This is an excerpt of a more significant research proposal I wrote this past Winter (2023). The research was highly informative for my profession and career. 

Abstract

Health literacy is the ability for patients to comprehend complex health information and make informed decisions relating to their health. The study proposes visual aids to bridge the communication gap between health professionals and patients. The World Health Organization (WHO) and the Center for Disease Control (CDC) recommend using visual aids in health communication materials, citing their usefulness in increasing health literacy. Visual aids are evaluated for their effectiveness in producing positive patient outcomes, behavior changes, and identifying scenarios where visual aids increase comprehension of health-related information. Instead of recommending visual aids as the only tool to increase health literacy, the study examines their effectiveness in clinical practice when paired with textual communications. The research engages the current discussion among health communicators, public health professionals and organizations, and academics in the field of health communication.

Literature Review

The synthesized literature presented will inform the research investigating the effectiveness of visual aids as tools to increase health literacy. The current project will also research visual aids’ efficacy in producing positive patient outcomes, behavior changes, and scenarios where visual aids should be employed for health communicative purposes. The study does not suggest that visual aids are the only tool to increase health literacy; instead, it explores their effectiveness in clinical practice. The literature review will use terms like a visual aid, illustration, infographic, or comic; the terms are used interchangeably. Provided definitions of visual aids and health literacy are guiding tenants for research. In addition, health communicative scholarly research creates the foundation for visual aids' effectiveness in increasing health literacy in clinical practice.

Defining Health Literacy and Textual Informatic Visual Aids

The U.S. Department of Health and Human Services initiative, “Health Literacy in Healthy People 2030,” separates the definition of health literacy into two categories; personal and organizational health literacy (Health Literacy in). Personal health literacy is the ability for individuals to understand and use the information to make informed decisions relating to their health. Organizational health literacy is an agency’s ability to inform its audience of health-related topics (Health Literacy in). Park et al. (1) share a complimentary health literacy definition quoting [1]Nielsen-Bholman from the Committee on Health Literacy (qtd. in Park 1). Nielsen-Bholman additionally clarifies that health literacy is the ability for a patient to comprehend health information to the effect they can make an informed decision about their health (Park et. al 1). Hafner et al. (6) define visual aids as "all media that are used to give information with the aid of non-moving images (aid to verbal or written information)." Additionally, "images comprise photographs, illustrations, drawings, infographics (method to visually communicate information) or pictograms” (Hafner et al. 6). Visual aids cannot determinately be a tool to increase health literacy if contributing factors are not considered. Kutner et al.'s (3) creation of the health literacy assessment administered to nineteen thousand individuals between the ages of sixteen and older is the most comprehensive health literacy study in the United States. The researchers systemized participant evaluative results in four sections determining if participants

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[1] Institute of Medicine (US) Committee on Health Literacy. Health Literacy: A Prescription to End Confusion. Edited by Lynn Nielsen-Bohlman et. al., National Academies Press (US), 2004. doi:10.17226/10883

had basic, below basic, intermediate, or proficient health literacy levels (Kutner et al. 10). Kutner et al.'s (10) findings concluded fifty-three percent of participants had intermediate health literacy, twenty-two percent of participants had basic health literacy, fourteen percent of participants had below basic health literacy, and twelve percent of participants had proficient health literacy in the United States in the year two-thousand and three. Royal and Erdmann's (99) study emphasizes the alarming number of adults in the United States with low health literacy. It underscores the medical community's need for communication materials readable for public consumption (Royal and Erdmann 99).

The Center for Disease Control’s health literacy information page, “Understanding Literacy & Numeracy,” recognizes the significance of health organizations and health professionals in recognizing and addressing health literacy as a detriment to health. Furthermore, it underscores that people with high literacy will not automatically have a proficient level of health literacy (Understanding Literacy &). Logan et al. (7) emphasize the intersection between health literacy and communication, explicitly stating the need for health communicators to promote patient-friendly language and pay mind to the current strategies for health promotion. Logan et al. add, “Without health literacy, medicine fails, public health fails, and people pay the cost for those failures with their lives,” (Logan et al. 9). The source exclaims what most articles regarding health literacy maintain; without health literacy or tools to increase health literacy, the problem is a matter of life and death.

Bridging the Gap between Providers and Patients

Patients with proficient health literacy have increased recall of health-related topics making informed decisions about their health, thus, increasing positive health outcomes. Researchers Kaufmann et al. (290) acknowledge the communication gap and assumptions between doctors and patients and propose visual aids to bridge the communication gap. The problem statement exemplifies patient struggle with information recall when medical recommendations are advised verbally alone, adding that low recall leads to poor health outcomes (Kaufmann et al. 291). Furthermore, Kempen et al. (323) complement Kaufmann et al. (292) visual aid research highlighting that information distributed visually is processed rapidly. Information recall that informs positive patient outcomes is successful when paired with medical illustrations and textual information (Kempen et al. 323).

