Development and Assessment of a Pictographic Pediatric Constipation Action Plan

Reeves, Patrick T.; Kolasinski, Nathan T.; Yin, H. Shonna; Echelmeyer, Sofia; Chumpitazi, Bruno P.; Rogers, Philip; Burklow, Carolyn Sullivan; Nylund, Cade M.

OBJECTIVE: To assess the Uniformed Services Constipation Action Plan (USCAP) as an evidence-based, personalized, clinical action tool with pictograms to aid clinicians and families in the management of functional constipation. STUDY DESIGN: The USCAP facilitates the management FC by using a health literacy-informed approach to provide instructions for pharmacotherapies and lifestyle modifications. This study included Part 1 (Pictogram Validation) and Part 2 (Assessment). For Part 1, Pictogram transparency, translucency, and recall were assessed by parent survey (transparency ≥85%, mean translucency score ≥5, recall ≥85% required for validation). For Part 2, the USCAP was assessed by parents, clinical librarians, and clinicians. Parental perceptions (n=65) were assessed using the the Consumer Information Rating Form (17 questions) to gauge comprehensibility, design quality and usefulness. Readability was assessed by 5 formulas and a Readability Composite Score was calculated. Clinical Librarians (n=3) used the Patient Education Materials Assessment Tool to measure understandability (19 questions) and Actionability (7 questions) (>80% rating was acceptable). Suitability was assessed by clinicians (n=34) using Doak’s Suitability Assessment of Materials (superior≥70% rating). RESULTS: All 12 pictograms demonstrated appropriate transparency, translucency and recall. Parental perceptions reflected appropriate comprehensibility, design quality, and usefulness. The Readability Composite Score was consistent with a fifth grade level. Clinical librarians reported acceptable understandability and actionability. Clinicians reported superior suitability. CONCLUSION: The USCAP met all criteria for clinical implementation and future study of USCAP implementation for treating children with chronic FC