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Does pictorial health information improve health behaviours and other outcomes? A systematic review protocol
  1. Danielle Schubbe1,
  2. Sarah Cohen2,
  3. Renata W Yen1,
  4. Maria VD Muijsenbergh3,
  5. Peter Scalia1,
  6. Catherine H Saunders1,
  7. Marie-Anne Durand1
  1. 1 The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
  2. 2 Dartmouth College, Hanover, New Hampshire, USA
  3. 3 Radboudumc University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Dr Marie-Anne Durand; marie-anne.durand{at}


Introduction Most health information is verbal or written, yet words alone may not be the most effective way to communicate health information. Lower health literacy is prevalent in the US and is linked to limited understanding of one’s medical condition and treatment. Pictures increase comprehension, recall, adherence and attention in health settings. This is called pictorial superiority. No systematic review has examined the impact of pictorial health information among patients and consumers, including those with lower health literacy.

Methods and analysis This systematic review and meta-analysis will assess the characteristics and effectiveness of pictorial health information on patient and consumer health behaviours and outcomes, as well as differentially among individuals of lower literacy/lower health literacy. We will conduct a systematic search across selected databases, as well as grey literature, from inception until June 2018. We will include randomised controlled trials in all languages with all types of participants that assess the effect of pictorial health information on patients’ and consumers’ health behaviours and outcomes. Two independent reviewers will conduct the primary screening of articles and data extraction for the selected articles with a third individual available to resolve conflicts. We will assess the quality of all included studies using the Cochrane risk of bias tool. We will combine all selected studies and do a test of heterogeneity. If there is sufficient homogeneity, we will pool studies into a meta-analysis. Independent of the heterogeneity of included studies, we will also conduct a narrative synthesis.

Ethics and dissemination No ethics approval is required. The results will be published in a peer-reviewed journal and presented at relevant conferences.

PROSPERO registration number CRD42018084743.

  • health information
  • health communication
  • health literacy
  • picture
  • picture superiority
  • visual aid

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  • Contributors DS, M-A D: study conception. DS, SC, M-A D: search strategy with Dartmouth Biomedical Libraries. DS: manuscript drafting. DS, M-A D, RWY: critical revisions of manuscript. DS, M-A D, RWY, SC, PS, CHS, MvdM: final approval of the version to be published.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests M-AD has developed the Option Grid patient decision aids, which are licensed to EBSCO Health. She receives consulting income from EBSCO Health and may receive royalties in the future. M-AD is a consultant for ACCESS Community Health Network.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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