WHO EPI-WIN webinar: Communicating risks and evidence in a Public Health Emergency (4) Communication between clinicians and patients

20 September, 2021

[Note from HIFA moderator (Neil): Our thanks to Richard Fitton for representing HIFA at the event on 14 September. Here is his third summary/observation. A recording of the webinar is now available here: https://www.youtube.com/watch?v=za0t0B-jP1Q ]

The researchers presenting to the EPI-WIN webinar explained that patients with low literacy and numeracy skills benefited from written complementary information and especially icons and illustrations. There may not have been very much done on this low numeracy and literacy population's needs.

With such improvements in visual media perhaps this is something that HIFA could look at?

5. Kessels RPC. Patients' memory for medical information. J R Soc Med. 2003;96(5):219–222.

40-80% of medical information provided by healthcare practitioners is forgotten immediately. The greater the amount of information presented, the lower the proportion correctly recalled;**4*

<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539473/#ref4>* furthermore, almost half of the information that is remembered is incorrect.**5* <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539473/#ref5>* For the forgetting of information there are three basic types of explanation—first, factors related to the clinician, such as use of difficult medical terminology; second, the mode of information (e.g. spoken versus written); and, third, factors related to the patient, such as low education or specific expectations*

*SPOKEN, WRITTEN OR NON-VERBAL?*

*The form or mode of information is also highly relevant. In most instances, medical advice is spoken, but this is not a very successful method. **21* <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539473/#ref21>* Written information is better remembered and leads to better treatment adherence. * *22* <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539473/#ref22>* However, written instructions do present difficulties to patients with low education or literacy and to non-native speakers, so other options have been investigated. For example, cartoons have been used to improve adherence to wound-care advice in patients just released from the emergency department: those who received the cartoon instructions displayed better compliance and answered more questions correctly. Patients with low education benefited more from the cartoon method than did patients with high education. **23*

<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539473/#ref23>* Others **1* <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539473/#ref1>*,**24* <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539473/#ref24>* have used pictographs— picture-writing—in cancer and HIV/AIDS. With spoken medical instructions only 14% of the information was remembered correctly, compared with over 80% when pictographs were used. **1* <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539473/#ref1>* Simple pictographs, with a clear and direct link between the picture and its meaning, are most effective. **24*

<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539473/#ref24>* Further studies should focus on the clinical applicability of pictographs and their cost-benefit ratio.*

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HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data

Email address: richardpeterfitton7 AT gmail.com