Working memory and the design of health materials: A cognitive factors perspective

https://doi.org/10.1016/j.pec.2008.11.005Get rights and content

Abstract

Objective

Working memory and other supportive cognitive processes involved in learning are reviewed in the context of developing patient education materials. We specifically focus on the impact of certain design factors such as text format and syntax, the inclusion of images, and the choice of modality on individuals’ ability to understand and remember health information.

Methods

A selective review of relevant cognitive and learning theories is discussed with regard to their potential impact on the optimal design of health materials.

Results

Working memory is measured as an individual's capacity to hold and manipulate information in active consciousness. It is limited by necessity, and well-designed health materials can effectively minimize extraneous cognitive demands placed on individuals, making working memory resources more available to better process content-related information.

Conclusions

Further research is needed to evaluate specific design principles and identify ideal uses of print versus video-based forms of communication for conveying information.

Practice implications

The process of developing health materials should account for the cognitive demands that extrinsic factors such as modality place on patients.

Introduction

Over the past two decades, the field of health literacy research has risen to prominence, directing greater attention and criticism to how healthcare providers and systems deliver information to patients and their families. The term health literacy itself refers to the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. As explained by the Institute of Medicine in its 2004 seminal report on the issue, there is a clear disconnect between what is asked of patients in the context of promoting and protecting health and the typical abilities possessed by most adults [1]. While individuals differ by cognitive and social skills as well as motivation, the manner in which health information is often communicated makes it excessively difficult for all patients to understand and retain health information and take sustainable steps towards recommended behaviors.

Recent health research has focused on evaluating promising interventions that target improving patients’ understanding of their personal health, with hopes of subsequently achieving medical adherence and improving outcomes. Typically, researchers have attempted to either (1) raise the health literacy skills of at-risk groups, (2) improve communication between patients and healthcare providers, (3) alter the health care system, or (4) change the design of educational materials [2]. Many strategies have focused on simplifying the text of written health materials, but rarely have these interventions fully addressed the science behind cognition, learning, and behavior. Consequently, such efforts have met with variable success [1], [3], [4], [5], [6].

In this paper, we unify several overlapping theories and concepts to introduce what we term a ‘cognitive factors’ perspective to the design of health materials. We review cognitive psychology and learning sciences principles and relate them to the design of patient education tools aimed at the transfer and retention of knowledge among patients across all literacy levels. Specifically, we assess factors involving the optimal design of written text and the use of illustrations and icons in print materials. Finally, we examine how the modality in which health information is communicated may be an important, context-dependent consideration when bringing together an educational strategy aimed at diverse patient populations.

Section snippets

Working memory and its constraints

Effective design of educational tools should facilitate communication of content and promote audience understanding, and the development of such materials should account for the cognitive processes underlying the user's interaction with them. Working memory is the resource through which people manipulate and actively keep information available for on-line processing. Working memory is activated in nearly all complex cognitive tasks (e.g. reading, mathematics, reasoning and problem solving),

Discussion and conclusion

The limited capacity of working memory highlights the need for effective design that minimizes the extraneous cognitive demands placed on patients and frees their mental resources to better process important information. When applying a cognitive factors approach to the development and refinement of health materials, it is also important to note the circumstance in which the material will likely be presented. Design strategies involving static media should consider audience characteristics as

Conflict of interest

Neither author has any conflicts of interest to disclose regarding this work.

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