Involve multiple senses when you teach

Back in 1996 Doak, Doak, & Root devoted a chapter to Visuals and How to Use Them. They gave lots of reasons to add illustrations to the text of patient teaching materials, and explained why they are important, including:
Everybody understands and remembers better when they see the message. The brain has more access routes and greater storage capacity for pictorial images than for words. Therefore, details that might otherwise be lost can be reconstructed through visual association.” (page 92)

A new study by Pusic, Ching, Yin, & Kessler (2014) confirms what we knew, and supports it with recent research. Their recommendations include:
— Decrease extraneous cognitive load. Eliminate decorations or excessive details on patient education materials.
— Present information using words and graphics for maximal uptake.
— Present the words and graphics at the same time.
— Use visual methods to present visual concepts.
— For maximal effectiveness, it matters how graphics are combined with text.

So yes, despite the fact that Doak’s Teaching Patients with Low Literacy Skills was written back in 1996, it was evidence-based and still holds true. In fact, the Suitability Assessment of Materials (SAM) scoring system described in that book can help you evaluate how well you have applied these principles in you patient education material.

I only wish the Pusic, Ching, Yin, & Kessler article added a plug for evaluation of understanding or teach back. Their presentation was structured around two cases, in which the patients’ parents “expressed their understanding.” Come on. You know a head nod, a “yes” and a smile doesn’t mean they understood. Right?


Doak, C. C., Doak, L. G., & Root, J. H. (1996). Teaching patients with low literacy skills (2nd ed.). Philadelphia: J. B. Lippincott Company. Available free, online, from:

Pusic, M. V., Ching, K., Yin, H. S., & Kessler, D. (2014). Seven practical principles for improving patient education: Evidence-based ideas from cognition science. Paediatr Child Health, 19(3), 119-122.

©2014, Fran London, MS, RN

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