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DESIGNING EFFECTIVE PRINT MATERIALS
TRAINER'S NOTES
PURPOSE AND CONTENT
By themselves, educational and advocacy materials do not change behaviour.
However, they are valuable tools to include in any efforts to change behaviour.
Whatever materials anyone produces, the key steps are the same. Experience and
research from around the world have been used to put together this unit. It aims to
help participants to discuss, understand and work with the key principles of
designing effective printed educational materials.
OBJECTIVES
Upon completion of this session participants will be able to:
1. Identify the key principles of effective and persuasive educational materials
2. Assess the strengths and weaknesses of a range of existing educational materials
3. Design simple but effective educational materials to target specific drug use
problems.
PREPARATION
1. Read the Session Notes.
2. Briefly review the instructions for Activity 1.
 Activity 1 requires some sample print materials. Collect these in advance and
review their strengths and weaknesses, share with participants after
completion of the exercise and participant presentations. Try to include a
range of different types of materials.

If additional materials are more illustrative of a principle or technique of
visual communication (or are more relevant to the audience's national and
cultural background), feel free to substitute or add overheads as appropriate.
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Designing effective print materials
Trainer's Notes
CORE LIBRARY
(1994) Producing National Drug and Therapeutic Information: The Malawi Approach to developing
standard treatment guidelines. WHO/DAP94.14. Geneva, World Health Organization
Essential Drugs Monitor (no. 24). Geneva, World Health Organization.
Essential Drugs Monitor (no. 28&29). Geneva, World Health Organization.
Contact 1994 Writing about health no. 136. Geneva, World Council of Churches.
AIDS Action, issue no. 40 March - May 1998 Healthlink.
VISUAL AIDS
1. Title slide
2. Session objectives
3. What is an effective printed educational material?
4. Six basic questions
5. Basic principles: planning
6. Basic principles: Planning, involve users
7. Ante-natal health talk
8. Basic principles: Planning: understand the causes
9. Generic
10. Basic principles: Planning Target decisions and actions
11. Talk about prescriptions
12. What’s missing from this leaflet?
13. Basic principles: Planning; Use credible sources
14. Savings, older and wiser
15. Basic principles: writing and editing text
16. Basic principles: Writing and editing text. Use brief, simple, clear and active text
17. Organising medicines at home
18. Basic principles: Writing and editing text. Focus on a few key messages
19. Basic principles: Writing and editing text. Repeat or reinforce key messages
20. Basic principles: Writing and editing text. Avoid jargon
21. Basic principles: Writing and editing text. Pretest/review the content.
22. Basic principles: Layout and design
23. Basic principles: Layout and design
24. Three basic steps, no medicines at all
25. Basic principles: Layout and design. Use bullets, boxes and numbers
26. Basic principles: Layout and design. Use simple illustrations
27. Different styles of illustrations
28. Poster
29. Pictorial Graph
30. Basic principles: Layout and design. Use colour wisely.
31. Open wide
32. Basic principles: Layout and design. Make the most of space
33. Prescribir en Generico; tonics
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Designing effective print materials
Trainer's Notes
34. Do not ask for injections
35. Sharing drugs
36. Tetracyclines
37. And finally..
38. Activities
39. Summary
ORGANISATION AND TIMING OF THE SESSION
A. Introduction and objectives - 15 minutes
B. Basic principles - 45 minutes
 Planning - 15 minutes
 Writing and editing - 15 minutes
 Layout and design -15 minutes
C Critical analysis - 20 minutes
Break - 20 minutes




Activity 1 - 20 minutes
Plenary presentation and discussion – 10 minutes
Activity 2 - 60 minutes
Plenary presentation and discussion – 20 minutes
A. INTRODUCTION AND OBJECTIVES (15 MINUTES)
Discuss the purpose and rationale for the session (OH 2) . Point out:

Printed materials come in all shapes and sizes. They can include:









posters for display in health centres or public places
manuals and guides for health worker and community training programmes
standard treatment guidelines
leaflets, brochures or fact sheets for prescribers, patients and community
members
newsletters and bulletins for a variety of audiences
wallcharts, flipcharts and other communication aids
T-shirts, folders, banners, signs and other promotional tools
reports and articles, including material in clinical and pharmacy literature.
These materials are often much cheaper than alternative prescribing and
consumer education strategies, and can reach many prescribers through the mail,
on bulletin boards, visual display or in person. They are also often very popular
with funding agencies and government departments because they represent
something visible that demonstrates activity.
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Designing effective print materials
Trainer's Notes
Ask if any participants have experience of producing printed materials. Ask what
they see as the advantages and disadvantages of print materials for communicating
about the rational use of drugs. Ask if they can identify ways that disadvantages can
be overcome.
Point out that one disadvantage is that:


