# Presentation: 515031

## 

_**of EDUCATIONAL MATERIALS:**_
**Key Cognitive Principles**

****

**Ruth S. Day**
**Duke University**

- FDA Drug Safety & Risk Management July 17, 2002

## “COGNITIVE ACCESSIBILITY”

- The _ease_
- with which
- people can

- find
- understand
- remember
- use

-  drug
-  information

-  in a safe and effective manner.

## COGNITIVE PRINCIPLES

## COGNITIVE PRINCIPLES

**Information Load**
**Chunking**
**Coding**
**Representation**
**Location**

## COGNITIVE PRINCIPLES

**Information Load**
**Chunking**
**Coding**
**Representation**
**Location**

**Readability**
**Comprehensibility**
**Attention**
**Cognitive Task**
**Metacognition**

## LOAD

**LOAD**

**How much is too much?**

## LOAD

**LOAD**

**Information****	****       **
**     ****Load****	****	****	****    **

**How much is too much?**

## LOAD

**LOAD**

**Information****	****       Cognitive**
**     ****Load****	****	****	****    Load**

**How much is too much?**

## EXAMPLE (Original) 

- Tell your doctor, nurse, and pharmacist if you ...
-  are allergic to any medicine, either prescription or    nonprescription (OTC);
-   **are pregnant or intend to become pregnant while using ****   this medicine**
** ** are breast-feeding;
-   are using any other prescription or nonprescription (OTC)    medicine, especially diuretics (water pills) or    potassium-containing medicines or supplements;
-   have any other medical problems, especially heart or     blood vessel disease or kidney disease;
-   are on a strict low-sodium diet or dialysis, or use low-salt    milk or salt substitutes;
-   have had a kidney transplant

*** ***_***Source:***_  Day, R. S. (1999) Optimizing patient comprehension through
-   medicine information leaflets:  Cognition experiments.  In A.G. Hartzema, S.
-  Tolleson-Rinehart, B.L. Sleath, and R.S. Day, *Optimizing Patien Comprehension*
*  **through Medicine Leaflets.* Rockville, MD: U.S. Pharmacopeia.  Pp. 60-176.

## Slide 10

## EXAMPLE (Original) 

- Tell your doctor, nurse, and pharmacist if you ...
-  are allergic to any medicine, either prescription or    nonprescription (OTC);
-   **are pregnant or intend to become pregnant while using ****   this medicine**
** ** are breast-feeding;
-   are using any other prescription or nonprescription (OTC)    medicine, especially diuretics (water pills) or    potassium-containing medicines or supplements;
-   have any other medical problems, especially heart or     blood vessel disease or kidney disease;
-   are on a strict low-sodium diet or dialysis, or use low-salt    milk or salt substitutes;
-   have had a kidney transplant

**~~~~~~~~~~~~~~~~~~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ****    ~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~    ****    ~~~~~~~**
**  ****~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~****    ~~~~~~~~~~~~~~~~~~~~~~~~~~~****    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~****    ~~~~~~~~~~~~~~~~~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~****    ~~~~~~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~**

## EXAMPLE (Original) 

- Tell your doctor, nurse, and pharmacist if you ...
-  are allergic to any medicine, either prescription or    nonprescription (OTC);
-   **are pregnant or intend to become pregnant while using ****   this medicine**
** ** are breast-feeding;
-   are using any other prescription or nonprescription (OTC)    medicine, especially diuretics (water pills) or    potassium-containing medicines or supplements;
-   have any other medical problems, especially heart or     blood vessel disease or kidney disease;
-   are on a strict low-sodium diet or dialysis, or use low-salt    milk or salt substitutes;
-   have had a kidney transplant

**~~~~~~~~~~~~~~~~~~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ****    ~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~    ****    ~~~~~~~**
**  ****~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~****    ~~~~~~~~~~~~~~~~~~~~~~~~~~~****    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~****    ~~~~~~~~~~~~~~~~~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~****    ~~~~~~~~~~~~~~**
**  ****~~~~~~~~~~~~~~~~~**

## EXAMPLE (Revised)

- Tell your doctor, nurse, and pharmacist if you have:
_**Allergies to Medicines**_
-   --prescription medicine
-   --nonprescription medicine (OTC)
_**Female Circumstances**_
-   --*are pregnant*
*  **--intend to become pregnant *
*        **while using this medicine*
*  **--*are breast-feeding
_**Other Medicines**_
-   --prescription medicine
-   --nonprescription medicine (OTC)
-   --especially:  --diuretics (water pills)
- 	          --potassium-containing
-                              medicines or supplements
_**Medical Conditions**_
-   --any other medical problems
-   --especially:  --heart disease
-                         --blood vessel disease
-                         --kidney disease
- 	          --kidney transplant
- 	          --on dialysis
_**Diet**_
-   --on a strict low-sodium diet
-   --use low-salt milk
-   --use salt substitutes

## COGNITIVE TASKS

** ****Read**
** ****Free Recall**
** ****Recognition****	**
** ****Comprehension**
-   --text, pictures
** ****Problem Solving**
-   --what do if ?

## COGNITIVE TASKS

** ****Read**
** ****Free Recall**
** ****Recognition****	**
** ****Comprehension**
-   --text, pictures
** ****Problem Solving**
-   --what do if ?

**Search & Find**
**Decision Making**
-   --self selection
-   --de-selection
**Metacognition**
-   --easy/hard?
-   --like it?

## COGNITIVE TASKS

** ****Read**
** ****Free Recall**
** ****Recognition****	**
** ****Comprehension**
-   --text, pictures
** ****Problem Solving**
-   --what do if ?

**Search & Find**
**Decision Making**
-   --self selection
-   --de-selection
**Metacognition**
-   --easy/hard?
-   --like it?

**Cognition**
**&**
**Actions**

-  Accuracy
-  Errors
**  ...****.**

## FORMAT SELECTION

- Warnings
- Dosage
- Side Effects
** ...****.**** **

**CONTENT**

_**FORMAT SELECTION**_

- Basic Strategy

## FORMAT SELECTION

- Indications
- Warnings
- Dosage
- Side Effects
** ...****.**** **

**CONTENT**

_**FORMAT SELECTION**_

- Basic Strategy

## FORMAT SELECTION

- Indications
- Warnings
- Dosage
- Side Effects
** ...****.**** **

**CONTENT**

-    Text
-          List
-          Outline
**                    ****...****.**

**FORMAT**

_**FORMAT SELECTION**_

- Basic Strategy

## FORMAT SELECTION

- Indications
- Warnings
- Dosage
- Side Effects
** ...****.**** **

**CONTENT**

- Use

-  Remember

-   Understand

- Find

-    Text
-          List
-          Outline
**                    ****...****.**

**COGNITIVE**
**TASK**

**FORMAT**

_**FORMAT SELECTION**_

- Basic Strategy

_***Source***_***:******  ***Adapted from Day, R.S. (1988) Alternative representations.
-     In G.H. Bower (Ed.), *The Psychology of Learning and Motivation, *
*   **22, *261-306.  New York: Academic Press.

## Format

## Content

**Content**

## Content

**Content**

**Content**

## Content

**Format 1**

**Content**

**Content**

## Content

**Format 1**

**Content**

**Format 2**

**Content**

## Content

**Format 1**

**Content**

**Format 3**

**Format 2**

**Content**

## INFORMATION

**Physically**
**  ****present**

_**INFORMATION**_

## INFORMATION

**Physically**
**  ****present**

**Functionally**
**    ****absent**

_**INFORMATION**_