Advertisement

Improving patients’ understanding, recall, satisfaction and compliance

  • Philip Ley
  • Sue Llewelyn
Chapter

Abstract

This chapter will examine some of the problems involved in giving information to patients. It will be shown that in general patients want information about their condition and their treatment, but many feel that they are not told enough, many do not understand what they are told, and many do not remember what is said. If it is accepted that patients should be adequately informed, this is clearly a state of affairs which needs to be remedied. It is also likely that patients’ compliance with advice and the speed and ease of recovery from illness are adversely affected by this lack of information. Although the main emphasis of this chapter will be on the improvement of information giving by health care providers, this is only one aspect of communication in the clinical encounter. Roter, Hall and Katz (1988) reviewed content analyses of consultation communications between doctors and patients.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adamson, T.E., Schann J.M. and Gullion, D.S. (1988) Patient feedback as a tool to influence physician counselling. Patient Education and Counselling, 11, 109–17.CrossRefGoogle Scholar
  2. Anderson, J.L., Dodman, S., Kopelman, M. and Fleming, A. (1979) Patient information recall in a rheumatology clinic. Rheumatology and Rehabilitation, 18, 18–22.CrossRefGoogle Scholar
  3. Anderson, K.O. and Masur, F. (1983) Psychological preparation for invasive medical and dental procedures. Journal of Behavioural Medicine, 6, 1–40.CrossRefGoogle Scholar
  4. Andrasik, F. and Murphy, W.D. (1977) Assessing the readability of thirty-nine behavior-modification training manuals. Journal of Applied Behavior Analysis, 10, 341–4.CrossRefGoogle Scholar
  5. Ausburn, L. (1981) Patient compliance with medication regimes, in Advances in Behavioural Medicine, Vol. 1, (ed) J.L. Sheppard, Cumberland College, Sydney.Google Scholar
  6. Baltimore, C. and Meyer, R.J. (1969) A study of storage, child behavior, traits, and mothers’ knowledge of toxicology in 52 poisoned families and 52 comparison families. Pediatrics, (Supplement) 44, 816–20.Google Scholar
  7. Barlett, E.E., Grayson, M., Barker, R. et al., (1984) The effects of physician communications skills on patient satisfaction, recall, and adherence. Journal of Chronic Diseases, 37, 755–64.CrossRefGoogle Scholar
  8. Bendick, M. and Cantu, M.C. (1978) The literacy of welfare clients. Social Services Review, March, 56–68.Google Scholar
  9. Bertakis, K.D. (1977) The communication of information from physician to patient: a method for increasing retention and satisfaction. Journal of Family Practice, 5, 217–22.Google Scholar
  10. Borland, R. and Naccarella, L. (1991) Reactions to the 1989 Quit campaign: results from two telephone surveys. Quit Evaluation Studies No. 5. Victorian Smoking and Health Program, Melbourne.Google Scholar
  11. Bourhis, R., Roth, S. and MacQueen, G. (1989) Communication in the hospital setting, a survey of medical and everyday language use amongst patients, nurses and doctors. Social Science and Medicine, 28, 339–46.CrossRefGoogle Scholar
  12. Boyle, C.M. (1970) Differences between patients’ and doctors’ interpretations of common medical terms. British Medical Journal, 2, 286–9.CrossRefGoogle Scholar
  13. Bradshaw, P.W., Ley, P., Kincey, J.A. and Bradshaw, J. (1975) Recall of medical advice: comprehensibility and specifity. British Journal of Social and Clinical Psychology, 14, 55–62.CrossRefGoogle Scholar
  14. Bragg, B.W. (1973) Seat Belts — Good Idea, but are They too Much Bother? An Analysis of the Relationship Between Attitudes Toward Seat Belts and Reported Seat Belt Use, Department of Transport, Road and Motor Vehicle Traffic Safety, Ottawa.Google Scholar
  15. Breznitz, S. (1984) Cry Wolf: the Psychology of False Alarms, Lawrence Erlbaum Associates, Hillsdale, NJ.Google Scholar
  16. Caron, H.S. (1985) Compliance: the case for objective measurement. Journal of Hypertension, 3, (Suppl.l), 11–17.Google Scholar