Print materials are usually relied on exclusively to change prescribing and
consumer practices although it has been shown that they barely work at all
unless combined with other more interactive approaches, such as face-to-face
education.
Many materials, even within these limits, are not designed in a way that increases
their chances of increasing knowledge or changing practice. Few materials are
pre-tested with the target audience, which is an essential step in effective
communication.
What is an effective printed educational material? (OH 3)
Ask a few participants to suggest what they consider to be an effective printed
material? Probe why they think something is effective. Probe for any constraints or
successes they have encountered in developing printed materials and how these
were evaluated for effectiveness. Check whether people think the simple definition
of effective printed material in the Session Notes goes far enough.
Six basic questions (OH 4)
The purpose of this session is to introduce participants to some important principles
for increasing the effectiveness of printed educational materials. Clear answers to six
basic questions are essential to developing effective material. Even within these, a
priority is to have clear answers to the first three questions.
Explain that:

WHY? – deals with purpose and need

WHO? – covers audience and what is known about the audience

WHAT? – focuses on content (main messages)

WHERE? – looks at the setting where the material will be used

WHEN? – addresses the timing for the communication

HOW? – considers what medium is best to use
Reinforce the point that combining different media has been shown to be the most
effective way of communicating.
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Designing effective print materials
Trainer's Notes
B. BASIC PRINCIPLES (30 MINUTES)
Three main areas (OH 5)
Make the following points:
 There are three main areas being looked at in this session: planning; writing and
editing text; layout and design
Basic principles: Overview (OH 5)
 Each area has specific basic principles. Go over each principle very briefly –
explain that you will give several examples of each in the next few minutes.


Most of these are applicable to consumer and prescriber education and to many
different types of educational materials as well.
Effective printed materials don’t need to be extremely costly to be effective. Good
black and white line drawings can be substituted for multi colour photographs or
designs. And where printing quality is low, for reasons of cost or equipment, it is
better to use simple line drawings that will reproduce easily than complex
illustrations, such as photographs, that will not reproduce well.
B1. Planning
Involve users (OH 6)
Point out:
 Effective material is relevant to the user.

The best way to ensure relevance is to involve the user in developing the material.
What about my fever? (OH 7)
 It is essential to know what materials prescribers, patients or community
members would like to have, and what information they most need.
Understand the causes (OH 8)
 Emphasise that it is extremely important to have an idea about why prescribers
or consumers engage in "incorrect" drug use, before designing educational
materials.

Remind participants about the use of focus group interviews and surveys to
uncover these motivations.
Plain aspirin; generic names (OH 9)
 The slide shows the front cover of a patient education pamphlet and a poster
from the Philippines.

The pamphlet was designed because prescribers stated that patient demand was
one of the most important reasons for using propoxyphene (as a placebo drug) in
focus group interviews.
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Designing effective print materials

Trainer's Notes
This poster is a result of research that consumers did not know the meaning of the
term "generic name", and also that they were worried about high drug prices.
The text explains the meaning of the term "generic" and links this knowledge with
how consumers can save money on drugs.
Target decisions and actions (OH 10)
 Explain that if you wish to change behaviour, an orientation to decisions and
actions is critical. Yet many educational materials do not emphasise what
prescribers or patients should do or not do for particular health problems. They
don’t state what should be stopped, what should be started, and why.
Talk about prescriptions; these few words (OH 11)
The following examples illustrate this action/decision-oriented approach:
 These two posters are aimed at encouraging patients to act.

The first encourages patients to talk to their doctor or other health worker about
the drug prescribed and explains why. It also gives some key questions to ask.

The second poster (from Australia) encourages patients to read directions and
labels carefully.
Ask participants which of these posters would motivate them to act. Why?
What’s missing? (OH 12)
 This brochure aims to stop doctors prescribing chloramphenicol in outpatient
practice.

Ask the group if there is anything important missing from this recommendation.
The key issue to get across here is the failure of the message to include
appropriate alternative behaviours.
Identify and use credible sources (OH 13)
 Point out how in the most effective prescribing education interventions in the
United States the sponsorship of a respected medical institution (in one case a
medical school, and in the other a local medical society) were obtained to increase
credibility).

