Design and Comprehension Testing of Tailored Asthma Control Infographics for Adults with Persistent Asthma

Abstract

Background: Adherence to daily inhaled corticosteroid medication is important for asthma control but low health literacy is a barrier to comprehension of control status and may contribute to medication nonadherence. Infographics tailored with patients' own data can support comprehension of health status, but these have not been applied to asthma successfully.

Objectives: This two-phased study developed and tested tailored infographics of (1) scores on the Asthma Control Questionnaire (ACQ), a self-report measure of symptom burden, and (2) pulmonary function test (PFT) results. The infographics are intended for use as communication and adherence-promotion tools in clinical interactions.

Methods: For both phases, participants (18+ years, English- or Spanish-speaking, persistent asthma) were recruited through two primary care clinics. In Phase I, we used a hybrid iterative participatory design process to refine prototype designs. In Phase II, we conducted individual comprehension assessment interviews with the finalized designs. Infographics were hand-tailored for each participant using their ACQ score and PFT results collected at the start of the interview. Two independent raters scored interview transcripts for gist and verbatim comprehension based on a predetermined rubric.

Results: The five Phase I design sessions led to final prototypes that participants (n = 21) considered appealing and easy to comprehend. All Phase II participants (n = 10) demonstrated complete gist and verbatim comprehension. Participants reacted favorably to receiving their information via infographics and expressed intentions to engage in self-management behaviors (e.g., medication adherence, smoking cessation, weight loss, and review of their care plan) in response to the information.

Conclusion: This study provides preliminary evidence that infographics can support comprehension of asthma control status and promote self-management intentions among adults with persistent asthma. Infographics can be programmed into electronic health records and/or standalone applications to allow for instant tailoring at the point of care.

Fig. 1

Initial prototype design of the Asthma Control Questionnaire (ACQ) infographic. CC BY 4.0 Adriana Arcia & Nicole Spiegel-Gotsch for Columbia Nursing, https://doi.org/10.7916/d8-w8hz-w605, p. 8.

Fig. 2

One of the initial prototype designs of the pulmonary function test (PFT) infographic that proved unsuccessful. CC BY 4.0 Adriana Arcia & Nicole Spiegel-Gotsch for Columbia Nursing, https://doi.org/10.7916/d8-w8hz-w605, p. 21.

Fig. 3

Front cover (L) and inside (R) of pamphlet to show Asthma Control Questionnaire (ACQ) scores at two time points. Redundancy in imagery, colors, and interpretive statements reinforces meaning. CC BY 4.0 Adriana Arcia & Nicole Spiegel-Gotsch for Columbia Nursing, https://doi.org/10.7916/d8-w8hz-w605, p. 3.

Fig. 4

Front cover (L) and inside (R) of final pamphlet design to show pulmonary function test (PFT) results. The amount and complexity of information is comparable to the initial prototype shown in Fig. 2 , but the superior imagery, information hierarchy, and layout promote the acceptability and comprehensibility of the infographic. CC BY 4.0 Adriana Arcia & Nicole Spiegel-Gotsch for Columbia Nursing, https://doi.org/10.7916/d8-w8hz-w605, p. 4.