  17. Carstairs, V. (1970) Channels of Communication, Scottish Home and Health Department, Edinburgh.Google Scholar
  18. Cartwright, A. (1964) Human Relations and Hospital Care, Routledge and Kegan Paul, London.Google Scholar
  19. Cartwright, A. (1967) Patients and Their Doctors, Routledge and Kegan Paul, London.Google Scholar
  20. Centre for Behavioural Research in Cancer (1992) Health Warnings and Contents Labelling on Tobacco Products, Centre for Behavioural Research in Cancer, Melbourne.Google Scholar
  21. Cole, R. (1979) The understanding of medical terminology used in printed health education materials. Health Education Journal, 38, 111–21.CrossRefGoogle Scholar
  22. Dale, E. and Chall, J.S. (1948a) A formula for predicting readability. Educational Research Bulletin, 27, 11–20.Google Scholar
  23. Dale, E. and Chall, J.S. (1948b) A formula for predicting readability: instructions. Educational Research Bulletin, 27, 27–54.Google Scholar
  24. Department of Health and Human Services (1980) Prescription drug products: patient package insert requirements. Federal Register, 45, 60754–817.Google Scholar
  25. Department of Health, Education and Welfare (1979 a) Prescription drug products: patient labelling requirements. Federal Register, 44, 40016–41.Google Scholar
  26. Department of Health, Education and Welfare (1979b) Readability Testing in Cancer Communications, DHEW (NIH 79–1689), Washington DC.Google Scholar
  27. Devine, E.C. and Cook, T.D. (1983) A meta-analysis of the effects of psycho-educational interventions on length of postsurgical hospital stay. Nursing Research, 32, 267–74.CrossRefGoogle Scholar
  28. DiMatteo, M.R. and DiNicola, D.D. (1982) Achieving Patient Compliance: The Psychology of the Medical Practitioner’s Role, Pergamon Press, New York.Google Scholar
  29. Doak, L.G. and Doak, C.C. (1980) Patient comprehension profiles: recent findings and strategies. Patient Counselling and Health Education, 2, 101–6.CrossRefGoogle Scholar
  30. Ellis, D.A., Hopkin, J.M., Leitch, A.G. and Crofton, J. (1979) ‘Doctors orders’: controlled trial of supplementary, written information for patients. British Medical Journal, 1, 456.CrossRefGoogle Scholar
  31. Epstein, L.H. and Cluss, P.A. (1982) A behavioural medicine perspective on adherence vs long-term medical regimens. Journal of Consulting and Clinical Psychology, 50, 950–71.CrossRefGoogle Scholar
  32. Faden, R.R., Beauchamp, T.L. and King, N.M.P. (1986) A History and Theory of Informed Consent, Oxford University Press, Oxford.Google Scholar
  33. Flesch, R. (1948) A new readability yardstick. Journal of Applied Psychology, 32, 221–33.CrossRefGoogle Scholar
  34. French, C., Mellor, M. and Parry, L. (1978) Patients’ views of the ophthalmic optician. Ophthalmic Optician, 28, 784–6.Google Scholar
  35. Fry, E.B. (1968) A readability formula that saves time. Journal of Reading, 11, 513–16; 575–8.Google Scholar
  36. Gibbs, R.D., Gibbs, P.H. and Henrich, J. (1987) Patient understanding of commonly used medical vocabulary. Journal of Family Practice, 25, 176–8.Google Scholar
  37. Gibbs, S., Waters, W.E. and George, C.F. (1987) The design of prescription information leaflets and the feasibility of their use in general practice. Pharmaceutical Medicine, 2, 23–33.Google Scholar
  38. Gibbs, S., Waters, W.E. and George, C.F. (1989a) The benefits of prescription information leaflets (1). British Journal of Clinical Pharmacology, 27, 723–39.CrossRefGoogle Scholar
  39. Gibbs, S., Waters, W.E. and George, C.F. (1989b) The benefits of prescription information leaflets (2). British Journal of Clinical Pharmacology, 28, 345–51.CrossRefGoogle Scholar
  40. Gibbs, S., Waters, W.E. and George, C.F. (1990) Communicating information to patients about medicine. Prescription information leaflets: a national survey. Journal of the Royal Society of Medicine, 83, 292–7.Google Scholar
  41. Glanz, K. and Rudd, J. (1990) Readability and content analysis of printed cholesterol education materials. Patient Education and Counselling, 16, 109–18.CrossRefGoogle Scholar
