Development of education material for providing orientation to the elderly who are candidates for hearing-aid use

Nakamura, Milena Yoko; Almeida, Katia de

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Audiology - Communication Research

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Sumário

Original Article • Audiol., Commun. Res. 23 • 2018 • https://doi.org/10.1590/2317-6431-2017-1938 copy

Development of education material for providing orientation to the elderly who are candidates for hearing-aid use

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To determine the characteristics and factors to be considered in the process of developing and designing education material in the field of health care aimed for a target population comprised of elderly people; and to develop multimedia material for counseling the elderly who are candidates for hearing-aid use considering the guidelines on health literacy.

Methods

A bibliographic survey of the design factors to be incorporated in the preparation of education material in the field of health care was conducted. In addition, its contents also encompassed orientation and counseling for the elderly who are candidates for hearing aids. The multimedia material developed was based on the literature surveyed.

Results

The guidelines on language, design, layout and typography, organization and graphic illustration according to the literature references studied. Then, 57 content presentation screens making up the multimedia material were drawn up and divided into two main areas: “orientation on hearing aids” and “listening with the hearing aids.”

Conclusion

When preparing education materials in the field of health care, it is important to consider text readability to ensure health information will be understood and learned. In order to access the compilation of our results, the multimedia material we developed as the final product of this study could be made available.

Keywords:
Hearing aids; Elderly, Orientation; Counseling; Health literacy

	Recommendation	Literature
Language	Use a text with high readability (ease of reading) and great cohesion among sentences.	People, irrespective of their literacy level, prefer reading simple to complex materials as they are easier to understand⁽⁴4 Caposecco A, Hickson L, Meyer C. Assembly and insertion of a self-fitting hearing aid: design of effective instruction materials. Trends Amplif. 2012;15(4):184-95. PMid:22389434. ^,¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ^,²⁰20 CDC: Centers For Disease Control and Prevention. Clear communication index user guide [Internet]. 2014 [acesso em 2015 Mar 20]. Disponível em: http://www.cdc.gov/ccindex/ pdf/clear-communication-user-guide.pdf http://www.cdc.gov/ccindex/ ... ^,²³23 Plain English Campaign. How to write medical information in plain English [Internet]. 2001 [acesso em 2015 Mar 20]. Disponível em: http://www.plainenglish.co.uk/files/ medicalguide.pdf http://www.plainenglish.co.uk/files/ ... ⁾
	Use familiar words, phrases, and sentences. Repeat main words, phrases and ideas.	This increases text cohesion, which makes it easier to understand. A highly cohesive text reduces the demand for cognitive processing⁽⁴4 Caposecco A, Hickson L, Meyer C. Assembly and insertion of a self-fitting hearing aid: design of effective instruction materials. Trends Amplif. 2012;15(4):184-95. PMid:22389434. ^,²⁰20 CDC: Centers For Disease Control and Prevention. Clear communication index user guide [Internet]. 2014 [acesso em 2015 Mar 20]. Disponível em: http://www.cdc.gov/ccindex/ pdf/clear-communication-user-guide.pdf http://www.cdc.gov/ccindex/ ... 21 National Cancer Institute. Pink-book – making health communication programs work [Internet]. 2004 [acesso em 2015 Mar 20]. Disponível em: www.cancer.gov/cancertopics/cancerlibrary ^-²²22 Plain English Campaign. Guide to design and layout [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: http://www.plainenglish.co.uk/files/designguide.pdf http://www.plainenglish.co.uk/files/des... ⁾
	Make clear the benefit of the information. Highlight its good points.	Be stimulating, promote quick responses⁽⁸8 Medina C. Interface entre design e fonoaudiologia: material instrucional impresso voltado aos usuários de aparelho de amplificação sonora individual [tese] Bauru: Universidade de São Paulo; 2017. ^,¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ^,²¹21 National Cancer Institute. Pink-book – making health communication programs work [Internet]. 2004 [acesso em 2015 Mar 20]. Disponível em: www.cancer.gov/cancertopics/cancerlibrary ⁾
	Use the active voice. Tell the reader what to do.	Increases readability and urges the reader to take action⁽⁴4 Caposecco A, Hickson L, Meyer C. Assembly and insertion of a self-fitting hearing aid: design of effective instruction materials. Trends Amplif. 2012;15(4):184-95. PMid:22389434. ^,¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ^,²⁰20 CDC: Centers For Disease Control and Prevention. Clear communication index user guide [Internet]. 2014 [acesso em 2015 Mar 20]. Disponível em: http://www.cdc.gov/ccindex/ pdf/clear-communication-user-guide.pdf http://www.cdc.gov/ccindex/ ... ^,²³23 Plain English Campaign. How to write medical information in plain English [Internet]. 2001 [acesso em 2015 Mar 20]. Disponível em: http://www.plainenglish.co.uk/files/ medicalguide.pdf http://www.plainenglish.co.uk/files/ ... ⁾
	Do not use double meaning words. Use analogies familiar to the reader. Avoid the use of jargon, technical or scientific terms, acronyms or abbreviations.	Reduce the demand for cognitive processing and facilitate understanding of the text. Define technical terms, when essential⁽³3 Nair EL, Cienkowski KM. The impact of health literacy on patient understanding of counseling and education materials. Int J Audiol. 2010;49(2):71-5. http://dx.doi.org/10.3109/14992020903280161. PMid:20151879. http://dx.doi.org/10.3109/1499202090328... ^,¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ^,21.23)
	Limit the use of statistics or mathematical concepts, symbols and quotation marks.	This may render the text more difficult to understand or cause misinterpretation ⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾

