Development and Assessment of a Pictographic Pediatric Constipation Action Plan

Patrick T Reeves, Nathan T Kolasinski, H Shonna Yin, Waleed Alqurashi, Sofia Echelmeyer, Bruno P Chumpitazi, Philip L Rogers, Carolyn Sullivan Burklow, Cade M Nylund, Patrick T Reeves, Nathan T Kolasinski, H Shonna Yin, Waleed Alqurashi, Sofia Echelmeyer, Bruno P Chumpitazi, Philip L Rogers, Carolyn Sullivan Burklow, Cade M Nylund

Abstract

Objective: To assess the Uniformed Services Constipation Action Plan (USCAP) as an evidence-based, personalized, clinical action tool with pictograms to aid clinicians and families in the management of functional constipation.

Study design: The USCAP facilitates the management functional constipation by using a health literacy-informed approach to provide instructions for pharmacotherapies and lifestyle modifications. This study included part 1 (pictogram validation) and part 2 (assessment). For part 1, pictogram transparency, translucency, and recall were assessed by parent survey (transparency ≥85%, mean translucency score ≥5, recall ≥85% required for validation). For part 2, the USCAP was assessed by parents, clinical librarians, and clinicians. Parental perceptions (n = 65) were assessed using the Consumer Information Rating Form (17 questions) to gauge comprehensibility, design quality and usefulness. Readability was assessed by 5 formulas and a Readability Composite Score was calculated. Clinical librarians (n = 3) used the Patient Education Materials Assessment Tool to measure understandability (19 questions) and actionability (7 questions) (>80% rating was acceptable). Suitability was assessed by clinicians (n = 34) using Doak's Suitability Assessment of Materials (superior ≥70% rating).

Results: All 12 pictograms demonstrated appropriate transparency, translucency, and recall. Parental perceptions reflected appropriate comprehensibility, design quality, and usefulness. The Readability Composite Score was consistent with a fifth-grade level. Clinical librarians reported acceptable understandability and actionability. Clinicians reported superior suitability.

Conclusions: The USCAP met all criteria for clinical implementation and future study of USCAP implementation for treating children with chronic functional constipation.

Keywords: discharge planning; functional; gastroenterology; patient education; pictogram; validation.

Published by Elsevier Inc.

Figures

Figure 1
Figure 1
USCAP. Version IV of the USCAP for use in pediatric patients with functional constipation. A downloadable version of this form is available at www.jpeds.com.
Figure 2
Figure 2
Intended pictogram meaning, key graphic elements, pictogram design, Transparency, Translucency, and Recall for the USCAP. Proposed and intended meaning for each image in conjunction with the visual key graphic elements selected to portray each meaning. The image is attached on the same row with the accompanying transparency (n, %), translucency (Likert score 1-7, where 1 = no relationship and 7 = very strong relationship; mean and SD), and recall (n, %). PBSFS, Pediatric Bristol Stool Form Scale.

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