The respected sponsor of the educational materials should be very visible in order
to be certain that the reader understands where the material comes from
(otherwise they may think it is simply a drug company advertisement).
Another way of establishing credibility is to emphasise quotes from respected
medical reference books that support your prescribing recommendations. For
consumer information you may choose a well-known public figure.
Savings; older and wiser (OH 14)
 Two examples highlight how credibility can be communicated:
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Designing effective print materials
Trainer's Notes

A poster from the Philippines promoting 15 government outlets for essential
drugs at half price included a picture of the then Minister of Health, Dr Bengzon.

The big Department of Health logo on the box illustrates that although the drugs
were low cost they were backed by the government.

Ask participants if identification with a government agency would be
advantageous from their perspectives. Point out the potential problem that
government may be viewed as "cost cutters" rather than interested in patient care.

The other illustration is of a leaflet and poster advertising a new edition of
analgesic guidelines. Here credibility is established through use and experience.
These have led to greater knowledge and wisdom.
B2. Writing and editing text
Writing and editing text
Use brief, simple, clear, active text (OH 15, 16)
 Emphasise the need to use clear and active language and to make sure that it is
appropriate for the audience.
Organising medicines at home (OH 17)
 Use the example of a booklet for older citizens:
 The advice is straightforward and in simple language
 The text is a good size – an important point for older people who may have
poor eyesight
 The font is informal – making the text look friendly and inviting.
Focus on a few key messages (OH 18)
 Point out that this is one of the most fundamental principles of communication in
all kinds of promotion.

Usually only four or five education points or recommendations should be
attempted in any one printed material. In a poster go for just one key idea.

Most health workers and consumers are busy people with little time to read long
texts unless it is part of a formal course.

Instead, communications theory suggests that only a few critical knowledge gaps,
or behaviours you wish to promote or change be emphasised and repeated.
Repeat or reinforce key messages (OH 19)
 Repetition is the foundation of advertising and communication.

Increases memory and learning.

Key message should be included in headline, content and conclusion.
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Trainer's Notes
Avoid jargon (OH 20)
 What ever you do, avoid "medicalese". For example, remind participants about
the example in the Session Notes recommending use of words like "stomach
problems" instead of "gastrointestinal disturbances".
 Write to express, not to impress.
Pre-test/review the content (OH 21)
 Refer to the need to check for spelling, grammar and consistency. Mention the
idea of a ‘house style’.

Stress the need to pre-test the content with the intended audience.

Suggest that colleagues or acknowledged experts can help ensure that nothing
vital is missing from the text, and that nothing is wrong.
B3. Layout and design
Overview (OH 22)
Remind participants that good layout will:

capture attention

encourage the user to read the material

guide the user through the material

emphasise important information

make information easy to find.
Use strong headlines and readable typefaces (OH 23)
 Review the reasons for major headlines.

They should capture the interest of the reader.

They should make the reader want to read the rest of the text. They can be
provocative questions as well as recommended actions.

If two headlines are needed one is usually less important than the other and is
considered a "minor" headline. This should be in smaller size and can be used to
visually "pull" the reader’s eye down into the main part of material.

Emphasise the need to choose typefaces carefully and to ensure that they help
communicate rather than detract from a message.
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Designing effective print materials
Trainer's Notes
Three simple steps; no medicine at all (OH 24)
 Read the headline and point out that this is a strong enticement to the viewer to
read further, one of the main purposes of a headline. After all, everyone want to
save money.

Point out how the design of the poster pulls the reader’s eye down and onwards.

Here is an example of a poster which is almost all headline. It seemingly breaks
some of the rules but it works because it is brightly coloured and the message is
sufficiently provocative to attract attention. It was also, in real life, part of a
campaign that included consumer education leaflets.
Use bullets, boxes and numbers (OH 25)
 Solid blocks of text are not easy to read.

Break up the text with visual signals that make it easier to follow the flow of the
material.

But don’t overdo it.
Use simple illustrations (OH 26)
 Many of the materials already shown have included visually appealing
illustrations. These illustrations can be used to:
 awaken interest
 tell a story
 show a behaviour which is being promoted or discouraged.
Remind participants:
 Illustrations and graphs do not need to be very expensive.
 Keep illustrations simple.
Different styles of illustrations (OH 27)

Line drawings are the easiest to reproduce in print and also the most likely to be
understood.

Test illustrations with end users. People interpret illustrations in different ways.
Any problems with this poster? (bar chart) (OH 28)
 Read out the translated text: The outcome depends on the prescription being
filled. Make sure that your patient can afford the drugs you prescribe.