	Recommendation	Justification
Typography	Use at least from 12- to 14-point types for text and 16-point types for headings.	Many elderly people have some sort of visual impairment that can not be corrected with glasses⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾
	Use sans-serif fonts.	Sans-serif fonts are easier for the brain to recognize⁽⁸8 Medina C. Interface entre design e fonoaudiologia: material instrucional impresso voltado aos usuários de aparelho de amplificação sonora individual [tese] Bauru: Universidade de São Paulo; 2017. ^,¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾
	Do not use UPPERCASE letters for writing an entire word.	Words written in uppercase only are more difficult to read, as there are fewer traits differentiating one from another (e.g. differences in size)⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾
	To highlight a word, use bold. Avoid underlined words or in italic s.	Underlined letters or letter in italics are harder to read⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾
*Layout*	Leave blanks, 10% to 35% per page, and blanks between heading, subheading and body text. Limit the amount of text and graphic illustrations per page.	This increases contrast and makes reading easier; Too much information per page can intimidate the reader⁽⁸8 Medina C. Interface entre design e fonoaudiologia: material instrucional impresso voltado aos usuários de aparelho de amplificação sonora individual [tese] Bauru: Universidade de São Paulo; 2017. ^,¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ^,²¹21 National Cancer Institute. Pink-book – making health communication programs work [Internet]. 2004 [acesso em 2015 Mar 20]. Disponível em: www.cancer.gov/cancertopics/cancerlibrary ⁾
	Use dark letters on light backgrounds. Use non-glossy paper for printed materials.	Elderly people have difficulty in perceiving differences when there is a low contrast between paper color and letter color⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ^,²⁰20 CDC: Centers For Disease Control and Prevention. Clear communication index user guide [Internet]. 2014 [acesso em 2015 Mar 20]. Disponível em: http://www.cdc.gov/ccindex/ pdf/clear-communication-user-guide.pdf http://www.cdc.gov/ccindex/ ... ^,²³23 Plain English Campaign. How to write medical information in plain English [Internet]. 2001 [acesso em 2015 Mar 20]. Disponível em: http://www.plainenglish.co.uk/files/ medicalguide.pdf http://www.plainenglish.co.uk/files/ ... ⁾ The reflection of light on paper makes it difficult to read⁽⁸8 Medina C. Interface entre design e fonoaudiologia: material instrucional impresso voltado aos usuários de aparelho de amplificação sonora individual [tese] Bauru: Universidade de São Paulo; 2017. ⁾
	Preferential text alignment to the left, not justified.	A justified alignment results in non-uniform word spacing, making the text more difficult to read⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ^,²²22 Plain English Campaign. Guide to design and layout [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: http://www.plainenglish.co.uk/files/designguide.pdf http://www.plainenglish.co.uk/files/des... ^,²³23 Plain English Campaign. How to write medical information in plain English [Internet]. 2001 [acesso em 2015 Mar 20]. Disponível em: http://www.plainenglish.co.uk/files/ medicalguide.pdf http://www.plainenglish.co.uk/files/ ... ⁾