The “gap” between health communication materials and their audience is recognized by scholars in the health field, noting specific areas of consideration. Written information is processed rapidly, causing patients to lack information recall, the lack of information recall retained from verbal information, and lower literacy rates comprehending textual information. Garrison-Joyner and Caravella (4) argued that illustrations are an effective communicative tool when culturally responsive, emphasizing the correlation between fear of adverse health outcomes for patients with low health literacy. The researchers suggest acknowledging health disparities in lower-income communities and proposing visual aids to increase health literacy (Garrison-Joyner and Caravella 18). Baxter et al. (150) complimentarily share their study results and the correlation between increased comprehension of health information in participants with lower literacy, furthering Garrison-Joyner and Caravella's (18) suggestion for visual application.

Baxter et al. (150) stress that educating communities with user-friendly infographics will not automatically increase health literacy. The application of design principles, consideration of multi-media learning, and cognitive principles inform a successful infographic. Likewise, Royal and Erdmann's (99) infographic research of twenty-two revealed recommendations for health communicators to increase the readability of materials, thereby increasing patients' health literacy and positive health outcome (Royal and Erdmann 102). Font variations in style and size and education level of text readability are considerations Royal and Erdmann (102) explored, causing the emphasis on illustration intentionality. Visual aids are helpful when they are intentional and illustrate health information (Royal and Erdmann 102). Notably, multiple selected sources emphasize the worth of health communication materials, including illustrations, illuminating the need for visual aids on a situational basis.

Making health literacy a more accessible skill among all demographics is a communal effort with various suggested tools to achieve competency; visual aids are only one tool suggested by health professionals. Visual aids are communicative tools with textual information and illustrations that reflect topical communications, increasing readability with written and visual explanations of health-related topics. A question Haragi et al. (158) contemplate is the function and relationship of medical illustrations in health communication materials. Haragi et al. investigate each necessary step in the design of health materials, defining illustrative categories (160) and textual communications (160) and discussing the design and evaluation of illustrations (162). Additionally, their pilot study with three-hundred forty-five elementary school students from grades four to six (163) indicates illustrations' ability to increase health literacy when illustrations complement textual information. Nonetheless, consideration of overly complex medical illustrations needs evaluation prior to dissemination, especially when they intend to increase health literacy (Haragi et al. 166).

Comprehensibility for All Literacy Levels

Dowse's (22) study of participants in South Africa advance Garrison-Joyner and Caravella's (18) and Haragi et al.'s (163) positions of the usefulness that illustrations lend to people with poor literacy, increasing their understanding and recall of health information. Dowse questions their efficacy in culturally diverse populations by concentrating on pharmaceutical illustrations on patients' medicine packages. Dowse (22) emphasizes low literacy rates, as eighteen percent of South Africans did not have formal education in primary years and above. Lower literacy means that patients' visual literacy and ability to conceptualize illustrations may not be more proficient. The study determines that years spent in formal education are not an accurate predictor of patients' level of visual literacy. Dowse suggests that paired written, verbal, and visual communication forms increase patients' understanding and recall of health information (Dowse 25).

The explicit re-emphasis from scholars in the field, such as Royal and Erdmann (102), Baxter et al. (150), Dowse (25), Haragi et al. (166), makes clear that illustrations, visual aids, infographics, and comics, alike, can increase health literacy. Nevertheless, these researchers stress careful consideration of the audience prior to informatic dissemination. Meppelink et al. (1183) clearly state the significance of making an informed decision deciding when it is appropriate to include illustrations on informatic health materials. Informed decisions are made when current awareness of knowledge and attitudes are weighed. Propositionally, Meppelink et al. (1182) hypothesize that textual information prepared for patients with low health literacy is comprehensible for people with high health literacy, improving recall and attitudinal change for both parties. The scholars propose illustrations as a complementary tool paired with readable text as a helpful health communicative device (Meppelink et al. 1183).

            The World Health Organization (WHO) “communicating for health” webpage has a section for health professionals dedicated to the use of visual aids (Make it visual). At the top of the page, WHO states, “communicators increasingly share health information through visual means.” Furthermore, underlining that visual aids increase understandability for people of all literacy and education levels (Make it visual). The literature synthesis assesses supporting and contrasting scholarly research questioning the effectiveness of visual aids’ ability to increase health literacy. Unambiguously, illustrations should be applied on a situational basis with consideration of audience, literacy, and additional environmental factors explored in this analysis.

Patients with higher levels of health literacy can grasp medical information; understanding and recalling medical information empowers them to make an informed decision about their health. When patients are armed with information, make a choice related to their health, and have a positive medical outcome, it means that their health literacy has increased. Because the previous statement is factually true, it means that informational materials with visual aids do increase health literacy. The literature review advocates for the effectiveness of visual aids in health communication, and further research in the area will solidify its situational efficacy.

Works Cited