Effect of Pictograph-based Discharge Instructions for Older Low-Literate Adults with Hip Replacement Surgery

2.50
Hdl Handle:
http://hdl.handle.net/10755/325570
Category:
Abstract
Type:
Research Study
Level of Evidence:
Other
Research Approach:
Quantitative Research
Title:
Effect of Pictograph-based Discharge Instructions for Older Low-Literate Adults with Hip Replacement Surgery
Author(s):
Choi, Jeungok
Lead Author STTI Affiliation:
Beta Zeta-at-Large
Author Details:
Jeungok Choi, PhD, MPH, RN, jeungokc@nursing.umass.edu - recipient of 2011 STTI Small Grant
Abstract:

Introduction:

Discharge instructions for hip replacement surgery are difficult to follow at home with the current text-based format because written text alone is not suitable for presenting lengthy, complex discharge instructions. To address this issue, the PI used pictographs (simple line drawings showing explicit discharge care actions to be taken) in addition to the simplified text. This approach is based on human cognitive preference for picture-based, rather than text-based, information. 

Aims:

The aim of this study was to evaluate the effect of pictograph-based discharge instructions, relative to current text-only instructions, on older low-literate adults’ (a) comprehension, recall, and adherence to discharge instructions, and (b) postsurgical complications (hip dislocation, infection in the incision, and leg blood clots) and readmission to hospital or emergency department 4 weeks after discharge from the hospital.

Methods:

Study design. Forty-two (42) consenting participants undergoing hip-replacement surgery were randomly assigned to receive either Web-based, pictograph discharge instructions (intervention, n=21) or the hospital’s usual text-only instructions (comparison, n=21).

Procedure. Participants were recruited from one rehabilitation hospital in western MA. After written informed consent was obtained, each participant was screened for inclusion and exclusion criteria and was randomly assigned to either the intervention or the comparison group. One or two days before discharge, participants in the intervention group received web-based discharge instructions in a one-on-one teaching session. At the end of the session, participants were given the web key and encouraged to access the web-based instructions at home after discharge. The comparison group received one-page of computer-generated text-only discharge instructions currently offered to patients at the participating hospital.

Measures. Comprehension and recall were measured by the 20-item, PI-developed questionnaire corresponding to 5 sections of the discharge instructions: diagnosis and treatments, medication, warning signs and symptoms, homecare activity advice, and follow-up. Adherence to discharge instructions was measured by self-report using the Discharge Instruction Questionnaire (DIQ). Frequency and type of complications were measured with the three most common and serious complications (dislocation of the hip replacement, infection in the incision, and blood clots in legs). Unscheduled admissions or visits to the hospital and ED were determined from dates of hospital and ED visits within 4 weeks of discharge.

Results:

Participants were mostly female (68.3%, n=28), had a mean age of 67.59 years (SD=5.41), and had a high school or equivalent diploma (50.0%, n=20). Participants were racially diverse (78.4% white, 13.5% African-American, 5.4% Hispanic, and 2.7% Asian/Pacific Islander). Participants’ mean S-TOFHLA score was 20.81 (SD=9.52), indicating marginal or inadequate health literacy.

Significantly greater improvements in scores on the comprehension/ recall questionnaire were found in the pictograph-formatted instruction group (intervention, mean=15.72, SD=3.23) than the written text-only instruction group (comparison, mean=12.89, SD=3.84):  t(35)= 2.43, p =.02.  There was also a significant difference in the DIQ scores (t(37)=3.52, p=.001) between the pictograph-formatted instruction group  (intervention, mean=4.16, SD=.69) and the written text-only instruction group (comparison, mean=3.32, SD=.78). However, there were no significant differences in the frequencies of complications (Chi-square (1) =2.29, p=.13), ED visits (Chi-square (1) =4.08, p=.05) and hospital readmission (Chi-square (1) =2.93, p=.09).

