Optimizing Patient Comprehension of Information Visualizations for Medication Adherence and Blood Pressure Public Deposited

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  • March 20, 2019
  • Sage, Adam
    • Affiliation: Eshelman School of Pharmacy, Pharmaceutical Sciences Program
  • Introduction: This dissertation focused on designing hypertension self-management visualizations that facilitate patient comprehension of blood pressure and medication adherence information. The objectives of this research were to: 1) assess patient preferences and understanding of visualization features; 2) assess whether condensing the display of blood pressure and medication adherence information into a single visualization improves patient comprehension of the inferred relationship between medication adherence and blood pressure control (compared to separate visualizations); 3) assess whether health literacy moderates the effect of condensed visualizations on comprehension; and 4) assess the validity and reliability of a newly developed hypertension-related visualization comprehension scale. Methods: Patients with hypertension (n=6) participated in user assessments to understand preferences for visualization features. Another sample of patients with hypertension (n=6) participated in cognitive interviews that assessed understanding of visualizations that incorporated patient preferences. A survey experiment with patients with hypertension (n=137) then assessed whether condensed visualizations improved comprehension of blood pressure and medication adherence information. Multiple regression analysis was used to assess the main effect of visualization type (condensed versus separate display) on comprehension, and the moderating effect of health literacy on comprehension. Exploratory and confirmatory factor analysis were used to assess the validity and reliability of the comprehension scale. Results: Patients preferred visualizations with blue/orange color-coded culturally recognizable symbols to show medication adherence, and the use of labeled blood pressure data points, horizontal reference lines, and a shaded “normal” blood pressure zone. Patients best understood a shaded “normal” blood pressure zone with color-coded symbols to show medication adherence. Condensed visualizations did not significantly improve comprehension, and health literacy did not moderate the relationship between visualization type and comprehension. However, greater health literacy (B=0.61, p=.0001) and hypertension knowledge (B=0.10, p<0.0001) were positively associated with comprehension. Exploratory and confirmatory factor analyses supported a unidimensional 4-item solution for the comprehension scale. Conclusion: This study is an important step in developing useful and useable data visualizations for self-managing HTN. Condensed-display visualizations did not improve patient comprehension of BP and medication adherence information. Future research should further investigate how to design visualizations that improve comprehension, specifically for patients with low health literacy.
Date of publication
Resource type
  • Chung, Arlene
  • Gotz, David
  • Bailey, Stacy
  • Blalock, Susan
  • Carpenter, Delesha
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018

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