Visual Aid for Hemoglobin A1c Results in Primary Care: A Pilot Study Sean A. Fiore, M.S., RN1; Rosemary Dale, Ed.D., APRN1,2; Margaret Aitken, D.N.P., APRN1,2 1University of Vermont College of Nursing and Health Sciences, 2Appletree Bay Primary Care ABSTRACT INTRODUCTION RESULTS DISCUSSION Purpose: Visual aids are associated with improved numeracy, health literacy, and outcomes.   Methods: An electronic visual aid A1c “report card” was developed for pilot study in primary care. Patients were surveyed regarding their reaction to visual aids. Results/Conclusion: Most patients would like to see visual aids for test results in the future. The majority found them useful, and those with abnormal A1c expressed intent to modify their behavior. Visual aids may inspire patients to consider behavioral changes such as increased exercise and improved diet. However, further study is needed to investigate whether patients do change behavior or A1c results improve in response to visual aid utilization. Background Numeracy is a common problem in the US 25% of general population with numeric reasoning deficits1 Lab test results often displayed in numeracy-ignorant tables Low numeracy predicts low health literacy Low health literacy associated with poorer outcomes Access to health information on the rise Required use of electronic health record (EHR) Increasing use patient portal systems Available information not portrayed with numeracy in mind Visual aids proven to be efficacious1 Improved risk perception Motivational Purpose: To pilot a visual aid in a primary care setting for hemoglobin A1c test results. Aims: To highlight features that patients find helpful or unhelpful To ascertain potential for motivation to change To explore possibility of introducing new clinical teaching tool to primary care clinic Population Characteristics 35 visual aid report cards sent, 17 survey responses 10 (59%) with type 2 diabetes mellitus (DMT2) 3 (30%) with DMT2 not at goal 3 (18%) with prediabetes 3 (100%) with prediabetes not at goal 4 (23%) with no diabetes or prediabetes 0 not at goal Patient Perception of Visual Aid (n=17) Well-described: 82% Non-confusing: 82% Useful: 65% Would like to see again in the future: 94% Motivational Intent Content Analysis Findings Most patients found the visual aid for test results clear, non-confusing, and useful Most patients are open to seeing visual aids used to deliver test results in the future Results consistent with existing literature Patients prefer visual aids over number tables2 Associated with desire to modify behaviors3 Lessons Difficult to implement as additional program to existing EHR Better if integrated into EHR software More useful as educational tool during patient encounter Limitations Most patients in sample already at goal Subjective desire to change May not predict actual change Risk for researcher bias CONCLUSIONS Patients largely appreciate clarity of test results presented with a visual aid Visual aids may promote better patient understanding of test results and associated risks EHR developers should consider utilizing visual aids Especially for patients with access to results Additional research will help confirm whether improved outcomes can be associated with visual aids METHODS AND MATERIALS Site: Local patient-centered medical home Sample: Adults 18+ receiving A1c screening Measures Patient perception Usefulness, confusing, descriptiveness, desire to see visual aid again in the future Behavioral intent Need for behavioral change, likeliness to change, type of changes necessary Content analysis Procedures RN inputs A1c results into tool, A1c report card generated Report card printed and mailed to patient RN follow up 7-10 days via telephone CONTACT REFERENCES Garciaia-Retamero, R., & Cokely, E. T. (2017). Designing Visual Aids That Promote Risk Literacy: A Systematic Review of Health Research and Evidence-Based Design Heuristics. Hum Factors, 59(4), 582-627. doi:10.1177/0018720817690634 Brewer, N. T., Gilkey, M. B., Lillie, S. E., Hesse, B. W., & Sheridan, S. L. (2012). Tables or bar graphs? Presenting test results in electronic medical records. Med Decis Making, 32(4), 545-553. doi:10.1177/0272989x12441395 Zikmund-Fisher, B. J., Exe, N. L., & Witteman, H. O. (2014). Numeracy and literacy independently predict patients' ability to identify out-of-range test results. J Med Internet Res, 16(8), e187. doi:10.2196/jmir.3241 CONTACT Sean A. Fiore University of Vermont College of Nursing and Health Sciences Email: sean.fiore@gmail.com