Using Pictures in Health Education, January 8-12, 2007

Resources from our Discussion

The role of pictures in improving health communication: a review of research on attention, comprehension, recall and adherence
Houts, PS, Doak CC, Doak LG, Loscalzo, MJ. Patient Education and Counseling, 61 (2006) 173-190
Erratum note with corrected graphic

Using pictures to improve health communication

Presentation by Peter Houts, PhD

Use of pictorials in medication instructions: A review of the literature
by Marra G. Katz, Sunil Kripalani, and Barry D. Weiss


Resources suggested by list members during this discussion:


The feds have a ton of variously free information. Start with the CDC Public Health library.

You can also go to Google and search only images. Once you put a word or topic in, you can then search "inside" by putting in .gov to pick up all images that are government (and thus mostly free of copyright). You always need to verify and check, but many government images are in fact available for free public use.

The Library of Congress is also a wonderful set of images (and they will say whether there is a copyright issue or not) if you want older or more "quaint" pictures:

Jan Potter


A quick resource is the microsoft online clipart gallery at
Includes photos, clipart and more. It's very extensive and free - though general. They also have a template gallery with many templates of common documents, such as newsletters, calendars, stationary, business forms, etc.

Megan Sety


Coming soon: visuals developed by nutritionist and marketing firm (See post #531 for attached samples):

Rebecca Turnbow


I just located two interesting websites for universal health symbols which might be of interest to this discussion. Both point to the need for research to identify universal public health symbols.

The first is a RWJ site discussing a project they supported for hospital symbols
and the other is the site for the Society for Environmental Graphic Design which helped them with the project.

Bertie Mo, Ph.D., MPH


One of the best research articles about the role and field testing of illustrations with which I'm familiar is the following:

Shea Judy A., Aguirre A, Sabatini J, Weiner J, Schaffer M, Asch D. Developing an Illustrated Version of the Consumer Assessment of Health Plans (CAHPS). Joint Commission Journal on Quality and Patient Safety, 2005. 31(1):32-42.

The article deals with a particularly challenging issue - how to illustrate survey concepts so that limited literacy populations can fully participate in sharing their opinions about their healthcare experiences. The article includes many illustrations and shows how concepts were translated into visuals that most can understand.

One other resource that I recommend in my plain language workshops is this text:
Lohr, Linda. Creating Graphics for Learning and Performance. Lessons in Visual Literacy. New Jersey: Merrill Prentice Hall, 2003. ISBN: 0-13-090712-X.

All of the discussions and recommendations in this text are not relevant for audiences with limited literacy skills. However, the principles and illustrations will give you a good start on understanding how graphics "work" to create meaning (or not).

Sue Stableford, MPH, MSB, Director

AHEC Health Literacy Center

University of New England


Here are two great resources that have been used in adult education
classes and could easily be used by health educators:
Picture Stories for Adult ESL Health Literacy
What a Friend Can Do For You - A Photonovela



There are some fantastic photonovellas available in Spanish for prenatal classes. They were developped by Susan Auger in South Carolina and are a great resource. They are available through Auger Communication.

Lisa Jones


Thank you Lisa. Yes, there are 7 photonovels on prenatal care with an ESL component. Topics include: conception, going to the clinic, nutrition/WIC, risks during pregnancy, childbirth, newborn care, and breastfeeding. We are currently in the planning stages of a new bilingual (Eng/Spanish) photonovel on gestational diabetes. It should be available by December, 2007. see

We also recently developed a bilingual (English/Spanish) photonovel series for the National Good Agricultural Practices (GAPs) program out of Cornell University. They focus on food safety, a particularly relevant topic given the recent outbreaks of salmonella and E.coli. One is targeted to farmworkers re: hygiene in the fields. The second is a story of a family who gets sick from salmonella. It contains practical steps for all stages of food preparation (shopping, cooking, storing, cleaning) to prevent food contamination and to kill harmful bacteria in home kitchens. (it's such a practical reference- I keep one in my own kitchen!) There is also a special section for pregnant women on preventing listeriosis -an infection that can be fatal to an unborn child. Listeria is often in contaminated fresh/soft cheeses made from unpasteurized milk. Initially, these photonovels were available at no charge, now I think there is a minor fee. See

Susan Auger


To Dr. Doak's point below, the US Administration on Aging has a large multi-media photo gallery of older adults engaged in a variety of activities at:

Also, also we took our own digital photographs for a nutrition and physical activity campaign for older adults at local senior centers. The main cost was staff time, since we used our own talent.

Kay Loughrey

US Administration on Aging.


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