Discussion:

Our study indicates that the pictograph-formatted instructions are effective in improving the comprehension/recall and discharge adherence of older adults with low literacy skills. However, there were no significant differences in frequencies of complications, ED and hospital admissions. This lack of significance may be due to the low occurrence of complications, ED and hospital readmissions and the small sample size (n=42). Future studies are suggested using a larger sample to further validate the study findings.

Conclusion:

Pictograph instructions can provide an effective strategy to improve discharge communication for older low-literate adults. This approach (using pictographs) can also be used to develop healthcare education materials for immigrants when language barriers present significant communication challenges for healthcare providers. Addressing the communication needs of immigrants using pictograph-formatted discharge instructions can be more efficient and practical than having interpreters and pre-translated healthcare materials available in healthcare settings.  

Keywords:
pictographs; discharge instructions; low health literacy; older adults; comprehension/recall; hip replacement surgery
MeSH:
Patient Discharge Education; Patient Education Handout; Arthroplasty, Replacement, Hip; Aged; Illiteracy
Repository Posting Date:
29-Aug-2014
Date of Publication:
29-Aug-2014
Citation:
Jeungok, C. (2011). Pictograph-Based Discharge Instructions for Low-Literate Older Adults After Hip Replacement Surgery. Journal Of Gerontological Nursing, 37(11), 47-56. doi:10.3928/00989134-20110706-03
Sponsors:
Sigma Theta Tau International
Note:
The Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryAbstracten
dc.typeResearch Studyen
dc.evidence.levelOtheren
dc.research.approachQuantitative Researchen
dc.titleEffect of Pictograph-based Discharge Instructions for Older Low-Literate Adults with Hip Replacement Surgeryen_US
dc.contributor.authorChoi, Jeungok-
dc.contributor.departmentBeta Zeta-at-Largeen
dc.author.detailsJeungok Choi, PhD, MPH, RN, jeungokc@nursing.umass.edu - recipient of 2011 STTI Small Granten_GB
dc.identifier.urihttp://hdl.handle.net/10755/325570-
dc.description.abstract<p><strong>Introduction: </strong></p> <p>Discharge instructions for hip replacement surgery are difficult to follow at home with the current text-based format because written text alone is not suitable for presenting lengthy, complex discharge instructions. To address this issue, the PI used pictographs (simple line drawings showing explicit discharge care actions to be taken) in addition to the simplified text. This approach is based on human cognitive preference for picture-based, rather than text-based, information.<strong style="font-size: 13px;"> </strong></p> <p><strong>Aims:</strong></p> <p>The aim of this study was to evaluate the effect of pictograph-based discharge instructions, relative to current text-only instructions, on older low-literate adults’ (a) comprehension, recall, and adherence to discharge instructions, and (b) postsurgical complications (hip dislocation, infection in the incision, and leg blood clots) and readmission to hospital or emergency department 4 weeks after discharge from the hospital.</p> <p><strong>Methods:</strong></p> <p><strong>Study design. </strong>Forty-two (42) consenting participants undergoing hip-replacement surgery were randomly assigned to receive either Web-based, pictograph discharge instructions (intervention, n=21) or the hospital’s usual text-only instructions (comparison, n=21).</p> <p><strong>Procedure. </strong>Participants were recruited from one rehabilitation hospital in western MA. After written informed consent was obtained, each participant was screened for inclusion and exclusion criteria and was randomly assigned to either the intervention or the comparison group. One or two days before discharge, participants in the intervention group received web-based discharge instructions in a one-on-one teaching session. At the end of the session, participants were given the web key and encouraged to access the web-based instructions at home after discharge. The comparison group received one-page of computer-generated text-only discharge instructions currently offered to patients at the participating hospital.