  42. Godfrey, S.S. and Laughery, K.R. (1984) The biasing effect of product familiarity on consumers’ awareness of hazard. Proceedings of the Human Factors Society, 28th Annual Meeting.Google Scholar
  43. Goldhaber, G.M. and de Turck, M.A. (1988a) Effects of consumers’ familiarity with a product on attention to and compliance with warnings. Journal of Product Liability, 11, 29–37.Google Scholar
  44. Goldhaber, G.M. and de Turck, M.A. (1988b) Effectiveness of warning signs: gender and familiarity effects. Journal of Product Liability, 11, 271–84.Google Scholar
  45. Goldhaber, G.M. and de Turck, M.A. (1988c) Effectiveness of warning signs: “familiarity effects”. Forensic Reports, 1, 281–301.Google Scholar
  46. Gordis, L. (1979) Conceptual and methodological problems in measuring compliance, in Compliance in Health Care, (eds R.B. Haynes, D.W. Taylor, and D.L. Sackett), Johns Hopkins University Press, Baltimore.Google Scholar
  47. Greenfield, S., Kaplan, S. and Ware, J.E. Jr. (1985) Expanding patient involvement in care: effects on patient outcomes. Annals of Internal Medicine, 102, 520–8.CrossRefGoogle Scholar
  48. Grundner, T.M. (1980) On the readability of surgical consent forms. New England Journal of Medicine, 302, 900–2.CrossRefGoogle Scholar
  49. Hall, J. and Dornan, M.C. (1988) What patients like about their medical care and how often they are asked: a meta-analysis of the satisfaction literature. Social Sciences and Medicine, 27, 935–9.CrossRefGoogle Scholar
  50. Hall, J. and Dornan, M.C. (1990) Patient socio-demographic characteristics as prediction of satisfaction with medical care: a meta-analysis. Social Sciences and Medicine, 30, 811–18.CrossRefGoogle Scholar
  51. Hall, J.A., Roter, D.L. and Katz, N.R. (1988) Metaanalysis of correlates of provider behavior in medical encounters. Medical Care, 26, 657–75.CrossRefGoogle Scholar
  52. Haynes, R.B. (1982) Improving patient compliance: an empirical view, in Adherence, Compliance and Generalisation in Behavioural Medicine, (ed R.B. Stuart), Brunner Mazd, New York.Google Scholar
  53. Haynes, R.B., Taylor, D.W., Sackett, D.L. et al. (1980) Can simple clinical measurements detect noncompliance? Hypertension, 2, 757–64.CrossRefGoogle Scholar
  54. Hermann, F. (1973) The out-patient prescription label as a source of medication errors. American Journal of Hospital Pharmacy, 30, 155–9.Google Scholar
  55. Holcomb, C.A. (1983) The cloze procedure and readability of patient-oriented drug information. Journal of Drug Education, 13, 347–57.CrossRefGoogle Scholar
  56. Kalish, R; and Reynolds, D. (1976) Death and Ethnicity: a Psycho-Cultural Study, University of Southern California Press, Los Angeles.Google Scholar
  57. Kanouse, D.E., Berry, S.H., Hayes-Roth, B., et al. (1981) Informing Patients About Drugs: Summary Report, Rand Corporation. Santa Monica, CA.Google Scholar
  58. Karnes, E.W., Leonard, S.D. and Rachwal, G. (1986) Effects of benign experiences on the perception of risk. Proceedings of the Human Factors Society, 30th Annual Meeting, 121–5.Google Scholar
  59. Kincey, J.A., Bradshaw, P.W. and Ley, P. (1975) Patients’ satisfaction and reported acceptance of advice in general practice. Journal of the Royal College of General Practitioners, 25, 558–66.Google Scholar
  60. Klare, G.R. (1963) The Measurement of Readability, Iowa State University Press, Iowa.Google Scholar
  61. Klare, G.R. (1974) Assessing readability. Reading Research Quarterly, 10, 62–102.CrossRefGoogle Scholar
  62. Klare, G.R. (1976) A second look at the validity of readability formulas. Journal of Reading Behavior, 8, 129–52.Google Scholar
  63. Klein, R. (1979) Public opinion and the National Health Service. British Medical Journal, 1, 1296–7.CrossRefGoogle Scholar
  64. Kupst, M.J., Dresser, K., Schulman, J.L. and Paul, M.H. (1975) Evaluation of methods to improve communication in the physician-patient relationship. American Journal of Orthopsychiatry, 45, 420–9.CrossRefGoogle Scholar
  65. Le Bas, J. (1989) Comprehensibility of patient education literature. Australian and New Zealand Journal of Psychiatry, 23, 542–6.CrossRefGoogle Scholar