Point out how the bar chart shows the different prices for various products with
the same active ingredient.

Ask the group what they think are the strengths and weaknesses of the design of
this poster.
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Designing effective print materials
Trainer's Notes

The principal strength is that it has a strong headline backed up by visual
material (the graph).

The weakness is that because all the text is the same size you don’t get pulled into
the "story".
Pictorial graphs (OH 29)
 Point out that using familiar images may be a way of adapting a bar chart or
graphs so that they more easily communicate information.
 Ask participants which they prefer, and encourage them to think about the type
of information they could convey with pictorial graphs.
Use colour wisely (OH 30)
Colour can:
 effectively draw attention to important messages
 improve attractiveness of the material
 aid understanding.
A little goes a long way.
Colours can have different meanings in different cultures
Open wide; taking the medicine (OH 31)
 This a very appealing illustration with a pun on what is said by the dentist "open
wide".

See also how the bright picture of the clown which is intended to attract attention
is reinforced further down by the bar chart which shows how to cut costs through
oral administration of antibiotics.

Point out how this page from a flipchart has attractive illustrations which tell a
story (when to take a prescribed drug).

The time is shown not only by the sun and the moon through the window but
also by the lamp illustrated in the third picture.

Patients were also given a simple black and white paper reproduction of the same
illustration as a line drawing to take away with their medicines.
Make the most of space (OH 32)
 Point out that most examples shown so far have been posters – which on their
own are ineffective!! However, there are other forms of printed materials, many
of which rely on a basic grid to help position headlines, type and illustrations.

The illustration shows a two column and a three column grid for a publication.
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Designing effective print materials
Trainer's Notes
C. CRITICAL ANALYSIS (20 MINUTES)

Tell the participants that they have been exposed to important principles of
persuasive print materials, they will have a chance to evaluate a number of
different educational materials from different countries. Ask them to volunteer
their opinions on the strengths and weaknesses of each of the following materials.
Prescribir en Generico; tonics (OH 33)
 The first one is a poster from Peru. It reads: Prescribe in Generics? And why not?
Strengths

None that are apparent

Next is a poster about tonics.


Strengths
Lively, eyecatching drawing.
Includes an alternative behaviour (food) to
inappropriate drugs.




Weaknesses
Visually dull
Does not demonstrate behaviour
Gives no rationale for message, e.g. the
"why"
Weaknesses
Does the visual of a slightly drunk individual
(looking very happy) really look like a strong
negative statement about tonics containing
alcohol.
Do not ask for injections; NEDP logistics (OH 34)



Strengths
Good strong illustration
Good graphic use of headlines
Gives alternative behaviour
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Strengths
Inexpensive to produce
Shows logos of sponsoring agencies
Tries to tell a story

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
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Weaknesses
Underlying rationale (the "why") not totally
clear
Use of the crossed out symbol not always
understood
Somewhat prescriptive
Weaknesses
No effective use of headlines or prioritising of
messages
Contains too much information for a poster –
would be better in a brochure.
Unclear aim – who is it for, what is it trying to
achieve?
Dull – looks like a graphic from an annual
report (that is probably its origin!!)
Sharing drugs; challenges (OH 35)
Strengths



None


Strengths

Lively headline with a clear target


11
Weaknesses
No effective use of headlines
Weak design – no clear flow and story line
can be misunderstood
Misleading message – the first message
could be misread as how to properly share
drugs
Role of the timechart not clear
Weaknesses
Too much information, too busy
Could have been 10 different educational
materials
Designing effective print materials
Trainer's Notes
Tetracyclines cause black teeth in children (OH 36)


Strengths
Clearly informs prescribers and patients why
tetracycline should be avoided in children
Good visual representation of the problem


Weaknesses
No alternative behaviour recommended
No clear sponsor of the message
AND FINALLY…
Let people know that they are about to break into small groups to do two activities.
But first, remind them again of the importance of checking that the text and the
design really aid communication. This means (OH 37):
 Testing the text, the illustrations and any colours used with users.

Checking the text and illustrations for accuracy with experts.