</p> <p><strong>Measures. </strong>Comprehension and recall were measured by the 20-item, PI-developed questionnaire corresponding to 5 sections of the discharge instructions: diagnosis and treatments, medication, warning signs and symptoms, homecare activity advice, and follow-up. Adherence to discharge instructions was measured by self-report using the Discharge Instruction Questionnaire (DIQ). Frequency and type of complications were measured with the three most common and serious complications (dislocation of the hip replacement, infection in the incision, and blood clots in legs). Unscheduled admissions or visits to the hospital and ED were determined from dates of hospital and ED visits within 4 weeks of discharge.</p> <p><strong>Results:</strong></p> <p>Participants were mostly female (68.3%, n=28), had a mean age of 67.59 years (SD=5.41), and had a high school or equivalent diploma (50.0%, n=20). Participants were racially diverse (78.4% white, 13.5% African-American, 5.4% Hispanic, and 2.7% Asian/Pacific Islander). Participants’ mean S-TOFHLA score was 20.81 (SD=9.52), indicating marginal or inadequate health literacy.</p> <p>Significantly greater improvements in scores on the comprehension/ recall questionnaire were found in the pictograph-formatted instruction group (intervention, mean=15.72, SD=3.23) than the written text-only instruction group (comparison, mean=12.89, SD=3.84): <em> t</em>(35)= 2.43, <em>p</em> =.02.  There was also a significant difference in the DIQ scores (<em>t</em>(37)=3.52, <em>p</em>=.001) between the pictograph-formatted instruction group  (intervention, mean=4.16, SD=.69) and the written text-only instruction group (comparison, mean=3.32, SD=.78). However, there were no significant differences in the frequencies of complications (<em>Chi-square</em> (1) =2.29, <em>p</em>=.13), ED visits (<em>Chi-square</em> (1) =4.08, <em>p</em>=.05) and hospital readmission (<em>Chi-square</em> (1) =2.93, <em>p</em>=.09).</p> <p><strong>Discussion:</strong></p> <p><strong></strong>Our study indicates that the pictograph-formatted instructions are effective in improving the comprehension/recall and discharge adherence of older adults with low literacy skills. However, there were no significant differences in frequencies of complications, ED and hospital admissions. This lack of significance may be due to the low occurrence of complications, ED and hospital readmissions and the small sample size (n=42). Future studies are suggested using a larger sample to further validate the study findings.<strong></strong></p> <p><strong>Conclusion:</strong></p> <p>Pictograph instructions can provide an effective strategy to improve discharge communication for older low-literate adults. This approach (using pictographs) can also be used to develop healthcare education materials for immigrants when language barriers present significant communication challenges for healthcare providers. Addressing the communication needs of immigrants using pictograph-formatted discharge instructions can be more efficient and practical than having interpreters and pre-translated healthcare materials available in healthcare settings.  </p>en_GB
dc.subjectpictographsen_GB
dc.subjectdischarge instructionsen_GB
dc.subjectlow health literacyen_GB
dc.subjectolder adultsen_GB
dc.subjectcomprehension/recallen_GB
dc.subjecthip replacement surgeryen_GB
dc.subject.meshPatient Discharge Educationen_US
dc.subject.meshPatient Education Handouten_US
dc.subject.meshArthroplasty, Replacement, Hipen_US
dc.subject.meshAgeden_US
dc.subject.meshIlliteracyen_US
dc.date.available2014-08-29T20:26:15Z-
dc.date.issued2014-08-29-
dc.date.accessioned2014-08-29T20:26:15Z-
dc.identifier.citationJeungok, C. (2011). Pictograph-Based Discharge Instructions for Low-Literate Older Adults After Hip Replacement Surgery. Journal Of Gerontological Nursing, 37(11), 47-56. doi:10.3928/00989134-20110706-03en
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
dc.identifier.citationJeungok, C. (2011). Pictograph-Based Discharge Instructions for Low-Literate Older Adults After Hip Replacement Surgery. Journal Of Gerontological Nursing, 37(11), 47-56. doi:10.3928/00989134-20110706-03en
dc.description.noteThe Sigma Theta Tau International grant application that funded this research, in whole or in part, was completed by the applicant and peer-reviewed prior to the award of the STTI grant. No further peer-review has taken place upon the completion of the STTI grant final report and its appearance in this repository.en
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