  66. Leeb, D., Bowers, D.G. and Lynch, J.B. (1976) Observations in the myth of informed consent. Plastic and Reconstructive Surgery, 58, 280–2.CrossRefGoogle Scholar
  67. Leventhal, H., Meyer, D. and Nerenz, D. (1980) The common sense representation of illness danger, in Contributions to Medical Psychology 2 (ed) S. Rachman, Pergamon Press, Oxford, pp. 7–30.Google Scholar
  68. Levy, R.L. and Loftus, G.R. (1983) Compliance and memory, in Everyday Memory, (ed) P. Morris, Academic Press, London.Google Scholar
  69. Levy, S. M. (1983) The process of death and dying: behavioral and social factors, in Coping with Chronic Disease, (eds) T.G. Burish and L.A. Bradley, Academic Press, New York.Google Scholar
  70. Ley, P. (1972a) Complaints by hospital staff and patients: a review of the literature. Bulletin of the British Psychological Society, 25, 115–20.Google Scholar
  71. Ley, P. (1972b) Primacy, rated importance and the recall of medical information. Journal of Health and Social Behavior, 13, 311–17.CrossRefGoogle Scholar
  72. Ley, P. (1973) Communication in the clinical setting. British Journal of Orthodontics, 1, 173–7.Google Scholar
  73. Ley, P. (1976) Towards better doctor-patient communications: contributions from social and experiment psychology, in Communication between Doctors and Patients, (ed) A.E. Bennett, Oxford, University Press, Oxford.Google Scholar
  74. Ley, P. (1977) Psychological studies of doctor-patient communication, in Contributions to Medical Psychology 1, (ed) S. Rachman, Pergamon Press7, Oxford, pp. 9–42.CrossRefGoogle Scholar
  75. Ley, P. (1978) Psychological and behavioural factors in weight loss, in Recent Advances in Obesity Research 2. (ed) G.A. Bray, Newman Publishing, London.Google Scholar
  76. Ley, P. (1979) Memory for medical information. British Journal of Social and Clinical Psychology, 18, 245–56.CrossRefGoogle Scholar
  77. Ley, P. (1980) Practical methods of improving compliance, in Banbury Report 6: Product Labelling and Health Risks, (eds L.A. Morris, M.B. Mazis and I. Barofsky) Cold Spring Harbor Laboratory, Cold Spring Harbor, Long Island.Google Scholar
  78. Ley, P. (1981) Professional non-compliance: a neglected problem. British Journal of Clinical Psychology, 20, 151–4.CrossRefGoogle Scholar
  79. Ley, P. (1982a). Giving information to patients, in Social Psychology and Behavioural Medicine, (ed) J.R. Eiser, Wiley, New York.Google Scholar
  80. Ley, P. (1982b) Studies of recall in medical settings. Human Learning, 1, 223–33.Google Scholar
  81. Ley, P. (1982c) Understanding, memory, satisfaction and compliance. British Journal of Clinical Psychology, 21, 241–54.CrossRefGoogle Scholar
  82. Ley, P. (1983) Patients’ understanding and recall in clinical communication failure, in Doctor-Patient Communication (eds) D. Pendleton and J. Hasler, Academic Press, London.Google Scholar
  83. Ley, P. (1986a) Cognitive variables and noncompliance. Journal of Compliance in Health Care, 1, 171–88.Google Scholar
  84. Ley, P. (1986b) Obesity in Community Clinical Psychology, (ed) H. Koch, Croom Helm, London.Google Scholar
  85. Ley, P. (1987) A possible method for interpreting the results of meta-analyses of the comparative effectiveness of different treatments. Behavior Research and Therapy, 25, 165–6.CrossRefGoogle Scholar
  86. Ley, P. (1988) Communicating with Patients. Croom Helm, London.Google Scholar
  87. Ley, P. (1991) Suggested Guidelines for Warning Labels: Report to the Preventive Strategies Panel of The National Health and Medical Research Council. National and Medical Research Council, Canberra.Google Scholar
  88. Ley, P. and Morris, L.A. (1984) Psychological aspects of written information for patients, in Contributions to Medical Psychology 3. (ed S. Rachman), Pergamon Press, Oxford.Google Scholar
  89. Ley, P. and Spelman, M.S. (1967) Communicating with the Patient, Staples Press, London.Google Scholar
  90. Ley, P., Bradshaw, P.W., Eaves, D. and Walker, C.M. (1973) A method for increasing patients’ recall of information presented by doctors. Psychological Medicine, 3, 217–20.CrossRefGoogle Scholar
