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WHAT WORKS IN EDUCATION The George Lucas Educational Foundation

Technical Writing Project: Fixing Prescription-Assistance Forms

Technical Writing Project: Fixing Prescription-Assistance Forms

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T. R. Girill
Society for Technical Communication/Lawrence Livermore National Lab.
trgirill@acm.org

Technical Writing: Fixing Prescription-Assistance Forms

The Problem

We have all seen those televised commercials for prescription asthma 
or arthritis treatments that end with the line "Can't afford your
medication? AstraZeneca may be able to help."  Anyone who pursues
that offer soon finds themselves involved in a legally and medically
complex process reflected by correspondingly complex instructions
and application forms.  AstraZeneca discovered that successfully
applying for their help was daunting for everyone (revealed by a high,
expensive-to-manage error rate), and even more frustrating for
applicants who were
    * not very literate,
    * not native English speakers, or
    * not young.

These technical communication problems are what led AZ to finance an
interesting usability and redesign project by three University of
Baltimore faculty members (Kathryn Summers, Michael Summers, and
Amy Pointer, "When you need the medicine but can't understand the
form," STC Intercom, February 2014, 61(2), 11-15).

Another Path to Literacy

Fixing the process and the paperwork by which patients apply to AZ for
prescription assistance is an effort in what is professionally called
"information design."  This does not quiet fit squarely with Common
Core text improvement skills (it is usually more focused on the physical
representation of information on forms and diagrams), nor is it rich
in science/engineering content (more about financial relationships or
business activity). 

Nevertheless, it offers a real-life, high-stakes case that bridges
nicely between pharmaceutical industry practices and very personal
health-care needs.  It doesn't call for the same biology or safety
background as does editing flaws in some material safety data sheet,
but that could be an advantage for students with weak science
preparation.  Improving prescription assistance documents could be
just the hook that shows "career technical education" students why
technical writing skills are very relevant to their own future on 
the job.

While the article cited above appeared in a limited-circulation
society journal, this link
https://drive.google.com/file/d/0B_GpgvtIPLFRNW9FZHJ0MGlBQUk/edit?usp=sh...
leads to a before/after two-page comparison of the instructions for
AZ's prescription-assistance program.  This comparison exposes three
key issues from whose study all science students can benefit.

Three Literacy Issues

Audience Analysis
The original instructions (left side on the comparison sheet) mixed
text intended for two very different audiences: patients, who knew 
little about medicine but were the authorities on their own insurance 
coverage and household assets, and doctors, on whom AZ was relying for 
both medical details (the exact prescription written) and professional
status (their unique DEA identifier).  Errors by both groups, and hence
administrative costs, ran high as a result of this audience confusion.
The revised instructions (right side) therefore try to clearly separate 
steps intended for patients from those for their doctors.

Complexity Management
AZ's original instructions and application form were so confusing partly
because the actual prescription-assistance procedure was itself
unnecessarily complex.  Trying to make the text more usable revealed
the need to improve the corporate activities as well:
    ...it was like shining a flashlight on
    the complexities of the underlying
    business process [Summers, p. 12]

One beneficial side effect of disciplined technical writing is that
it often leads, as here, to more disciplined actions in the first place.
In this case, for instance, someone did their homework and generated
the easy to use list of monthly and yearly qualifying incomes itemized
in the table at the center of the revised instructions (right side).

Information Density
The revised AZ instructions look quite different than the originals.
They have about half as many words and a larger font, both boons to
low-literacy applicants.  The new page heading ("Application for Free
AstraZeneca Medicines") reveals at first glance much more than did the
old one ("Patient Application").  And the telephone number for queries
is still easy to find at the page bottom.  Teachers know quite a bit 
about "reducing cognitive load" in a demanding lesson, and this 
usability edit applies that same approach to helping patients pursue
prescription assistance.

Empirical Results

This wouldn't be a science post if there were no measurable results!
Summers was able to check her progress by conducting a controlled,
within-subjects experiment on 59 sample users (about half low literacy
and half seniors).  The revised AZ instructions and forms had a 48%
lower error rate (133% lower for the key income-level tests) than
the original version.  In addition, time on task actually increased
by 15% because so many people, in their confusion, had missed
important steps or skipped required fields in the unedited version.
The empirical result of this usability edit was both many more satisfied
patients and significant cost savings for the company.  Those are
good reasons for anyone to master technical writing skills.

[Want more relevant background?  See
http://www.ebstc.org/TechLit/handbook/handbooktoc.html

 

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