Academic journal article Human Factors

Repetition Improves Older and Younger Adult Memory for Automated Appointment Messages

Academic journal article Human Factors

Repetition Improves Older and Younger Adult Memory for Automated Appointment Messages

Article excerpt


Cognitive and Communication Factors Related to Appointment Attendance

The failure of patients to attend health care appointments is well documented (e.g., Deyo & Inui, 1980). It is a particular concern for older adults, who require proportionally more health services (U.S. Department of Health & Human Services, 1990) than do younger adults. People miss appointments for many reasons, including scheduling conflicts, lack of transportation, and other factors. Nonattendance is also frequently traced to forgetting (e.g., Deyo & Inui, 1980; Oppenheim, Bergman, & English, 1979). Such prospective memory failures also reflect comprehension and retrospective memory problems, because people must first receive, attend to, understand, and remember information about the task before they can remember to actually perform the task (e.g., Einstein, Holland, McDaniel, & Guynn, 1992). In fact, people miss appointments because they do not receive complete information or they misunderstand the information that is presented (Hofmann & Rockart, 1969; Oppenheim et al., 1979).

Comprehension and memory are especially important for appointment attendance. People need to know what the appointment is for, when and where to go, what to do before attending (e.g., fasting or other preappointment procedures), what symptoms might occur after the appointment, and even why the service is important. People interpret this information in light of what they know about the illness, the service, or other factors in order to develop a plan for attending the appointment. Because creating and carrying out an adherence plan is resource-consuming, it is likely to be influenced by the amount of available cognitive resources, which often declines with age (Salthouse, 1991).

Because appointment attendance depends on understanding many types of information, it is highly dependent on communication between health organizations and clients. Spoken communication in particular is important because of automated telephone messaging systems, which allow spoken messages to be recorded, saved on a computer, and sent to clients by telephone (Leirer, Tanke, & Morrow, 1995). Many hospitals, health maintenance organizations, and public health centers now routinely send their clients telephone messages about health service appointments, taking medication, or other services. However, although automated messages have been shown to improve appointment attendance (e.g., Leirer, Morrow, Pariante, & Doksum, 1989), these studies have not focused on the messages themselves. Improving the design of appointment messages may further increase the potential of automated systems for improving appointment adherence.

Designing Appointment Messages

Message comprehension. To understand a message, people create a situation model (or mental model) that represents the situations described by the message (van Dijk & Kintsch, 1985). Listeners or readers create this representation by recognizing words, parsing syntax, integrating information across sentences, and elaborating this information with background knowledge. A hallmark of the situation level of comprehension is the ability to draw inferences from the message. For example, if a message states that an appointment is at 10:00 a.m. and that fasting is required for 12 h before the appointment, one must plan to skip breakfast. These processes must be coordinated in working memory, which can be viewed as a limited capacity mental work space where information is temporarily stored while processed. Thus working memory capacity is a fundamental constraint on comprehension (Baddeley, 1986; van Dijk & Kintsch, 1983).

Age differences in message comprehension. People are more likely to create an accurate situation model despite limited cognitive resources when a message has appropriate information (content) and organization, contains clear and simple terminology, and is presented in an appropriate modality such as speech or print (Morrow, 1997). …

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