  91. Ley, P., Bradshaw, P.W., Kincey, J.A. and Atherton, S.T. (1976) Increasing patients’ satisfaction with communication. British Journal of Social and Clinical Psychology, 15, 403–13.CrossRefGoogle Scholar
  92. Ley, P., Flaherty, B., Smith, F. et al. (1985) A Comparative Study of the Effects of Two Warning Messages about Volatile Substances, Drug and Alcohol Authority, Sydney.Google Scholar
  93. Ley, P., Goldman, ML, Bradshaw, P.W. et al. (1972) The comprehensibility of some X-ray leaflets. Journal of the Institute of Health Education, 10, 47–53.Google Scholar
  94. Ley, P., Jain, V.K. and Skilbeck, C.E. (1975) A method for decreasing patients’ medication errors. Psychological Medicine, 6, 599–601.CrossRefGoogle Scholar
  95. Ley, P., Skilbeck, C.E. and Tulips, J.C. (1975) Satisfaction, understanding and compliance in a general practice sample. Unpublished manuscript.Google Scholar
  96. Ley, P., Whitworth, M.A., Skilbeck, C.E. et al. (1976) Improving doctor-patient communication in general practice. Journal of the Royal College of General Practitioners, 26, 720–4.Google Scholar
  97. Liguori, S. (1978) A quantitative assessment of the readability of P.P.I.s. Drug Intelligence and Clinical Pharmacy, 12, 712–16.Google Scholar
  98. McLaughlin, H. (1969) SMOG grading: and new readability formula. Journal of Reading, 22, 639–46.Google Scholar
  99. Mathews, A. and Ridgeway, V. (1984) Psychological preparation for surgery, in Health Care and Human Behaviour, (eds A. Mathews and A. Steptoe), Academic Press, London.Google Scholar
  100. Mayou, R., Williamson, B. and Foster, A. (1976) Attitudes and advice after myocardial infarction, British Medical journal, 1, 1577–9.CrossRefGoogle Scholar
  101. Mazzuca, S.A. (1982) Does patient education in chronic disease have therapeutic value? Journal of Chronic Diseases, 35, 521–9.CrossRefGoogle Scholar
  102. Meichenbaum, D. and Turk, D.C. (1987) Facilitating Treatment Adherence: a Practitioner’s Guidebook, Plenum Press, New York.CrossRefGoogle Scholar
  103. Morisky, D.E., Green, L.W. and Levine, D.M. (1986) . Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24, 67–74.CrossRefGoogle Scholar
  104. Morris, L.A. (1990) Communicating Therapeutic Risks, Springer Verlag, New York.CrossRefGoogle Scholar
  105. Morris, L.A. and Groft, S. (1982) Patient package inserts: a research perspective, in Drug Therapeutic Concepts for Clinicians. (ed) K. Melmon, Elsevier, New York.Google Scholar
  106. Morris, L.A. and Halperin, J. (1979) Effects of written drug information on patient knowledge and compliance: a literature review. American Journal of Public Health, 69, 47–52.CrossRefGoogle Scholar
  107. Morrow G. (1980) How readable are surgical consent forms? Journal of the American Medical Association, 244, 56–8.CrossRefGoogle Scholar
  108. Mullen, P.D. Green, L.W. and Persinger, CS. (1985) Clinical trials of patient education for chronic conditions: a comparative meta-analysis of intervention types. Preventive Medicine, 14, 753–81.CrossRefGoogle Scholar
  109. Mumford, E., Schlesinger, H.J. and Glass, G.V. (1982) The effects of psychological intervention on recovery from survey and heart attacks: an analysis of the literature. American Journal of Public Health, 72, 141–51.CrossRefGoogle Scholar
  110. Norell, S.E. (1981) Accuracy of patient interviews and estimates by clinic staff in determining medication compliance. Social Science and Medicine, 15E, 57–61.CrossRefGoogle Scholar
  111. Norell, S.E., Alfredsson, L., Bergman, U. et al. (1984) Spacing of medications schedules t.i.d. American Journal of Hospital Pharmacy, 41, 1183–5.Google Scholar
  112. O’Farrell, T.J. and Keuther, N.J. (1983) Readability of behaviour therapy self-help manuals. Behavior Therapy, 14, 449–54.CrossRefGoogle Scholar
  113. Parkin, D.M. (1976) Survey of the success of communications between hospital staff and patients. Public Health, London, 90, 203–9.CrossRefGoogle Scholar
  114. Parkin, D.M., Henney, CR., Quirk, J. and Crooks, J. (1976) Deviations from prescribed treatment after discharge from hospital. British Medical Journal, 2, 686–8.CrossRefGoogle Scholar
