Make sure pamphlets are working as education tools

Correct design problems and teach staff

Written handouts work best when used as a supplement to reinforce personal instruction that is given verbally.

"A pamphlet is not a good teaching tool when it is not used as a teaching tool, but merely handed to the learner. The contents need to be discussed by the learner and health care provider for the pamphlet to become a teaching tool," says Fran London, MS, RN, a health education specialist at The Emily Center, Phoenix Children’s Hospital.

They should never be the only way information is imparted to patients, agrees Sandra Cornett, RN, PhD, director OSU/AHEC Health Literacy Program, Office of Health Sciences, The Ohio State University (OSU) in Columbus.

However pamphlets are versatile and can be used to reinforce teaching at workshops and for future reference; as part of discharge instructions; in waiting rooms on wall racks or bulletin boards for stimulating interest in a particular topic or for general information; and they can be mailed to patients for continuing follow-up, says Cornett.

"Pamphlets can also be given to patients as pre-reading’ to give the patient a head start on the content to be covered in person," she says.

When educating patients, pamphlets are best used for information that is complex, needs to be shared with others in the family, or needs to be referred to at home, says London. For example, step-by-step instructions on a home care skill are very important to have in writing.

"Pamphlets can reinforce teaching and be referred to at home to aid memory. They can be shared with people not present at the teaching session. They also can guide teaching so all health care providers in a group cover the same material," says London.

To be effective, however, pamphlets need to be targeted to the learner’s needs, she says. The educator should assess the learner’s needs and abilities before pulling out the pamphlet.

The educator must decide whether or not a particular pamphlet should be given based on the assessment of their patient’s learning needs and the kind of learner they are, agrees Cornett. While some patients learn best by reading, others are visual or auditory learners. "Literacy, of course, is a big issue, but all pamphlets should be easy to read regardless of the person’s ability to read," she says.

Pamphlets are not always a good teaching tool if they are used without helping the person adapt the information to their situation. Educators need to individualize the pamphlet while teaching by pointing out key areas that the patient should read and highlighting these areas, says Cornett. They should teach patients to use these sections as a reference and future resource. If the pamphlet has areas to write individualized instruction, the educator should do that.

"Ask patients to read a portion of the pamphlet and then ask questions about what they read to determine if they are comprehending the message and can use the information in their situation," says Cornett. It helps if the educator poses problems for them to solve using the information.

"Often left out of pamphlets is the opportunity for the learner to become actively involved in the learning process. They are too often passive materials," says London. Handouts and booklets created at Phoenix Children’s Hospital all include cues for the learner to interact. Often, topics for discussion are included such as: "Now that you’ve read this, tell your nurse or doctor what you would do if . . ." or "Show your nurse or doctor how you . . ." When appropriate, the review is presented as a crossword puzzle that the health care provider can review with the learner.

Effective by design

When poorly written, pamphlets can be overwhelming and ineffective as a teaching tool. "Often, too much information is presented and not in a way that helps the reader use the information to make decisions about care," says Cornett.

No more than three to five key messages should be in one piece of material and only the essential information covered. Doing audience research before the piece is made is important to determine what information they think is important to know, she says.

"The design should grab the readers attention and look easy-to-read, and key messages should be up front and action-oriented. The message also should be framed from the reader’s perspective," says Cornett. Good layout and design includes the following aspects:

  • looks uncluttered with ample white space and short line length (two to five inches) or gutters for columns and generous margins;
  • use of upper and lower case letters (not all caps, even in titles) — 12- to 14-point serif typeface;
  • infrequent use of italics;
  • visible subheadings used that are conversational in nature such as statements or questions.
  • white space balanced with words and illustrations. All illustrations labeled or with captions and culturally suitable and meaningful for reader;
  • key points emphasized by using boxes, lines, bold, increased print size, different typeface, and color;
  • engages reader by using formats such as story, dialogue, checklist and self-quiz.

Pamphlets should be field-tested with the intended readers before the material is finalized and printed. This will help ensure that the piece is appropriate and will not be discarded.

Once put into circulation the effectiveness of the pamphlet might be determined by evaluating the patient’s behavior in terms of adherence to treatment and self-care in accordance with the content, says Cornett.

A patient education manager should cut a pamphlet from a teaching materials list when the health care providers do not review the contents with the learners, says London. If an educator doesn’t care whether or not the learner understands the contents, then the information is not essential for self-care and is not serving as an education tool, she explains.

Also, a pamphlet should be pulled from use when the topic no longer is applicable for that patient population. However, the pamphlet usually is overhauled or revised to better meet the needs of the patient population rather than pulled from the list, says Cornett.

"Determining whether or not revisions are needed is based on changes in the message that need to be done and/or changes that need to be done to enhance the usefulness of the pamphlet and get more people to read it," she says.

For more information on how to make sure pamphlets are effective teaching tools, contact:

  • Sandra Cornett, RN, PhD, Director, OSU/AHEC Health Literacy Program, Office of Health Sciences, The Ohio State University, 218 Meiling Hall, 370 W. Ninth Ave., Columbus, OH 43210-1238. Telephone: (614) 292-0716. E-mail:
  • Fran London, MS, RN, Health Education Specialist, The Emily Center, Phoenix Children’s Hospital, 1919 E. Thomas Road, Phoenix, AZ 85016. Telephone: (602) 546-1408. E-mail: Web site: