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Using Comic-Based Concussion Discharge Instructions to Address Caregiver Health Literacy in the Emergency Department

Published:January 03, 2023DOI:https://doi.org/10.1016/j.jen.2022.12.006

      Abstract

      Introduction

      This study compared the effectiveness of comic-based with text-based concussion discharge instructions on improving caregiver knowledge. This study also examined the role of social determinants of health on comprehension instructions.

      Methods

      This was an observational study of the caregivers of pediatric concussion patients. Caregivers' health literacy and demographics related socioeconomic factors were obtained. After the patients’ evaluation in the emergency department, caregivers were given printed comic-based concussion discharge instructions. Caregivers were contacted 3 days later and tested overall knowledge of discharge instructions’ content. These survey results were compared with historical controls who received text-based instructions.

      Results

      A total of 120 participants were recruited, and 86 participants completed follow-up procedures. When comparing the caregivers’ recall ability with a comic-based vs traditional text-based instructions, caregivers with comic-based content were more likely to accurately recall overall discharge instructions (77.5% vs 44%, P < .001), particularly physical rest and activity restrictions (86.5% vs 63%, P < .001). Caregivers also were less likely to misidentify a red flag symptom (7.5% vs 19%, P < .04). Comic-based instructions did not increase recall of cognitive rest instructions or postconcussive symptoms. When examining demographic factors, caregivers who could not recall 3 postconcussive symptoms were more likely to be Hispanic or Black, less likely to be college educated, and more likely to have low health literacy.

      Discussion

      Novel methods should be explored to adequately prepare caregivers for continuing postconcussive care at home. Discharge instructions must be tailored to address caregivers’ baseline health literacy and how caregivers digest and retain information.