  115. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1982) Making Health Care Decisions, US Government Printing Office, Washington DCGoogle Scholar
  116. Pyrczak, F. and Roth, D.H. (1976) Readability of directions on non-prescription drugs. Journal of the American Pharmaceutical Association, 16, 242–3.Google Scholar
  117. Reynolds, P.M. Sanson-Fisher, R.W., Poole, A.D. et al. (1981) Cancer and communication: information-giving in an oncology clinic. British Medical Journal, 282, 1449–51.CrossRefGoogle Scholar
  118. Richwald, CA., Wamsley, M.A., Coulson, A.H. and Moriskey, D.E. (1988) Are condom instructions readable? Results of a readability study. Public Health Reports, 103, 355–9.Google Scholar
  119. Ridour, S., Waters, W.E. and George, C.F. (1986) Knowledge of and attitudes to medicines in the Southampton community. British Journal of Clinical Pharmacology, 21, 701–11.CrossRefGoogle Scholar
  120. Rosenthal, R. and Rubin, D.B. (1982) A simple general purpose display of magnitude of experimental effect. Journal of Educational Psychology, 74, 166–9.CrossRefGoogle Scholar
  121. Roter, D. (1977) Patient participation in the patient-provider interaction: the effects of patient question. Asking on the quality of the interaction, satisfaction and compliance. Health Education Monographs, 5, 281–315.CrossRefGoogle Scholar
  122. Roter, D.L., Hall, J.A., and Katz, N.R. (1988) Patient-physician communication: a descriptive summary of the literature. Patient Education and Counselling, 12, 99–119.CrossRefGoogle Scholar
  123. Roth, H.P. (1987) Measurement of compliance. Patient Education and Counselling, 10, 107–16.CrossRefGoogle Scholar
  124. Roth, H.P., Caron, H.S., Ort, R.S. et al. (1962) Patients’ beliefs about peptic ulcer and its treatment. Annals of Internal Medicine, 56, 72–80.CrossRefGoogle Scholar
  125. Rudd, P. and Marshall, C (1987) Resolving problems of measuring compliance with medication monitors. Journal of Compliance in Health Care, 2, 23–35.Google Scholar
  126. Sackett, D.L. and Snow, J.C. (1979) Magnitude of compliance and non-compliance, in Compliance in Health Care (eds R.B. Haynes, D.W. Taylor and D.L. Sackett), Johns Hopkins University Press, Baltimore.Google Scholar
  127. Sanazaro, P.J. (1985) A survey of patient satisfaction, knowledge and compliance. Western Journal of Medicine, 142, 703–5.Google Scholar
  128. Sharf, B.F. (1988), Teaching patients to speak up: Past and future trends. Patient Education and Counselling, 11, 95–108.CrossRefGoogle Scholar
  129. Skilbeck, C.E., Tulips, J.G. and Ley, P. (1977) Effects of fear arousal, fear position, fear exposure, and sidedness on compliance with dietary instructions. European Journal of Social Psychology, 7, 221–39.CrossRefGoogle Scholar
  130. Tabak, E. (1988) Encouraging patient question asking: a clinical trial. Patient Education and Counselling, 12, 37–49.CrossRefGoogle Scholar
  131. Taylor, W.L. (1953) Cloze procedure: a new tool for measuring readability. Journalism Quarterly, 30, 415–33.Google Scholar
  132. Thrush, R.S. and Lanese, R.R. (1962) The use of printed material in diabetes education. Diabetes, 11, 132–7.Google Scholar
  133. Tring, F.C. and Hayes-Allen, M.C. (1973) Understanding and misunderstanding of some medical terms. British Journal of Medical Education, 7, 53–9.CrossRefGoogle Scholar
  134. Wallace, L.M. (1986) Communication variables in the design of pre-surgical preparatory information. British Journal of Clinical Psychology, 25, 111–18.CrossRefGoogle Scholar
  135. Weisman, C.S. and Teitelbaum, M.A. (1989) Women and health care communication. Patient Education and Counselling, 11, 109–17.Google Scholar
  136. Wright, P., Creighton, P. and Threlfall, S.M. (1982) Some factors determining what instructions will be read, Ergonomics, 25, 225–37.CrossRefGoogle Scholar
  137. Young, L. and Humphrey, M. (1985) Cognitive methods of preparing women for hysterectomy: does a booklet help? British Journal of Clinical Psychology, 24, 303–4.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1995

Authors and Affiliations

  • Philip Ley
  • Sue Llewelyn

There are no affiliations available

Personalised recommendations