Evaluation of the Use of Colors and Drawings for Pain Communication for Hmong Patients

Aims: The aim of the present study was to explore: (1) the feasibility of using color and pain drawing to describe pain; (2) the cultural appropriateness of pain body diagram (PBD); and (3) the cultural meaning of colors used in pain expression within one cultural group—the Hmong residing in the United States. Design: A qualitative-descriptive study. Methods: Data were collected sequentially in two phases with different Hmong participants from a Midwestern city using (1) focus groups to determine colors used for pain intensity and qualities along with preferences for drawing versus using the PBD; and (2) individual interviews to determine pain-related meanings of colors and cultural appropriateness of PBDs. Interviews were recorded, transcribed, and analyzed using summative and directed content analyses. Results: Of 67 participants, 73% were female, the average age was 53.7±14.9 years, and 67% received Medicaid. In Phase I, most participants were unable to draw their pain on a blank page and preferred using a PBD. Most could select colors for pain intensity levels, with white and red indicating no pain and severe pain, respectively. In Phase II, white, red, and black had cultural meanings related to pain while colors such as yellow, orange, and blue had personal meanings. All participants perceived the PBD to be culturally appropriate. Conclusions: The study's findings have implications for how to use colors in pain communication and confirm that PBDs can be used with Hmong patients.