CONSUMER COMPREHENSION of EDUCATIONAL MATERIALS: Key Cognitive Principles

1. CONSUMER COMPREHENSION of EDUCATIONAL MATERIALS: Key Cognitive Principles  Ruth S. Day Duke University FDA Drug Safety & Risk Management July 17, 2002

2. “COGNITIVE ACCESSIBILITY” The ease with which people can find understand remember use drug information in a safe and effective manner.

3. COGNITIVE PRINCIPLES

4. COGNITIVE PRINCIPLES Information Load Chunking Coding Representation Location

5. COGNITIVE PRINCIPLES Information Load Chunking Coding Representation Location Readability Comprehensibility Attention Cognitive Task Metacognition

6. LOAD How much is too much?

7. LOAD How much is too much? Information Load

8. LOAD How much is too much? Information Cognitive Load Load

9. 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.

11. 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 • ~~~~~~~~~~~~~~~~~~~~~~~~~~ • ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~ • ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~ • ~~~~~~~~~ • ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ • ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~ • ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ • ~~~~~~~~~~~~~~~~~

12. 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 • ~~~~~~~~~~~~~~~~~~~~~~~~~~ • ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~ • ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~ • ~~~~~~~~~ • ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ • ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~ • ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ • ~~~~~~~~~~~~~~~~~

13. 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 supplements Medical 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

14. COGNITIVE TASKS Read Free Recall Recognition Comprehension --text, pictures Problem Solving --what do if ?

15. 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?

16. 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? Accuracy Errors …. Cognition & Actions

17. FORMAT SELECTION Basic Strategy Indications Warnings Dosage Side Effects …. CONTENT

18. FORMAT SELECTION Basic Strategy Indications Warnings Dosage Side Effects …. CONTENT

19. FORMAT SELECTION Basic Strategy Indications Warnings Dosage Side Effects …. CONTENT Text List Outline …. FORMAT

20. FORMAT SELECTION Basic Strategy Indications Warnings Dosage Side Effects …. CONTENT Find Understand Text List Outline …. Remember Use COGNITIVE TASK FORMAT 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.

21. Format

22. Content Format

23. Content Format Content

24. Content Format Format 1 Content

25. Content Format Format 1 Content Format 2

26. Content Format Format 1 Content Format 2 Format 3

27. INFORMATION Physically present

28. INFORMATION Physically present Functionally absent