Formalization of an Evaluation Grid for Assessing the Quality of Visual Aids to Enhance Individual Health Education in General Medical Consultations

Overview

The VISUMEG project aims to formalize an assessment framework for evaluating digital visual aids that are useful for effective communication in health education. It became necessary to gather the quality criteria for visual aids mentioned in the broader literature and then discuss with direct stakeholders (general practitioners and general medicine patients) the criteria relevant to general medicine.

According to the World Health Organization, health is defined as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Health is determined by biological, psychological, social, and cultural factors and must therefore be considered holistically. It is influenced by the various events that individuals encounter throughout their lives. They are given the means to take charge of their own health with the aim of improving it. At the individual and collective levels, patients are supported through preventive measures and health promotion initiatives. Educational tools are developed to facilitate the transmission of useful information to patients, develop their health knowledge and skills, and increase their autonomy so that they can make their own decisions. This is the definition of health education. In their practice, general practitioners play a key role in patient health education. They support patients in a variety of areas: providing information, prevention, screening, therapeutic education, primary care, follow-up, coordination of care, etc. The common thread linking all these areas is the use of communication tools to foster the doctor-patient relationship and thus enable optimal care. These communication tools include visual aids (sketches, diagrams, posters, leaflets, animations and videos, anatomical charts and even 3D models, etc.). These aids, which are widely used in medicine, primarily engage the sense of sight. Several studies and literature reviews have shown the usefulness of visual aids in improving healthcare communication, with a positive impact on patient attention, memory, understanding, compliance, and satisfaction. However, studies on the value of visual aids in general practice consultations are rarer. An initial self-administered questionnaire survey of 376 French general practitioners was conducted by Dr. Jean-Denis Hoonakker in 2019 on the use of visual aids by French general practitioners. Thirty-four percent of them reported using visual aids on a daily basis, 71% at least once a week, and 94% found them useful or very useful. However, 77% felt that they did not use them enough during consultations. The main obstacles to their use were the time spent searching for suitable visual aids, the lack of high-quality visual aids, and a lack of familiarity with their use. A common request made by doctors was for a single database of high-quality digital visual aids to be created to facilitate their use during consultations. The quality of visual aids therefore seems to be one of the main limitations to their use in general practice. The fact that the quality of a visual aid can directly impact its usefulness in consultations was already highlighted by Dr. Hoonakker. His work suggested that higher-quality visual aids would encourage their use in general practice consultations. However, no grid has been validated in the literature for assessing the quality of visual aids in general practice consultations. This initial thesis gave rise to a research project at the Department of General Medicine Teaching and Research at the Créteil Faculty of Health: the VISUMEG project. Its objective is to formalize an assessment framework for evaluating digital visual aids that are useful for effective communication in health education. It became necessary to gather the quality criteria for visual media mentioned in the broader literature and then to discuss with the direct stakeholders (general practitioners and general medicine patients) the criteria relevant to general medicine. Two literature reviews were conducted in parallel by Dr. Marie-Louise Grudzinski and Dr. Charlotte Moinard in the fields of health on the one hand and education and marketing sciences on the other. The 94 studies included compared the impact of a quality criterion between two visual aids on the participant's attention, comprehension, memorization, adherence, or satisfaction. Numerous quality criteria, specific to each visual aid, were identified. Common characteristics were highlighted in both fields. They concerned the format of the visual aid (simple, uncluttered, realistic, colorful, animated, well-organized, with key information highlighted using visual cues), its content (tailored to the patient's literacy level, culture, and educational objective, with a limited amount of information, created with the patient's participation, balancing emotional and cognitive value), and the representation of risk (pictograms, bar charts). Based on these two theses, certain elements also need to be clarified. The quality criteria identified differ depending on the type of visual aid and the educational objective sought. Furthermore, the studies included did not always allow for a conclusion to be drawn regarding the impact (positive or negative) of the quality criterion evaluated on the patient. Finally, it is not certain that all the criteria found are applicable to general medicine, as the studies rarely concerned this specialty. These two studies provide an immediate outlook for the next stage of the VISUMEG project. Using the data obtained from the literature reviews, we wish to determine the quality criteria that seem most relevant to general practice consultations and to verify their applicability in this discipline using a consensus method. The objective of this work will be to evaluate the relevance of these criteria according to the type of visual aid and the desired impact on patients in general practice consultations. The list of criteria relevant for use in general practice will then enable the formalization of an assessment grid based on the selected quality criteria, with the aim of evaluating the usefulness of the various visual aids.

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