	Recommendation	Justification
Organization	The main message should always be in the first paragraph and then the details, with the explanation on the subject, should follow.	It is the most frequently read part of written documents and should motivate the reader to continue reading. Readers find information more easily⁽⁴4 Caposecco A, Hickson L, Meyer C. Assembly and insertion of a self-fitting hearing aid: design of effective instruction materials. Trends Amplif. 2012;15(4):184-95. PMid:22389434. ^,⁸8 Medina C. Interface entre design e fonoaudiologia: material instrucional impresso voltado aos usuários de aparelho de amplificação sonora individual [tese] Bauru: Universidade de São Paulo; 2017. ^,¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ^,²⁰20 CDC: Centers For Disease Control and Prevention. Clear communication index user guide [Internet]. 2014 [acesso em 2015 Mar 20]. Disponível em: http://www.cdc.gov/ccindex/ pdf/clear-communication-user-guide.pdf http://www.cdc.gov/ccindex/ ... ⁾
	Organize the information into blocks with headings.	They provide context and help the reader to find the desired information by easily distinguishing headings from the rest of the text⁽⁸8 Medina C. Interface entre design e fonoaudiologia: material instrucional impresso voltado aos usuários de aparelho de amplificação sonora individual [tese] Bauru: Universidade de São Paulo; 2017. ^,²⁰20 CDC: Centers For Disease Control and Prevention. Clear communication index user guide [Internet]. 2014 [acesso em 2015 Mar 20]. Disponível em: http://www.cdc.gov/ccindex/ pdf/clear-communication-user-guide.pdf http://www.cdc.gov/ccindex/ ... ⁾
	Use questions in headings and subheadings.	This invites the reader to think about the answers⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ^,²¹21 National Cancer Institute. Pink-book – making health communication programs work [Internet]. 2004 [acesso em 2015 Mar 20]. Disponível em: www.cancer.gov/cancertopics/cancerlibrary ⁾
	Use short paragraphs expressing only one idea or subject.	This makes reading and understanding of the text easier⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾
	Offer the reader 3 to 4 pieces of information per page.	This helps information retention⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾
	Key words or key ideas should go in text boxes. Use bullet points when possible.	This highlights relevant information. Low literacy readers have difficulty finding the most important piece of information on a given page⁽⁴4 Caposecco A, Hickson L, Meyer C. Assembly and insertion of a self-fitting hearing aid: design of effective instruction materials. Trends Amplif. 2012;15(4):184-95. PMid:22389434. ^,¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾
	Sentences should be short, containing 8 to 12 words, on average. A line of text must be between 60 and 72 characters in length.	This reduces the demand for cognitive processing⁽⁴4 Caposecco A, Hickson L, Meyer C. Assembly and insertion of a self-fitting hearing aid: design of effective instruction materials. Trends Amplif. 2012;15(4):184-95. PMid:22389434. ^,⁵5 Caposecco A, Hickson L, Meyer C. Hearing aid user guides: suitability for older adults. Int J Audiol. 2014;53(S1, Suppl 1):S43-51. http://dx.doi.org/10.3109/14992027.2013.832417. PMid:24447232. http://dx.doi.org/10.3109/14992027.2013... ^,²³23 Plain English Campaign. How to write medical information in plain English [Internet]. 2001 [acesso em 2015 Mar 20]. Disponível em: http://www.plainenglish.co.uk/files/ medicalguide.pdf http://www.plainenglish.co.uk/files/ ... ⁾
	Include a summary of the key points at the end of each session or document.	This helps the reader to remember the main points addressed⁽²⁰20 CDC: Centers For Disease Control and Prevention. Clear communication index user guide [Internet]. 2014 [acesso em 2015 Mar 20]. Disponível em: http://www.cdc.gov/ccindex/ pdf/clear-communication-user-guide.pdf http://www.cdc.gov/ccindex/ ... ⁾

