Development and implementation of plain language, pictogram-based materials to improve physician/parent communication about medication instructions

A disproportionate percentage of those with low socioeconomic (SES) status have a documented higher risk of poor health compared to the overall population. Low literacy and limited English language proficiency are important components that contribute to existing disparities. The NYU/Bellevue H.E.L.P. (Health Education and Literacy for Parents) Project designed and evaluated a low literacy intervention to help low SES parents understand and follow medication treatment plans. The plain-language, pictogram-based, medication-specific instruction and reminder/tracking sheets are tailored for individual patients and are available in English and Spanish. Pediatricians review these materials with parents and provide easy-to-use, standardized dosing instruments when liquid medication is prescribed.

Studies demonstrate the benefit of reinforcing verbal communications with pictograms and written instructions. Such reinforcement has considerable potential for decreasing medication errors, however, pediatric research in this area is limited. We thus performed a randomized controlled trial to assess the pictogram-based intervention in Bellevue Hospital's pediatric emergency room. Intervention caregivers had significantly improved medication knowledge, dosing accuracy, and adherence.

Materials designed to enhance patient/provider communication must not only be effective, but must also be easy for providers to use. Computer software was developed to allow the provider to quickly choose the medication dose, frequency, and duration, as well as the language needed.

This presentation describes the development of the intervention, from design to implementation, including the training of health care providers. Topics of discussion will include design of pictograms, use of plain language instructions, pilot testing with multicultural/multilingual clinic patients, and use of consultants.