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Comprehension, utility, & preferences of prostate cancer survivors for visual timelines of patient-reported outcomes co-designed for limited graph literacy: Meters and emojis over comics

Co-authors Andrea Hartzler and Lauren Snyder discuss this month's JAMIA Journal Club selection: 

Snyder L, Phan D, Williams K, Piqueiras E, Connor S, George S, et al. Comprehension, utility and preferences of prostate cancer survivors for visual timelines of patient-reported outcomes co-designed for limited graph literacy: meters and emojis over comics. J Am Med Inform Assoc. 2022;ocac148. doi:10.1093/jamia/ocac148.

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Andrea Hartzler, PhD
Associate Professor
University of Washington
Department of Biomedical Informatics and Medical Education

Andrea Hartzler is an Associate Professor in the Department of Biomedical Informatics and Medical Education at the University of Washington and co-directs the Clinical Informatics and Patient-Centered Technologies Graduate program. She also serves as a clinical informatics leader in operational efforts at University of Washington Medicine. Dr. Hartzler’s research spans consumer health informatics, clinical informatics, and human-computer interaction with a focus on the human-centered design of technologies that promote health equity. She has award-winning publications and national leadership in patient-centered informatics, including contributions to national committees and workgroups, and a strong network of outstanding multidisciplinary collaborators. Dr. Hartzler earned her PhD in Biomedical Informatics at the University of Washington in 2009. She was an Investigator at Kaiser Permanente Washington Health Research Institute before joining the faculty at University of Washington School of Medicine in 2017.    

Lauren E. Snyder, PhD, MPH
Senior Program Officer - Integrated Portfolio Management
Bill and Melinda Gates Foundation

Lauren is a senior program officer in Integrated Portfolio Management at the Bill and Melinda Gates Foundation. Her interests include the intersection of data science and human centered design to improve population health. Lauren received her PhD in Biomedical and Health Informatics from the University of Washington’s School of Medicine and was a National Library of Medicine pre-doctoral trainee. She also earned a Master of Public Health from the University of North Carolina. Prior to starting her PhD, Lauren completed the CDC’s Applied Public Health Informatics Fellowship and worked as an epidemiologist for Denver Public Health.  

JAMIA Journal Club managers and monthly moderators are JAMIA Student Editorial Board members:


Christina Baker, MS, BSN, NCSN, RN-BC
PhD Candidate - Faculty Teaching Fellow
University of Colorado, Anschutz Medical Campus
Denver, CO


George Karway, PhD, MS, BSc.
Postdoctoral Student
University of Wisconsin Madison
Madison, WI

Statement of Purpose

Visual timelines of patient-reported outcomes (PRO) can help prostate cancer survivors manage longitudinal data, compare with population averages, and consider future trajectories. PRO visualizations are most effective when designed with deliberate consideration of users. Yet, graph literacy is often overlooked as a design constraint, particularly when users with limited graph literacy are not engaged in their development. We conducted user testing to assess comprehension, utility, and preference of longitudinal PRO visualizations designed for prostate cancer survivors with limited literacy. Findings identify design considerations for PRO visualizations, contributing to the knowledge base for visualization best practices. We describe our process to meaningfully engage patients from diverse and hard-to-reach groups for remote user testing, an important endeavor for health equity in biomedical informatics. Graph literacy is an important design consideration for PRO visualizations. Biomedical informatics researchers should be intentional in understanding user needs by involving diverse and representative individuals during development.

Target Audience

The target audience for this activity is professionals and students interested in health informatics.

Learning Objectives

After participating in this webinar, the listener should be better able to: 

  •  Explain the importance of graph literacy in patient comprehension and use of visualizations of patient-reported outcomes 
  • Practice strategies for engaging hard to reach groups in biomedical informatics research
  • Apply intentional methods to understand needs, barriers, and preferences of patients from diverse backgrounds 


  • 35-minute presentation by article author(s) considering salient features of the published study and its potential impact on practice
  • 25-minute discussion of questions submitted by learners via the webinar tools and moderated by JAMIA Student Editorial Board members 

Accreditation Statement

The American Medical Informatics Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Commercial Support

No commercial support was received for this activity.

Disclosures for this Activity

The following planners and staff who are in a position to control the content of this activity disclose that they have no financial relationships with commercial interests/ineligible entities:

Presenters: Andrea Hartzler; Lauren E. Snyder
JAMIA Journal Club Planners: Christina Baker; George Karway; Kirk Roberts
AMIA Staff: Susanne Arnold

Dates and Times: -
Type: Webinar
Course Format(s): On Demand
Price: Free