Illustrated Safety Training Materials for Illustrated Safety Training Materials for Low Literacy Carwash WorkersLow Literacy Carwash Workers

Micki BaronMicki BaronOccupational Health BranchOccupational Health Branch

July 1, 2008July 1, 2008

ObjectivesObjectives Summarize current literature on illustrated Summarize current literature on illustrated

health education materialshealth education materials Medication adherence Medication adherence Child injury preventionChild injury prevention

Provide recommendations for current projectProvide recommendations for current project DesignDesign ImplementationImplementation EvaluationEvaluation

MethodsMethods

Search of peer review databasesSearch of peer review databases PubmedPubmed UCSF online journal databaseUCSF online journal database

www search using key termswww search using key terms Few occupational health studiesFew occupational health studies Used studies in health communication and Used studies in health communication and

health literacy health literacy

Four Steps to SuccessFour Steps to Success

AttentionAttention ComprehensionComprehension RecallRecall AdherenceAdherence

AttentionAttention

Pictures increase attention to instructionsPictures increase attention to instructions Culturally relevant/sensitive pictures preferredCulturally relevant/sensitive pictures preferred

ComprehensionComprehension

Difficult to evaluate Difficult to evaluate Pictures have positive influencePictures have positive influence Findings:Findings:

Line drawings Line drawings Pictures and text in close proximityPictures and text in close proximity Culturally relevant/sensitive picturesCulturally relevant/sensitive pictures Illustrate ideas that reader already understandsIllustrate ideas that reader already understands

Line DrawingsLine Drawings

Line drawings are preferred to shaded drawings Line drawings are preferred to shaded drawings and photographs and photographs SimplicitySimplicity Minimize distracting detailMinimize distracting detail

Pictures and TextPictures and Text

Pictures and text in close proximityPictures and text in close proximity Text in simple languageText in simple language Consistent fontConsistent font Large font sizeLarge font size

Cultural RelevanceCultural Relevance Cameroonian study created images locallyCameroonian study created images locally

South African study compared South African study compared locally created images with locally created images with USP standardized imagesUSP standardized images

Concept ComprehensionConcept Comprehension Pictures must depict familiar concepts Pictures must depict familiar concepts

Reader may try to guess conceptReader may try to guess concept Pictures that represent concepts that are beyond the Pictures that represent concepts that are beyond the

comprehension of target may not be usefulcomprehension of target may not be useful

Guiding questions:Guiding questions: Is lockout/tagout a familiar concept?Is lockout/tagout a familiar concept? How can we communicate the concept differently?How can we communicate the concept differently? Is there an analogous concept in the workplace?Is there an analogous concept in the workplace? How can we determine how workers understand How can we determine how workers understand

lockout/tagout?lockout/tagout?

Sample PicturesSample PicturesCulturally irrelevantDistracting detailsComplicated text

Culturally Irrelevant Disconnected imagesComplicated Text

Culturally irrelevant

Disconnected images

No text

Recall and AdherenceRecall and Adherence

Positive effects on free and cued recallPositive effects on free and cued recall Free recall – ability to remember information without Free recall – ability to remember information without

a prompta prompt Cued recall – ability to remember information with a Cued recall – ability to remember information with a

promptprompt

Positive effects on adherencePositive effects on adherence

Confounding StudyConfounding Study

Injury Prevention Education Using Pictorial Injury Prevention Education Using Pictorial InformationInformation

Powell EC, Tanz RR, Uyeda A, Gaffney MB and Sheehan KMPowell EC, Tanz RR, Uyeda A, Gaffney MB and Sheehan KM

Pediatrics Pediatrics 20002000

Confounding StudyConfounding Study MethodsMethods

Pictorial anticipatory guide (PAG) – 46 familiesPictorial anticipatory guide (PAG) – 46 families Pictures and textPictures and text

The Injury Prevention Program (TIPP) – 20 familiesThe Injury Prevention Program (TIPP) – 20 families Text onlyText only

Tested recall onlyTested recall only No significant difference between intervention No significant difference between intervention

and control groupsand control groups LimitationsLimitations

PAG not formally evaluatedPAG not formally evaluated Small sample sizeSmall sample size

Recommendations for Creating Recommendations for Creating Illustrated Educational MaterialsIllustrated Educational Materials

Fully explain intended message and outcome to Fully explain intended message and outcome to artistartist

Simple line drawingsSimple line drawings Pictures and text in close proximityPictures and text in close proximity Culturally relevant picturesCulturally relevant pictures Involve target population in designInvolve target population in design

Recommendations for Recommendations for ImplementationImplementation

Explain pictures and text to workers at trainingExplain pictures and text to workers at training Pilot study to determine efficacy of toolPilot study to determine efficacy of tool

Worker and non-worker subjectsWorker and non-worker subjects

Create a recall toolCreate a recall tool Poster Poster Pocket cardPocket card

Determine means for evaluation over timeDetermine means for evaluation over time Test long-term recallTest long-term recall

For the FutureFor the Future

Multi-media and computer trainingsMulti-media and computer trainings Sheet metal workers union avatarsSheet metal workers union avatars Roofers union computer-based trainingRoofers union computer-based training Compelling and interactiveCompelling and interactive Computer literacy skillsComputer literacy skills

Other ConsiderationsOther Considerations

Storytelling Storytelling Illustrated stories to recreate situationsIllustrated stories to recreate situations Comic book styleComic book style

Scenarios and problem solvingScenarios and problem solving Illustrated scenariosIllustrated scenarios Open-ended solutions for group workOpen-ended solutions for group work

Interactive non-literate training sessionsInteractive non-literate training sessions Demonstrations, role-playing, discussionsDemonstrations, role-playing, discussions

Literature RelevanceLiterature Relevance

Instructive picturesInstructive pictures Set of tasksSet of tasks

Positive health messagesPositive health messages Complex health conceptsComplex health concepts Professional/non-professional relationshipProfessional/non-professional relationship Literacy levelsLiteracy levels

LimitationsLimitations Different instructionsDifferent instructions

Lockout/tagout vs. medication takingLockout/tagout vs. medication taking Different desired outcomesDifferent desired outcomes

Increased workplace safety vs. treatment adherenceIncreased workplace safety vs. treatment adherence Different settings Different settings

Workplace vs. clinic or ERWorkplace vs. clinic or ER Different target populationsDifferent target populations

Workers vs. patientsWorkers vs. patients Different EvaluationsDifferent Evaluations

Safety vs. treatment adherence Safety vs. treatment adherence

Thank YouThank You

Bob Harrison, MD, MPHBob Harrison, MD, MPH David Harrington, MPHDavid Harrington, MPH

Questions?Questions?