Safety Training for Low Literacy Carwash Workers
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Illustrated Safety Training Materials for Illustrated Safety Training Materials for Low Literacy Carwash WorkersLow Literacy Carwash Workers
Micki BaronMicki BaronOccupational Health BranchOccupational Health Branch
July 1, 2008July 1, 2008
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ObjectivesObjectives Summarize current literature on illustrated Summarize current literature on illustrated
health education materialshealth education materials Medication adherence Medication adherence Child injury preventionChild injury prevention
Provide recommendations for current projectProvide recommendations for current project DesignDesign ImplementationImplementation EvaluationEvaluation
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MethodsMethods
Search of peer review databasesSearch of peer review databases PubmedPubmed UCSF online journal databaseUCSF online journal database
www search using key termswww search using key terms Few occupational health studiesFew occupational health studies Used studies in health communication and Used studies in health communication and
health literacy health literacy
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Four Steps to SuccessFour Steps to Success
AttentionAttention ComprehensionComprehension RecallRecall AdherenceAdherence
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AttentionAttention
Pictures increase attention to instructionsPictures increase attention to instructions Culturally relevant/sensitive pictures preferredCulturally relevant/sensitive pictures preferred
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ComprehensionComprehension
Difficult to evaluate Difficult to evaluate Pictures have positive influencePictures have positive influence Findings:Findings:
Line drawings Line drawings Pictures and text in close proximityPictures and text in close proximity Culturally relevant/sensitive picturesCulturally relevant/sensitive pictures Illustrate ideas that reader already understandsIllustrate ideas that reader already understands
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Line DrawingsLine Drawings
Line drawings are preferred to shaded drawings Line drawings are preferred to shaded drawings and photographs and photographs SimplicitySimplicity Minimize distracting detailMinimize distracting detail
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Pictures and TextPictures and Text
Pictures and text in close proximityPictures and text in close proximity Text in simple languageText in simple language Consistent fontConsistent font Large font sizeLarge font size
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Cultural RelevanceCultural Relevance Cameroonian study created images locallyCameroonian study created images locally
South African study compared South African study compared locally created images with locally created images with USP standardized imagesUSP standardized images
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Concept ComprehensionConcept Comprehension Pictures must depict familiar concepts Pictures must depict familiar concepts
Reader may try to guess conceptReader may try to guess concept Pictures that represent concepts that are beyond the Pictures that represent concepts that are beyond the
comprehension of target may not be usefulcomprehension of target may not be useful
Guiding questions:Guiding questions: Is lockout/tagout a familiar concept?Is lockout/tagout a familiar concept? How can we communicate the concept differently?How can we communicate the concept differently? Is there an analogous concept in the workplace?Is there an analogous concept in the workplace? How can we determine how workers understand How can we determine how workers understand
lockout/tagout?lockout/tagout?
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Sample PicturesSample PicturesCulturally irrelevantDistracting detailsComplicated text
Culturally Irrelevant Disconnected imagesComplicated Text
Culturally irrelevant
Disconnected images
No text
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Recall and AdherenceRecall and Adherence
Positive effects on free and cued recallPositive effects on free and cued recall Free recall – ability to remember information without Free recall – ability to remember information without
a prompta prompt Cued recall – ability to remember information with a Cued recall – ability to remember information with a
promptprompt
Positive effects on adherencePositive effects on adherence
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Confounding StudyConfounding Study
Injury Prevention Education Using Pictorial Injury Prevention Education Using Pictorial InformationInformation
Powell EC, Tanz RR, Uyeda A, Gaffney MB and Sheehan KMPowell EC, Tanz RR, Uyeda A, Gaffney MB and Sheehan KM
Pediatrics Pediatrics 20002000
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Confounding StudyConfounding Study MethodsMethods
Pictorial anticipatory guide (PAG) – 46 familiesPictorial anticipatory guide (PAG) – 46 families Pictures and textPictures and text
The Injury Prevention Program (TIPP) – 20 familiesThe Injury Prevention Program (TIPP) – 20 families Text onlyText only
Tested recall onlyTested recall only No significant difference between intervention No significant difference between intervention
and control groupsand control groups LimitationsLimitations
PAG not formally evaluatedPAG not formally evaluated Small sample sizeSmall sample size
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Recommendations for Creating Recommendations for Creating Illustrated Educational MaterialsIllustrated Educational Materials
Fully explain intended message and outcome to Fully explain intended message and outcome to artistartist
Simple line drawingsSimple line drawings Pictures and text in close proximityPictures and text in close proximity Culturally relevant picturesCulturally relevant pictures Involve target population in designInvolve target population in design
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Recommendations for Recommendations for ImplementationImplementation
Explain pictures and text to workers at trainingExplain pictures and text to workers at training Pilot study to determine efficacy of toolPilot study to determine efficacy of tool
Worker and non-worker subjectsWorker and non-worker subjects
Create a recall toolCreate a recall tool Poster Poster Pocket cardPocket card
Determine means for evaluation over timeDetermine means for evaluation over time Test long-term recallTest long-term recall
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For the FutureFor the Future
Multi-media and computer trainingsMulti-media and computer trainings Sheet metal workers union avatarsSheet metal workers union avatars Roofers union computer-based trainingRoofers union computer-based training Compelling and interactiveCompelling and interactive Computer literacy skillsComputer literacy skills
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Other ConsiderationsOther Considerations
Storytelling Storytelling Illustrated stories to recreate situationsIllustrated stories to recreate situations Comic book styleComic book style
Scenarios and problem solvingScenarios and problem solving Illustrated scenariosIllustrated scenarios Open-ended solutions for group workOpen-ended solutions for group work
Interactive non-literate training sessionsInteractive non-literate training sessions Demonstrations, role-playing, discussionsDemonstrations, role-playing, discussions
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Literature RelevanceLiterature Relevance
Instructive picturesInstructive pictures Set of tasksSet of tasks
Positive health messagesPositive health messages Complex health conceptsComplex health concepts Professional/non-professional relationshipProfessional/non-professional relationship Literacy levelsLiteracy levels
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LimitationsLimitations Different instructionsDifferent instructions
Lockout/tagout vs. medication takingLockout/tagout vs. medication taking Different desired outcomesDifferent desired outcomes
Increased workplace safety vs. treatment adherenceIncreased workplace safety vs. treatment adherence Different settings Different settings
Workplace vs. clinic or ERWorkplace vs. clinic or ER Different target populationsDifferent target populations
Workers vs. patientsWorkers vs. patients Different EvaluationsDifferent Evaluations
Safety vs. treatment adherence Safety vs. treatment adherence
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Thank YouThank You
Bob Harrison, MD, MPHBob Harrison, MD, MPH David Harrington, MPHDavid Harrington, MPH
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Questions?Questions?