>Hi - I'm Peter Houts - and I'm looking forward to sharing some of what I 

>have learned while working with Ceci and Len Doak about how to best use 

>pictures in health communications.  I realize that health communications 

>is a very broad subject and my expertise is primarily in how to 

>communicate directions for managing illness - both to patients and to 

>family caregivers.

>

>The work that we did together was published as a literature 

>review:  Houts, PS, Doak CC, Doak LG, Loscalzo, MJ. "The role of pictures 

>in improving health communication: a review of research on attention, 

>comprehension, recall and adherence" Patient Education and Counseling, 61 

>(2006) 173-190

>

>The PDF file that Julie will make available is adapted from a slide talk 

>that I will be giving to the American Psychosocial Oncology Society in 

>March.  It is intended to spark interest in using pictures among people 

>who study how patients cope with cancer.

>

>I have been reading the messages that people posted before our session 

>officially began and here are some of my thoughts in response.

>

>With respect to clip art - I have NOT found it useful to use clip art or 

>art done for purposes other than the one I am trying to illustrate.  The 

>reason is that the art should be closely related to the text in order for 

>the viewer to link them and in order to have maximum impact on people's 

>comprehension, recall and behavior change.  Art that does not relate 

>directly to what is being said has been shown to have no effect on 

>comprehension, recall, or behavior.  Many patient education materials do 

>use "warm fuzzy" art, but little is gained other than possibly drawing 

>attention to the document.  In the case of poor readers, they are likely 

>to be confused by art that is unrelated to the information being conveyed.

>

>I agree very much with the points made by Marcia - that pictures by 

>themselves, without explanatory text, are likely to be interpreted in many 

>different ways by viewers.  That is why text - simply written - should 

>always be closely linked to art.  As I say in the slide show - the use of 

>pictures should build on a foundation of clear, simple writing.

>

>In reply to Nancy Simpson's questions about stick figures - I have found 

>that they work very well.  Both of our research studies used stick figures 

>and, not only did people remember their meanings, the study participants 

>spontaneously said they enjoyed working with them.  One advantage of stick 

>figures is that they are culturally neutral.  (You can see examples of the 

>stick figures we used in the pdf file of my slide show.) One objection I 

>have heard to using stick figures was from a person who showed our 

>research drawings to health educators in Africa who said that very thin 

>people were thought to have AIDS.  They suggested making the lines thicker 

>so the figures did not seem emaciated.  My other experience with stick 

>figures was in asking people in focus groups what kind of pictures they 

>preferred in the "Eldercare at Home" book that I edited.  In the focus 

>group, people said they wanted color pictures of people who look like 

>themselves.  This was not possible given the diversity of the intended 

>audience and the expense of creating the pictures.  I, personally, think 

>that what people say they want in a focus group is not necessarily the 

>same as what works in the real world.  I suspect that those focus group 

>participants would have responded positively to stick figures if they were 

>linked to information they wanted to learn.

>

>As to the cost of creating art - there are many people who are skilled at 

>drawing and who will work for reasonable rates.  For the Eldercare at Home 

>book, it took about 20 minutes per drawing when I sat with the artist, 

>explained what I wanted, and responded to his draft ideas.  Once he 

>understood the kind of drawings I wanted, I was able to communicate with 

>him by FAX which saved both of us travel time.  I believe we paid him $50 

>an hour which meant that each drawing cost roughly $20.  This was a very 

>reasonable rate in view of the fact that we generated over 200 drawings 

>for that project.    It is important that the health educator be the 

>person who decides what should be in the drawings - not the artist.  This 

>means you will have to work out in your mind what you want the drawing to 

>include before talking with an artist and then give feedback to his/her 

>sketches until you have what you want.

>

>Peter