      Key words

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      References

        • Bryan M.A.
        • Rowhani-Rahbar A.
        • Comstock R.D.
        • Rivara F.
        Seattle Sports Concussion Research Collaborative. Sports- and Recreation-Related Concussions in US Youth.
        Pediatrics. 2016; 138e2154635https://doi.org/10.1542/peds.2015-4635
        • Halstead M.E.
        • Walter K.D.
        Council on Sports Medicine and Fitness. American Academy of Pediatrics. Clinical report–sport-related concussion in children and adolescents.
        Pediatrics. 2010; 126: 597-615https://doi.org/10.1542/peds.2010-2005
        • Stillman A.
        • Alexander M.
        • Mannix R.
        • Madigan N.
        • Pascual-Leone A.
        • Meehan W.P.
        Concussion: evaluation and management.
        Cleve Clin J Med. 2017; 84: 623-630https://doi.org/10.3949/CCJM.84A.16013
        • Corwin D.J.
        • Grady M.F.
        • Joffe M.D.
        • Zonfrillo M.R.
        Pediatric mild traumatic brain injury in the acute setting.
        Pediatr Emerg Care. 2017; 33: 643-649https://doi.org/10.1097/PEC.0000000000001252
        • McCrory P.
        • Meeuwisse W.H.
        • Aubry M.
        • et al.
        Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport, Zurich, November 2012.
        J Athl Train. 2013; 48: 554-575https://doi.org/10.4085/1062-6050-48.4.05
        • Grubenhoff J.A.
        • Deakyne S.J.
        • Comstock R.D.
        • Kirkwood M.W.
        • Bajaj L.
        Outpatient follow-up and return to school after emergency department evaluation among children with persistent post-concussion symptoms.
        Brain Inj. 2015; 29: 1-6https://doi.org/10.3109/02699052.2015.1035325
        • Seabury S.A.
        • Gaudette E.
        • Goldman D.P.
        • et al.
        Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: results from the TRACK-TBI study.
        JAMA Netw Open. 2018; 1e180210https://doi.org/10.1001/JAMANETWORKOPEN.2018.0210
        • Langlois J.
        Heads Up: Brain Injury in Your Practice A Tool Kit for PhysiAcians.
        Centers for Disease Control and Prevention, 2008
        • Samuels-Kalow M.E.
        • Stack A.M.
        • Porter S.C.
        Effective discharge communication in the emergency department.
        Ann Emerg Med. 2012; 60: 152-159https://doi.org/10.1016/J.ANNEMERGMED.2011.10.023
        • Morrison A.K.
        • Schapira M.M.
        • Gorelick M.H.
        • Hoffmann R.G.
        • Brousseau D.C.
        Low caregiver health literacy is associated with higher pediatric emergency department use and nonurgent visits.
        Acad Pediatr. 2014; 14: 309-314https://doi.org/10.1016/J.ACAP.2014.01.004
        • Glick A.F.
        • Farkas J.S.
        • Nicholson J.
        • et al.
        Parental management of discharge instructions: a systematic review.
        Pediatrics. 2017; 140e20164165https://doi.org/10.1542/PEDS.2016-4165
        • Glick A.F.
        • Farkas J.S.
        • Rosenberg R.E.
        • et al.
        Accuracy of parent perception of comprehension of discharge instructions: role of plan complexity and health literacy.
        Acad Pediatr. 2020; 20: 516-523https://doi.org/10.1016/J.ACAP.2020.01.002
        • Thomas D.G.
        • Bradley L.
        • Servi A.
        • et al.
        Parental knowledge and recall of concussion discharge instructions.
        J Emerg Nurs. 2018; 44: 52-56https://doi.org/10.1016/j.jen.2017.04.012
        • Kolberg K.
        • Larson J.
        • Almeida A.
        • et al.
        The feasibility of using comic-based concussion discharge instructions: gauging likeability and knowledge improvement among adolescents and parents.
        Pediatr Emerg Care. 2021; 37: E1603-E1610https://doi.org/10.1097/PEC.0000000000002133
        • Babcock L.
        • Kurowski B.G.
        • Zhang N.
        • Dexheimer J.W.
        • Dyas J.
        • Wade S.L.
        Adolescents with mild traumatic brain injury get SMART: an analysis of a novel web-based intervention.
        Telemed J Health. 2017; 23: 600-607https://doi.org/10.1089/TMJ.2016.0215
        • Kurowski B.G.
        • Wade S.L.
        • Dexheimer J.W.
        • Dyas J.
        • Zhang N.
        • Babcock L.
        Feasibility and potential benefits of a web-based intervention delivered acutely after mild traumatic brain injury in adolescents: a pilot study.
        J Head Trauma Rehabil. 2016; 31: 369-378https://doi.org/10.1097/HTR.0000000000000180
        • Dexheimer J.W.
        • Kurowski B.G.
        • Anders S.H.
        • McClanahan N.
        • Wade S.L.
        • Babcock L.
        Usability evaluation of the SMART application for youth with mTBI.
        Int J Med Inform. 2017; 97: 163-170https://doi.org/10.1016/J.IJMEDINF.2016.10.007
        • Sandhu H.
        • Wilson K.
        • Reed N.
        • Mihailidis A.
        A mobile phone app for the self-management of pediatric concussion: development and usability testing.
        JMIR Hum Factors. 2019; 6e12135https://doi.org/10.2196/12135
        • Kantorski B.
        • Commisso D.R.
        • Sanford-Dolly C.W.
        • Pollock J.A.
        The use of a mobile application to teach concussion-related health knowledge.
        J STEM Outreach. 2020; 3https://doi.org/10.15695/JSTEM/V3I1.05
        • Schmidt M.
        • Fisher A.P.
        • Sensenbaugh J.
        • et al.
        User experience (re)design and evaluation of a self-guided, mobile health app for adolescents with mild traumatic Brain Injury.
        J Form Des Learn. 2020; 4: 51-64https://doi.org/10.1007/S41686-019-00038-X
      1. The Patient education materials assessment tool (PEMAT) and user’s guide. Agency for Healthcare Research and Quality.

      Biography

      Tom N. Pham is Assistant Professor, Department of Pediatrics (Emergency Medicine), University of Texas Southwestern, Dallas, TX.

      Biography

      Andrea K. Morrison is Associate Professor, Department of Pediatrics (Emergency Medicine), Medical College of Wisconsin, Wauwatosa, WI.

      Biography

      Michael S. Menard is Family Medicine Physician, Aurora Family Medicine, Aurora, OH.

      Biography

      Deborah Martinez is Registered Nurse, Urgent Care, Children’s Hospital of Wisconsin, Wauwatosa, WI.

      Biography

      Danny G. Thomas is Professor, Department of Pediatrics (Emergency Medicine), Medical College of Wisconsin, Wauwatosa, WI. ORCID identifier: https://orcid.org/0000-0002-7470-9835.