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Web-Based, Pictograph-Formatted Discharge Instructions for Low-Literacy Older Adults After Hip Replacement Surgery: Findings of End-User Evaluation of the Website

Choi, Jeungok PhD, MPH, RN; Jacelon, Cynthia S. PhD, RN-BC, CRRN, FAAN; Kalmakis, Karen A. PhD, MPH, FNP-BC

doi: 10.1002/rnj.274
Continuing Education

Purpose: The purpose of this study was to develop web-based, pictograph-formatted discharge instructions and evaluate the website with intended users to maximize the relevance and clarity of the website.

Design: A descriptive study.

Methods: Low-literacy text and 45 sets of pictographs were implemented in web-based instructions. The content, design, function, and navigation of the website were reviewed by 15 low-literate older adults following hip replacement surgery.

Findings: Participants observed that the simple line drawings with clear background were well suited to web pages and helped to convey the points made. They also suggested changes such as adding an additional alphabetical index menu to enhance easy navigation and removing hypertext links to avoid distraction.

Conclusions: Web-based, pictograph-formatted discharge instructions were well received by low-literate older adults, who perceived the website easy to use and understand.

Clinical Relevance: A pictograph-formatted approach may provide effective strategies to promote understanding of lengthy, complex action-based discharge instructions in rehabilitation facilities.

College of Nursing, University of Massachusetts Amherst, Amherst, MA, USA

Correspondence: Jeungok Choi, College of Nursing, University of Massachusetts Amherst, 120 Skinner Hall, 651 North Pleasant Street, Amherst, MA 01003, USA. E-mail:

Accepted February 11, 2016.

Cite this article as: Choi P. J., Jacelon C. S., & Kalmakis K. A. (2017). Web-based, pictograph-formatted discharge instructions for low-literacy older adult after hip replacement surgery: Findings of end-user evaluation of the website. Rehabilitation Nursing, 42(5), 254–261. doi: 10.1002/rnj.274

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