Exploring the use of graphics in written health information for people with aphasia

Background: One of the documented design features of aphasia-friendly written information is the inclusion of graphics. People with aphasia have identified a preference for the inclusion of photographic illustrations in printed education materials (PEMs); however this preference contrasts with research suggesting that line drawings may be a more effective graphic type. Few studies have explored how graphics affect reading comprehension for people with aphasia.

Aims: The aims of this research were (1) to determine if black and white line drawings and colour photographs affect the reading comprehension of people with and without aphasia, and (2) to explore perceptions of graphic helpfulness and preferences for including line drawings and photographic illustrations in PEMs.

Methods & Procedures: A total of 22 people with aphasia and 15 of their significant others completed a purposefully developed cloze reading comprehension task, with multiple-choice response options. Response options contained (1) no illustrations, (2) black and white line drawings, or (3) colour photographs. The reading comprehension task was timed. The impact of no illustrations, line drawings, and photographs on (a) reading comprehension (measured in number of paragraphs correctly completed), and (b) response times (measured in seconds) was examined. Participants also completed a face-to-face graphic preference survey.

Outcomes & Results: There were no significant differences on the reading comprehension task for participants with aphasia and those without, between (a) the number of paragraphs correctly completed in the set with no graphics, line drawings, and photographs, (b) the time taken to complete paragraphs in each of the three sets, and (c) the mean time taken to correctly complete paragraphs in each of the three sets. In contrast, the majority of participants perceived that pictures help understanding and make reading quicker. Significantly more participants with aphasia, compared to participants without, reported that they needed pictures to understand writing, and all participants with aphasia preferred health information to contain graphics. Several participants did not have a preference for line drawings or photographs in PEMs. Of those who did have a preference, more participants preferred written health information to contain photographs.

Conclusions: Both participants with and without aphasia perceived that graphics in PEMs were helpful, however significantly more participants with aphasia reported that graphics were needed to understand text. The finding that line drawings and colour photographs did not significantly assist comprehension should not discount other benefits graphics may have in PEMs for people with aphasia.