Pictures and text in instructions for medical devices: effects on recall and actual performance.

OBJECTIVE The present study aimed to contribute to the design of effective health education information. Based on cognitive-psychological theory, pictures were expected to improve understanding of two existing textual instructions for using asthma devices (inhaler chamber and peak flow meter). From an analysis of the affordances and constraints of both devices this effect was expected to be stronger with the inhaler chamber than with the peak flow meter. METHODS To test this, both instructions were systematically illustrated with seven line-drawings visualizing the actions. In two separate randomized controlled trials with in total 99 participants from the general public, the original text-only versions were compared to the text-picture versions of the same instruction. Dependent variables were participants' recall of the instructions and the quality of their performance with the instruction observed from video-recordings. RESULTS Conform expectations, the results showed significant positive effects of pictures on recall and performance in both instructions, especially with the inhaler chamber. CONCLUSION Thus, pictures may contribute to a better comprehension and use of medical devices that are inherently less clear. PRACTICE IMPLICATIONS Health educators may optimize instruction design by careful analysis of the device with instruction and observational testing with potential users.

[1]  Charles R. Beck.  Visual cueing strategies: Pictorial, textual and combinational effects , 1984 .

[2]  Franck Ganier,et al.  Processing text and pictures in procedural instructions , 2000 .

[3]  Alice J. Corkill,et al.  REMEMBERING WRITTEN INSTRUCTIONS: TAB A GOES INTO SLOT C, OR DOES IT? , 1988 .

[4]  George R. Bieger,et al.  Comprehending Spatial and Contextual Information in Picture-Text Instructions , 1986 .

[5]  D. Filippatou,et al.  Pictures, Titles, Reading Accuracy and Reading Comprehension: a research review (1973‐95) , 1996 .

[6]  Robert M. Bernard.  Using extended captions to improve learning from instructional illustrations , 1990, Br. J. Educ. Technol..

[7]  W. Howard Levie,et al.  Effects of text illustrations: A review of research , 1982 .

[8]  F. GANIER,et al.  Factors affecting the processing of procedural instructions: implications for document design , 2004, IEEE Transactions on Professional Communication.

[9]  S J Payne,et al.  Interleaving reading and acting while following procedural instructions. , 2001, Journal of experimental psychology. Applied.

[10]  Jules Amar.  Le travail humain , 1923 .

[11]  W Schnotz,et al.  [Influence of the type of visualization on the construction of mental models during picture and text comprehension]. , 1999, Zeitschrift fur experimentelle Psychologie : Organ der Deutschen Gesellschaft fur Psychologie.

[12]  P. Johnson-Laird,et al.  Mental Models: Towards a Cognitive Science of Language, Inference, and Consciousness , 1985 .

[13]  R. Mayer,et al.  Multimedia learning: Are we asking the right questions? , 1997 .

[14]  D. Wright,et al.  Handbook of Applied Cognition , 1999 .

[15]  Stephen M. Kosslyn,et al.  Elements of graph design , 1993 .

[16]  Franck Ganier,et al.  Effets du format de présentation des instructions sur l'apprentissage de procédures à l'aide de documents techniques , 2000 .

[17]  D. Stone,et al.  How Do Young Adults Read Directions with and without Pictures , 1981 .

[18]  R. Mayer,et al.  A generative theory of textbook design: Using annotated illustrations to foster meaningful learning of science text , 1995 .

[19]  W. Schnotz,et al.  Einflüsse der Visualisierungsform auf die Konstruktion mentaler Modelle beim Text- und Bildverstehen , 1999 .

[20]  Bernd Weidenmann,et al.  Chapter 2 Codes of Instructional Pictures , 1994 .

[21]  D. Norman.  The psychology of everyday things , 1990 .

[22]  C. Achterberg,et al.  Text and graphics: manipulating nutrition brochures to maximize recall. , 1999, Health education research.

[23]  H. Oostendorp,et al.  The Construction of Mental Representations During Reading , 1998 .

[24]  M. Dignan,et al.  The use of illustrations and narrative text style to improve readability of a health education brochure. , 1992, Journal of cancer education : the official journal of the American Association for Cancer Education.

[25]  R. Mayer,et al.  For whom is a picture worth a thousand words? Extensions of a dual-coding theory of multimedia learning. , 1994 .

[26]  M. Hegarty.  Mental animation: inferring motion from static displays of mechanical systems. , 1992, Journal of experimental psychology. Learning, memory, and cognition.

[27]  Donald A. Norman,et al.  The psychopathology of everyday things , 1995 .

[28]  R. Morrell,et al.  The effects of age, illustrations, and task variables on the performance of procedural assembly tasks. , 1993, Psychology and aging.

[29]  Valérie Gyselinck,et al.  The role of illustrations in text comprehension: What, when, for whom, and why? , 1999 .

[30]  Linda B. Gambrell,et al.  Mental imagery, text illustrations, and children's story comprehension and recall. , 1993 .

[31]  R. Mayer,et al.  Cognitive Principles of Multimedia Learning: The Role of Modality and Contiguity , 1999 .

[32]  G. Kok,et al.  Effectiveness of a multidisciplinary education protocol in children with asthma (0-4 years) in primary health care. , 1994, The Journal of asthma : official journal of the Association for the Care of Asthma.

[33]  S. Dumais,et al.  Handbook of applied cognition , 2007 .