Module 6: Making and Measuring Visual Education Tools

Illustrations are perhaps the most cost-effective, easily portable, simple, and effective educational tools. However, visual materials are often designed from the point of view of the artist, rather than the audience. In such cases, the illustrations are based upon the technical and creative skills of producers, and can be easily misunderstood by the target audience. The result is often a visually attractive material that lacks educational value, or that causes confusion for the participants. Materials are often created without recognizing the ways in which cultural habits, values and communication styles influence the interpretation of visual messages. Therefore, one must make every effort to account for cultural sensitivity and the needs of the target audience. Complicated written explanations must be avoided, and text should be minimal. One should also be aware of local preference for visual messages. According to the pilot study by Wong in South Africa, only a small number of participants were able to understand the simplified black-and-white illustrations. It was much easier for participants to understand the color pictures. This ability to identify color pictures may be the result of people usually perceiving objects ‘in color’ instead of ‘black-and-white’. This type of understanding is fundamental in creating both visually appealing and understandable visual communication images.(1)

Methods of Measuring the Effectiveness of Visual Literacy Programs in Healthcare

All innovative programs require a way of measuring their efficacy. Visual literacy tools similarly need on-going evaluation to assess their impact. The evaluation strategy should include a three-pronged measurement that involves what to measure, how to measure, and when to measure.

What: The Process, Content and Outcomes

The effectiveness of visual literary tools need to be examined by assessing the process of the visual aids as well as the outcome of the educational intervention. The process refers to the qualities and acceptability of the medium (e.g. Is it catchy? Is the message clear and understandable? Did it make an impression?). The outcome refers to actual changes in help-seeking behaviour (e.g. did a cataract screening advertising campaign lead to an increased number of people seeking cataract surgeries in a village?).

How: Questionnaires, Interviews, Focus Groups

The methods for receiving feedback include interviews with patients that have received the educational intervention, use of questionnaires, or more technologically-complex methods such as visual mapping scans, which chart the eye movements of an individual standing in front of a poster and measure the amount of time spent viewing it. The most commonly used evaluation method is a questionnaire that is developed to assess patient knowledge and understanding about the educational material, including a basic knowledge of the medical condition itself, possible side effects of the medication or procedure, and familiarity with the concepts of resistance and adherence. In the South African video pilot study by Wong, a pilot questionnaire was created and given to study participants to eliminate any ambiguously worded or misleading questions. This questionnaire was given in a private room both pre- and post-video viewing.(2) When creating an effective questionnaire, one should similarly ensure that it does not contain leading and biased questions.

The most appropriate method for examining the effectiveness of a visual literacy campaign is to statistically measure patients' knowledge and uptake of the procedure before and after the educational intervention, which will enable the researcher to determine whether the intended message was conveyed through the visual communication tools.

When: Impact on Short Term and Long Term Health Outcomes

The collection and monitoring of the target population should be done in the short term as well as the long term to determine if a lasting change has occurred due to the visual resource. For example, the researcher can monitor trends in the number of people seeking vaccinations, family planning counseling, ante-natal screenings or eye examinations.

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(1) Hugoa, J. and Skibbeb, A. “Facing visual illiteracy in South African health education; a pilot study.” The Journal of Audiovisual Media in Medicine. (1991). 14.2: 47-50. Accessed on 16 June 2010.

(2)Wong, I. “The Development and Assessment of an Innovative Video to Introduce Concepts of Adherence in Soweto, South Africa.” A Thesis Submitted to the Yale University School of Medicine in Partial Fulfillment of the Requirements for the Degree of Doctor of Medicine. 2004. 2, 5-7, 11-14, 16-31, 38-42, 44. Accessed on 16 June 2010.