1. Type II Diabetes Claire Sahlberg Redmond, OR

2. 1.
Project Decisions
Or, why diabetes?

3. Redmond Family Medical Center
Dr. Fixott
A private practice in a historic 1918 building
5 office staff
3 dogs
1 physician

4. Ladybug
Gaia
Ophelia

5. Redmond Family Medicine Clinic
No EHR
The clinic is currently in the process of transitioning to an electronic system.
Currently, all notes are dictated and then transcribed. The note is saved in the EHR and also printed and placed in the paper chart
No Medical Assistant
On my second day, the MA had a family emergency and had to leave for an extended period of time
With no other MA’s at the clinic, all of her responsibilities fell to myself and the other staff
But lots of fun!

6. They feel fine at the start… I can’t make them believe they have a disease.
Dr. Fixott, on diabetes

7. The problem with silent diseases
Dr. Fixott asked that I create a handout for newly diagnosed diabetic patients
Many patients have difficulty understanding the seriousness of the disease and possible consequences
My goal was to create a simple, straightforward patient-friendly guide

8. Age-Adjusted Percentages 2006-2009
Oregon
Deschutes County
Overweight
36.1%
41.0%
Obese
24.5%
15.7%
Diabetes
6.8%
5.0%

9. 2.
Considerations
Why less is more

10. INFORMATION OVERLOAD

11. We receive 5X as much information today as we did in 1986
Content in 2016
We receive 5X as much information today as we did in 1986
Studies of visualized information demonstrate:

12. Increase in willingness to read with color visuals vs black and white
80%
Increase in willingness to read with color visuals vs black and white
323%
Improvement in following directions with illustrations vs text alone
15%
Improvement in medicine label understanding when using text+pictures vs text alone

13. What does it mean to be “patient friendly?”2.
Assessing the content
What does it mean to be “patient friendly?”

14. Using printed and written information to function
in society, to achieve one’s goals, and to
develop one’s knowledge and potential.
The Health Literacy of America’s Adults, 2003

15. Below Basic Basic Health Literacy
Circle the date of a medical appointment on a hospital appointment slip
Identify what it is permissible to drink before a medical test based on short instructions
Basic
Give two reasons a person with no symptoms of a specific disease should be tested for the disease, based on information in a clearly written pamphlet

16. Intermediate Proficient Health Literacy
Find the age range during which children should receive a particular vaccine based on a chart
Determine a healthy weight for a specified height based on a BMI graph
Proficient
Find information required to determine a medical term by searching through a complex document

17. Health Literacy
Adults in the oldest age group, 65 and older, had lower average health literacy than adults in younger age groups
Adults with self-reported poor health had lower health literacy scores
Adults with no insurance or on Medicaid or Medicare had the lowest health literacy scores

18. Where does this project fall?
Readability
Readability
The average adult reads at the 8th or 9th grade levels, and 20% read at 5th grade level or below
Most materials should be aimed at 5th or 6th grade reading levels
Where does this project fall?
Fry Readability Formula: 9th grade
Raygor Graph: 6th grade
PEMAT

19. Understandability Assessments
PEMAT- Patient Education Materials Assessment Tool
Content
Purpose is evident
Does not include information/content that distracts from its purpose
Word Choice/Style
Common, everyday language
Define medical terms if used
Material uses the active voice
Numbers
Easy and clear to understand
User does not need to perform calculations

20. Understandability Assessments
PEMAT- Patient Education Materials Assessment Tools
Organization
Information is broken into short sections
Sections have informative headers
Material is in a logical sequence
Layout/Design
Use of visual cues (arrows, bullets, boxes) to draw attention to key points
PEMAT
Visual Aids
Used whenever they could make content more easily understood
Reinforce the content
Used simple tables with short and clear row/column headings
Illustrations are clear and uncluttered

21. 2.
Summary
What did I learn?

22. Thoughts for future improvements
Diabetes is a BIG topic
The most difficult part of this project was paring down the information
It may be useful to have a series of flyers focusing on different aspects of the disease
Design Matters
The layout and presentation matters just as much as the actual written text
Medical materials often seem to be lagging behind in thoughtful design
Despite my best efforts…
Writing in plain language is extremely hard
With more time, I would like to further improve the readability

23. Thanks!
Any questions?
Claire Sahlberg, MS3

24. References
Alleyne, R. (2011). Welcome to the information age- 174 newspapers a day. The Telegraph.
Dowse, R. and M. Ehlers (2005). "Medicine labels incorporating pictograms: do they influence understanding and adherence?" Patient Education and Counseling 58(1):
Green, R. (1989) The Persuasive Properties of Color.
Levie, W. H. and R. Lentz (1982). "Effects of Text Illustrations: A Review of Research." Educational Communication and Technology 30(4):
Winett, L., et al. (2013). "The State of Our Health 2013."
Kutner, M., et al. (2006). The Health Literacy of America's Adults: Results from the 2013 Assessment of Adult Literacy. Washington, DC, NCES.
(2008). America's Health Literacy: Why We Need Accessible Health Informaiton. An Issue Brief From the U.S. Department of Health and Human Services.
"Readability Formulas." Retrieved April 24, 2016, from
(2013). "PEMAT for Printable Materials (PEMAT-P)." Retrieved April 23, 2016, from