	Recommendation	Justification
Graphic Illustration	Use high quality visuals. Use illustrative resources to help communicate the message.	Figures increase attention, improve understanding and recall of written material for those with low literacy⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ^,²⁰20 CDC: Centers For Disease Control and Prevention. Clear communication index user guide [Internet]. 2014 [acesso em 2015 Mar 20]. Disponível em: http://www.cdc.gov/ccindex/ pdf/clear-communication-user-guide.pdf http://www.cdc.gov/ccindex/ ... ⁾
	Use simple (linear) drawings without unnecessary details.	Photography is an important resource for drawing attention to the message; however, simple designs have fewer distracting elements⁽⁴4 Caposecco A, Hickson L, Meyer C. Assembly and insertion of a self-fitting hearing aid: design of effective instruction materials. Trends Amplif. 2012;15(4):184-95. PMid:22389434. ^,⁸8 Medina C. Interface entre design e fonoaudiologia: material instrucional impresso voltado aos usuários de aparelho de amplificação sonora individual [tese] Bauru: Universidade de São Paulo; 2017. ^,¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾
	Use familiar images and symbols that are attractive to the reader. Use cartoon characters with caution.	They should be used to support the text and assist in the retention of information. If the image lacks credibility, it might not be taken seriously⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾
	Place explanatory captions close to the images. Use arrows and labels to illustrate the figures.	This helps to explain meaning and promote correct interpretation⁽⁴4 Caposecco A, Hickson L, Meyer C. Assembly and insertion of a self-fitting hearing aid: design of effective instruction materials. Trends Amplif. 2012;15(4):184-95. PMid:22389434. ^,⁸8 Medina C. Interface entre design e fonoaudiologia: material instrucional impresso voltado aos usuários de aparelho de amplificação sonora individual [tese] Bauru: Universidade de São Paulo; 2017. ^,¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾
	Should a sequence of illustrations be used, number the images.	This ensures that the reader will understand all the elements contained in graphic illustrations⁽¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾
	Use actual photographs to illustrate body parts or small pictures.	Photographs are good for drawing attention, especially when on the cover of the document ⁽⁸8 Medina C. Interface entre design e fonoaudiologia: material instrucional impresso voltado aos usuários de aparelho de amplificação sonora individual [tese] Bauru: Universidade de São Paulo; 2017. ^,¹⁹19 CDC: Centers For Disease Control and Prevention. Simply put: a guide for creating easy-to-understand materials [Internet]. 2009 [acesso em 2015 Mar 20]. Disponível em: www.cdc.gov/healthliteracy/pdf/Simply_Put.pdf ⁾

	What is a hearing aid?	• Definition and function • Types of hearing aids • Technology
Orientation on the hearing aid	How does the hearing aid work?	• Turning it on and off • Volume control • How to replace its battery? • Microphone
	How to put on and take off the hearing aid?	• Right side and left side • How to put on the mold/device • How to take off the mold/device
	How to talk on the phone with the hearing aid on?	• Microphone pickup • Phone Coil • Accessories
	Hearing aid care and maintenance	• Hearing aid care • Cleaning of the mold • Types of hearing aids
Listening with the hearing aid (counseling)	How is the adaptation to the hearing aid?	• What is the purpose of the hearing aid? • Adaptation to amplification • Routines of use • The importance of monitoring and follow-up
	What should I expect from my hearing aid?	• Benefits and expectations
	How will my listening be affected in different situations?	• Quiet settings • Noisy settings • Radio and television
	How to better understand what people are saying?	• Lip and face reading • Communication strategies

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[1] Conflict of interests: No.