CONSUMER COMPREHENSIONof EDUCATIONAL MATERIALS:

Key Cognitive Principles

Ruth S. Day

Duke University

FDA Drug Safety & Risk Management July 17, 2002

“COGNITIVE ACCESSIBILITY”

The ease with which

people can

findunderstandrememberuse

drug information

in a safe and effective manner.

COGNITIVE PRINCIPLES

COGNITIVE PRINCIPLES

Information Load

Chunking

Coding

Representation

Location

COGNITIVE PRINCIPLES

Information Load

Chunking

Coding

Representation

Location

ReadabilityComprehensibility

Attention

Cognitive Task

Metacognition

LOADHow much is too much?

LOAD

Information Load

How much is too much?

LOAD

Information Cognitive Load Load

How much is too much?

EXAMPLE (Original) Tell your doctor, nurse, and pharmacist if you …• are allergic to any medicine, either prescription or nonprescription (OTC);• are pregnant or intend to become pregnant while using this medicine• are breast-feeding;• are using any other prescription or nonprescription (OTC) medicine, especially diuretics (water pills) or potassium-containing medicines or supplements;• have any other medical problems, especially heart or blood vessel disease or kidney disease;• are on a strict low-sodium diet or dialysis, or use low-salt milk or salt substitutes;• have had a kidney transplant

Source: Day, R. S. (1999) Optimizing patient comprehension through medicine information leaflets: Cognition experiments. In A.G. Hartzema, S. Tolleson-Rinehart, B.L. Sleath, and R.S. Day, Optimizing Patien Comprehension through Medicine Leaflets. Rockville, MD: U.S. Pharmacopeia. Pp. 60-176.

EXAMPLE (Original) Tell your doctor, nurse, and pharmacist if you …• are allergic to any medicine, either prescription or nonprescription (OTC);• are pregnant or intend to become pregnant while using this medicine• are breast-feeding;• are using any other prescription or nonprescription (OTC) medicine, especially diuretics (water pills) or potassium-containing medicines or supplements;• have any other medical problems, especially heart or blood vessel disease or kidney disease;• are on a strict low-sodium diet or dialysis, or use low-salt milk or salt substitutes;• have had a kidney transplant

~~~~~~~~~~~~~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~• ~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~

EXAMPLE (Original) Tell your doctor, nurse, and pharmacist if you …• are allergic to any medicine, either prescription or nonprescription (OTC);• are pregnant or intend to become pregnant while using this medicine• are breast-feeding;• are using any other prescription or nonprescription (OTC) medicine, especially diuretics (water pills) or potassium-containing medicines or supplements;• have any other medical problems, especially heart or blood vessel disease or kidney disease;• are on a strict low-sodium diet or dialysis, or use low-salt milk or salt substitutes;• have had a kidney transplant

~~~~~~~~~~~~~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~• ~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~• ~~~~~~~~~~~~~~~~~

EXAMPLE (Revised)Tell your doctor, nurse, and pharmacist if you have:

Allergies to Medicines --prescription medicine --nonprescription medicine (OTC)

Female Circumstances --are pregnant --intend to become pregnant while using this medicine --are breast-feeding

Other Medicines --prescription medicine --nonprescription medicine (OTC) --especially: --diuretics (water pills)

--potassium-containing medicines or supplementsMedical Conditions --any other medical problems --especially: --heart disease --blood vessel disease --kidney disease

--kidney transplant --on dialysis

Diet --on a strict low-sodium diet --use low-salt milk --use salt substitutes

COGNITIVE TASKS

Read

Free Recall

Recognition

Comprehension --text, pictures

Problem Solving --what do if ?

COGNITIVE TASKS

Read

Free Recall

Recognition

Comprehension --text, pictures

Problem Solving --what do if ?

Search & Find

Decision Making --self selection --de-selection

Metacognition --easy/hard? --like it?

COGNITIVE TASKS

Read

Free Recall

Recognition

Comprehension --text, pictures

Problem Solving --what do if ?

Search & Find

Decision Making --self selection --de-selection

Metacognition --easy/hard? --like it?

Cognition&

Actions

Accuracy Errors ….

Indications

Warnings

Dosage

Side Effects ….

CO

NTE

NT

FORMAT SELECTIONBasic Strategy

Indications

Warnings

Dosage

Side Effects ….

CO

NTE

NT

FORMAT SELECTIONBasic Strategy

Indications

Warnings

Dosage

Side Effects ….

CO

NTE

NT

Tex

t

Li

st

O

utline

…

.

FORMAT

FORMAT SELECTIONBasic Strategy

Indications

Warnings

Dosage

Side Effects ….

CO

NTE

NT

Use Remember

UnderstandFind

Tex

t

Li

st

O

utline

…

. COGNITIVETASKFORMAT

FORMAT SELECTIONBasic Strategy

Source: Adapted from Day, R.S. (1988) Alternative representations. In G.H. Bower (Ed.), The Psychology of Learning and Motivation, 22, 261-306. New York: Academic Press.

Format

FormatContent

Format

Content

Content

Format

Format 1

Content

Content

Format

Format 1

ContentFormat 2

Content

Format

Format 1

Content

Format 3

Format 2

Content

Physically present

INFORMATION

Physically present

Functionally absent

INFORMATION