recommendations. Outcomes were safe sleep knowledge, adherence, and usefulness of materials, controlling for maternal health literacy. RESULTS: Safe sleep knowledge increased across all time points with no overall group difference, though gains for sleep-evocative and general health items varied. Odds of bed sharing were higher and exclusive crib use lower for the brochure group (P < .05). Mothers and home visitors reported similar usefulness, though home visitors reported greater dialogue via the book and mothers in the book group reported more book sharing with their baby. CONCLUSIONS: While a specially designed children's book and brochures were equally effective conveying aggregate safe sleep knowledge in low-SES mothers, adherence to exclusive crib use and avoiding bed sharing were greater in the book group, attributable to enhanced dialogue, readability and emotional engagement. Children's books are a promising mode of anticipatory guidance, warranting further investigation.

Printed Educational Materials' Impact on Tobacco Cessation Brief Interventions in CAM Practice: Patient and Practitioner Experiences.

Printed educational materials (PEMs) have long demonstrated their usefulness as economical and effective media for health communication. In this article, we evaluate the impact of targeted tobacco cessation PEMS for use along with a brief intervention training designed for three types of complementary and alternative medicine (CAM) practitioners: chiropractic, acupuncture, and massage. We describe how PEMs in CAM practitioners' offices were perceived and used by practitioners and by patients. Semistructured qualitative interviews were conducted with 53 practitioners and 38 of their patients. This analysis specifically focused on developing and distributing project-related posters and pamphlets in CAM practice. Our findings indicate that materials (1) legitimated tobacco-related expertise among CAM practitioners and tobacco-related conversations as part of routine CAM practice, (2) increased practitioners' willingness to approach the topic of tobacco with patients, (3) created an effective way to communicate tobacco-related information and broaden the reach of brief intervention initiatives, and (4) were given to patients who were not willing to engage in direct discussion of tobacco use with practitioners.

Developing an alcohol education leaflet for pregnant women using qualitative and quantitative data.

OBJECTIVE: This article summarizes the process of developing and evaluating a series of alcohol educational leaflets with pregnant women. METHODS: Four group interviews were conducted with a total of 33 pregnant women. RESULTS: The copy, font, and color should be tailored to pregnant women. Scientifically compelling information was preferred; the use of too many colors and objects was considered distracting and reducing the seriousness of the information. The facts presented through a patient's photo of fetal alcohol syndrome and a graph impressed the participants, since they were tired of the illustrations found in many other materials. Pregnant women who are interested and motivated to learn about alcohol consumption valued the quality of the information, rather than visual appeal. CONCLUSIONS: Testing a draft leaflet with the target population before final development and dissemination is a critical component of an educational outreach effort. Incorporating feedback can help enhance the quality of the end product.

Elaboração e avaliação de material educativo impresso para auxiliar na adesão medicamentosa de pacientes pediátricos pós-alta hospitalar / Development and evaluation of printed educational material to improve the medication compliance of pediatric patients after hospital discharge

O uso frequente de medicamentos off-label ou não licenciados na área da pediatria é um problema mundial que ocorre devido à indisponibilidade de formas farmacêuticas adequadas com dosagens apropriadas para a administração em crianças. Durante a internação, tal dificuldade pode ser contornada a partir da derivação de formas farmacêuticas sólidas, originando as chamadas preparações líquidas extemporâneas. Porém, para garantir o uso dos medicamentos após a alta hospitalar mesmo quando a família não pode pagar a manipulação destes, faz-se necessária uma orientação adequada de como realizar a derivação em casa pelo próprio cuidador do paciente. Objetivos: elaborar e avaliar um material educativo impresso (MEI) para auxiliar na preparação de medicamentos extemporâneos pós-alta hospitalar em pediatria. Métodos: Foi elaborada uma primeira versão de MEI e avaliada por 26 profissionais da saúde por meio do instrumento EVALPEM (Evaluation of Printed Education Materials) modificado. A partir das contribuições dos profissionais foi elaborada uma segunda versão avaliada por 5 cuidadores de crianças utilizando-se o questionário adaptado de Doak. Resultados: a primeira versão do MEI foi bem aceita pela maioria dos profissionais, onde 80,8% dos participantes consideraram as informações como sendo de qualidade e 87,5% concordaram totalmente com o domínio, legibilidade e características de impressão. A segunda versão obteve 89,1% no domínio compreensão, 90,6% em autoeficácia e 100% em atratividade, aceitação cultural e persuasão. Conclusões: o MEI demonstrou ser uma ferramenta importante para orientar o preparo

The frequent use of non-licensed or off-label drugs in pediatrics is a world problem that occurs due to the unavailability of appropriate pharmaceutical forms with proper doses to administration in children. During hospitalization, this difficulty can be avoided with the derivation of solid pharmaceutical forms, originating the so-called extemporaneous liquid preparations. Nevertheless, to guarantee the use of medication after hospital discharge – especially when the family cannot pay for its manipulation –, it is necessary to provide appropriate guidance to caregivers on how to prepare the derivation at home. Aim: to create and evaluate printed educational material (PEM) to help in the preparation of extemporaneous formulations after hospital discharge in pediatrics. Methods: a first version of the PEM was created and evaluated by 26 health workers, using the instrument EVALPEM (Evaluation of Printed Education Materials) modified. From the contribution of these professionals, a new version was developed and evaluated by five children caregivers, using an adaptation of the Doak questionnaire. Results: The first version of the PEM was well-accepted by most of the professionals, as 80.8% of them completely agreed about the quality of the information and 87.5% totally agreed about the legibility and printing features. The second version received 89.1% of approval in the field understanding, 90.6% in self-effectiveness, and 100% in atractiveness, cultural acceptance, and persuasion. Conclusions: The PEM proved to be an important tool to guide the correct preparation and administration of extemporaneous formulations by the caregivers of pediatric patients