Checking the material for spelling and grammar (especially the headlines and
sub-heads).
ACTIVITIES (OH 38)
ACTIVITY 1 (20 MINUTES)
EVALUATING MATERIALS
RATIONALE
In this module some basic principles of effective printed communications are proposed as
part of an overall effort to improve drug use. Often resources and expertise needed to
meet all of these criteria are lacking; however, even within limited budgets print materials
can be graphic and effective.
This activity will give the participant experience in evaluating materials in relation to the
principles discussed in the Session Notes.
INSTRUCTIONS
1. The participant will be given two examples of educational materials which have been
published and disseminated in different parts of the world.
2. The participant should begin by rapidly reviewing one. They should first try to quickly
understand the major messages, and spend only about five minutes reading the text.
3. Their task will be to evaluate the examples according to the principles outlined in this unit.
After review, they should answer the questions on the Worksheet below.
4. The participant should mark a "+" if the material satisfies a principle, a "-" if it does not,
and a “?” if it is in between or not relevant. If there is time, they should proceed to the
second example.
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Designing effective print materials
Trainer's Notes
5. The groups should select a group member to present to plenary. In the presentation there
is not enough time to cover all the questions in the worksheet, so the presenter should
focus on the key issues:
a) Say what the material is (newsletter, press pack, leaflet, etc.).
b) Is the target audience clear?
c) Does it seem relevant to the target audience’s needs?
d) Is the message interesting and clear?
e) Is there a credible sponsor?
f)
Would this material, or an adaptation, be feasible/useful in presenter’s own country?
Why/why not?
Evaluation of Existing Print Materials
RESPONSE: + Yes;
- No;
? in between (or not relevant)
Example A
1. Is it clear who the material is for? (target
audience)
2. Is it clear what problem it is trying to solve?
3. Is the information clearly presented?
4. Is it easy to understand?
5. Is it relevant to the target audience?
6. Is the quality good?
7. Is it visually interesting (+) or boring (-)?
(design, layout)
8. Can you identify the key message easily?
9. Is there a credible sponsor? (do you trust the
information?)
10. Is this relevant for use in your country?
11. Could you adapt it for use in your country?
12. What would help to improve this material?
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Example B
Designing effective print materials
Trainer's Notes
ACTIVITY 2 (60 MINUTES)
Sketching out a plan for printed education material for
prescribers or the public in your country
RATIONALE
This activity aims to give participants experience in selecting, planning and outlining a
simple education material (such as a leaflet, poster or page of a newsletter) to target a
specific drug use problem. This will also enable them to evaluate the applicability of the
principles reviewed to real-world drug use problems in their own country and help to
identify what other communication strategies might be needed.
INSTRUCTIONS
1. Participants should divide into regional/country groups. From the work conducted
last week in identifying priority topics of concern about rational drug use, groups
should select one that all members feel describes an important and correctable
drug use problem in their country/region, and one that might need some printed
support material.
Groups should spend a maximum of five minutes deciding what problem to tackle. If
there is no overall agreement, they should choose one of the following topics:




Over-use of expensive and risky analgesics, such as dipyrone, when cheaper,
safer alternatives (e.g. aspirin) are just as effective.
Insisting on getting injections in the health centre or from a local "injectionist".
Use of oral antibiotics for mild diarrhoea when ORT is the therapy of choice.
Failure to complete a course of treatment when symptoms disappear.
2. They should Identify who is their audience being as specific as possible (the
general public is not a good audience!) and why they are selecting that audience.
3. Participants should identify why they are using print material to reach that
audience and what they want the print material to do. (What is the purpose? – Do
they want to develop a poster to invite young people to a workshop? Do they
want to prepare a training manual for community health workers? Do they want to
produce a leaflet for mothers about how to give children medicine?)
4. Identify what type of material (T-shirt? Training manual?)
5. Decide upon one to three main messages for the material.
6. What will be the title or headline?
7. What illustrations will they use?
8. How will they pre-test the material?
9. How will they distribute the material?
10. How will they test or evaluate the effectiveness of the material?
Participants will be asked to produce a one-page summary of their plan, providing
answers to the above questions. The attached framework might help. They should
also produce a rough layout of what such a material might look like (a poster, leaflet,
cover of a book, page of a newsletter) and consider what other media might be used
with the print material.
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Designing effective print materials
Trainer's Notes
In presenting back to the group, participants should focus on what was the most
difficult or challenging part of doing this exercise, and what they learned from doing it.
Framework for deciding on a print material
1. Problem to be
addressed
2. Audience
(Who?)
3. Purpose (what
do you hope to
achieve?)
4. Type of material
5. Key message(s)



6. Headline
7. Illustrations
8. Plan for pretesting
9. Distribution plan
10. Evaluation plan
11. Possible other
media to use to
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Designing effective print materials
Trainer's Notes
complement print
Summary (OH 39)
Give summary of the session and present wrap up.
16