Impact of Illustrated Postoperative Instructions on Knowledge and Retention During a Cleft Lip and Palate Surgical Mission

• Published in: The Cleft palate-craniofacial journal Vol. 60; no. 8; p. 1010
• Main Authors: Card, Elizabeth B, Morales, Carrie E, Ramirez, Juan M, Billingslea, Marce, Marroquín, Ariel, Trueblood, Eo, Javia, Luv R, McCormack, Susan M, Friedland, Leonard R, Low, David W, Schwartz, Alan Jay, Scott, Michelle, Jackson, Oksana A
• Format: Journal Article
• Language: English
• Published: United States 01.08.2023
• Subjects: Child; Cleft Lip - surgery; Cleft Palate - surgery; Humans; Medical Missions; Prospective Studies; palatoplasty; ethics/health policies; nonsyndromic clefting
• ISSN: 1545-1569
• DOI: 10.1177/10556656221100052

To determine the impact of illustrated postoperative instructions on patient-caregiver knowledge and retention. Prospective study with all participants receiving an educational intervention. Pediatric plastic surgical missions in Guatemala City, Guatemala, between 2019 and 2020. A total of 63 majority-indigenous Guatemalan caregivers of patients receiving cleft lip and/or palate surgery. Illustrated culturally appropriate postoperative care instructions were iteratively developed and given to caregivers who were surveyed on illustration-based and text-based information at preoperative, postoperative, and four-week follow-up time points. Postoperative care knowledge of illustration-based versus text-based information as determined by the ability to answer 11 illustration- and 8 text-based all-or-nothing questions, as well as retention of knowledge as determined by the same survey given at four weeks follow-up. Scores for illustration-based and text-based information both significantly increased after caregivers received the postoperative instructions (+13.30 ± 3.78 % SE, + 11.26 ± 4.81 % SE;  < .05). At follow-up, scores were unchanged for illustration-based (-3.42 ± 4.49 % SE,  > .05), but significantly lower for text-based information (-28.46 ± 6.09 % SE,  < .01). Retention of text-based information at follow-up correlated positively with education level and Spanish literacy, but not for illustration-based. In the setting of language and cultural barriers on a surgical mission, understanding of illustration-based and text-based information both increased after verbal explanation of illustrated postoperative instructions. Illustration-based information was more likely to be retained by patient caregivers after four weeks than text-based information, the latter of which correlated with increased education and literacy.