The effect of different styles of medical illustration on information comprehension, the perception of educational material and illness beliefs

https://doi.org/10.1016/j.pec.2019.09.026Get rights and content

Highlights

  • Medical illustration embedded in an educational text improved illness understanding.

  • The addition of an image to the text made the material more visually appealing.

  • A cartoon conveyed information about treatment better than text without images.

  • Neither the anatomical image nor CT scan affected information comprehension.

Abstract

Objective

To explore how the addition of a medical illustration and its style affected information comprehension, perception of educational material and illness beliefs.

Methods

204 people recruited in a supermarket were randomised to read one of the four leaflets about gout and fill out a questionnaire. Three leaflets had a picture showing gout in the form of a cartoon, an anatomical drawing or a computed tomography scan (CT). The control leaflet did not contain images.

Results

Seeing an illustrated leaflet helped correctly identify treatment for gout X2(1, N = 204) = 5.51, p=0.019. Out of the three images, only the cartoon was better than text in conveying information about treatment X2(1, n = 102) = 8.84, p=0.018. Participants perceived illustrated leaflets as more visually appealing t(70) = 3.09, p = 0.003, and the anatomical image was seen as more helpful for understanding of the illness than the cartoon. Pictures did not significantly influence lay illness perceptions about gout.

Conclusion

Pictures aid the understanding of health information and increase the visual appeal of materials. While simpler illustrations convey information more effectively, people prefer more detailed anatomical images; CT scans offer no benefits over simpler images.

Practice implications

The results can help guide the use of images in gout education material.

Introduction

A substantial body of research has demonstrated benefits of using visual materials in patient education. Compared to text-only interventions, the addition of visual aids can improve comprehension of medical information, recall and compliance with medical advice [1,2]. Patient education materials employ a variety of illustrations including anatomical drawings of the body, cartoons and other styles of pictures. However, few studies looked at what styles of illustrations are more helpful for conveying health information.

It is thought that simpler images are easier to interpret as there are no distracting details. A research by Moll [3] explored the effect of several illustration types on the communicational value of a health message. His analysis revealed that an educational booklet containing cartoons was the most effective for improving information comprehension, and simple line drawings were second in effectiveness. A review on the role of pictures in health communication found that the simplification of visual aids was essential for effective communication of health information [4].

On the other hand, previous research has shown that viewing computed tomography (CT) scans can also improve people’s understanding of illness and treatment [[5], [6], [7]]. A study in the general population found a better understanding and recall of medical information, as well as greater levels of satisfaction in the way diagnoses were communicated, in those who viewed CT images [8].

Medical scans are complex and highly detailed visualisations of structures of the body and may be difficult for a layperson to interpret. Therefore, it is unclear whether medical images have any educational benefits over simpler visual mediums such as cartoons or simple drawings.

This study investigated firstly how the addition of a medical illustration to an educational text affected information comprehension and people’s perception of educational material. It was hypothesised an educational leaflet on gout with an embedded medical illustration of gout would improve people’s understanding of the information about the disease and will be more interesting than the same leaflet without images. Secondly, the study compared the impacts of three illustration styles including a cartoon, a simple anatomical drawing and a CT scan. A leaflet about gout containing a cartoon was expected to improve understanding of information about gout more so than other illustrations.

Section snippets

Study design

The study employed a quasi-experimental design with four arms 1:1 allocation ratio and one measurement immediately after the intervention.

Shoppers at a local supermarket were approached with an invitation to take part in research aiming to explore better ways of presenting information about gout. The participants were asked to read one of the four educational leaflets on gout and fill out a questionnaire. Three leaflets had an embedded image showing the foot of a person with gout depicted in

Demographic characteristics

There were no statistically significant differences between the four groups in demographic characteristics, the number of people with gout and the number of people whose family or friends were diagnosed with gout (see Table 1). The majority of the sample identified as New Zealand European (46%), 19% as Indian and 10% as Māori. 61% of the participants were females. The age of the sample ranged from 18 to 87 years with an average of 46.9 years (SD = 17.5).

Perception of the intervention leaflet

The leaflet containing a medical

Discussion

Although research evidence suggests that the addition of images to patient educational materials can aid understanding of health information, a large proportion of such materials do not contain illustrations. Moreover, what type of illustrations offer the most benefits is still unclear, as it is unclear whether medical scans should be used in patient education. This study contributes to the literature on the role of visual aids and is one of the first modern studies directly comparing various

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of Competing Interest

Dr Dalbeth reports research grant funding from Amgen and AstraZeneca, and speaker fees from Pfizer, Horizon, Janssen, and Abbvie, and consulting fees from Horizon, AstraZeneca, Hengrui, Dyve, and Kowa.

Acknowledgments

We confirm all personal identifiers have been removed or disguised so the participants described are not identifiable and cannot be identified through the details of the story.

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