Catherine Stones

Assessing the quality and usability of smartphone apps for pain self-management.

OBJECTIVE To evaluate smartphone apps intended for self-management of pain using quality assessment criteria and usability testing with prospective users. DESIGN 1) Survey and content analysis of available apps; and 2) individual usability study of two apps. SETTING University of Leeds, United Kingdom. PARTICIPANTS Forty-one participants (aged 19-59 years) with experience of chronic or recurrent pain episodes. METHODS We undertook a survey, content analysis, and quality appraisal of all currently available mobile phone apps for self-management of pain. Two apps were then selected and assessed with usability testing. RESULTS Twelve apps met the inclusion criteria. The quality assessment revealed wide variation in their clinical content, interface design, and usability to support self-management of pain. Very little user or clinician involvement was identified in the development of the apps. From the usability testing, participants stated a preference for an interface design employing a lighter color scheme and particular text font. Although very few participants were aware of pain-reporting apps prior to participation, many would consider use in the future. CONCLUSIONS Variation in app quality and a lack of user and clinician engagement in development were found across the pain apps in this research. Usability testing identified a range of user preferences. Although useful information was obtained, it would be beneficial to involve users earlier in the process of development, as well as establishing ways to merge end user requirements with evidence-based content, to provide high-quality and usable apps for self-management of pain.

DMASC: a tool for visualizing user paths through a Web site

In an e-learning environment it is crucial that accurate Web usage data can be collected and analysed to ensure that on-line learning material is optimally structured and designed. In this paper we investigate the relationship between cached and non-cached Web log files as we identify and analyse user paths through an e-learning Web site. We outline the development of a web data mining and data visualization tool DMASC (Direction Mapping and Sequence Chart). We also demonstrate, using a set of test data, how our mining and mapping methods can be used to reveal otherwise unseen Web design flaws.

Online food nutrition labelling in the UK: how consistent are supermarkets in their presentation of nutrition labels online?

OBJECTIVE To evaluate consistency levels of nutrition labelling on supermarket websites. DESIGN This is a comparative, quantitative study examining page position, content and design of nutrition labels on own-brand and branded products. Online and in-store nutrition labels were examined, categorised and analysed to discern variety of label designs used and consistency between online and in-store labelling. SETTING Five large online food retailers in the UK. SUBJECTS Nutrition labels displayed on 100 webpages were examined for twenty branded and own-brand products. Equivalent labels on in-store packaged products were also examined. RESULTS Eight different combinations of nutrition label designs were found. The online supermarket sites were found to use from three to six of these label combinations across the sample. The consistency level between online and in-store package labels ranged from 25 % to 90 %. In many cases the nutrition label required scrolling to view and in all cases items could be purchased without the label being visible from the search result listings. CONCLUSIONS The main recommendation of the paper is that online nutrition labelling needs to be much more consistently presented than is currently practised, both within each website and between online and in-store experiences. Particular attention should be made to polychrome colour and the inclusion of summary graphics. Designers should also ensure visibility of the label and raise its vertical page position. The paper also proposes additional expansion of the use of nutrition information online, using nutrition values as database fields in search criteria and checkout aggregation reporting.

Breaking the cycle: extending the persistent pain cycle diagram using an affective pictorial metaphor.

The persistent pain cycle diagram is a common feature of pain management literature. but how is it designed and is it fulfilling its potential in terms of providing information to motivate behavioral change? This article examines on-line persistent pain diagrams and critically discusses their purpose and design approach. By using broad information design theories by Karabeg and particular approaches to dialogic visual communications in business, this article argues the need for motivational as well as cognitive diagrams. It also outlines the design of a new persistent pain cycle that is currently being used with chronic pain patients in NHS Bradford, UK. This new cycle adopts and then visually extends an established verbal metaphor within acceptance and commitment therapy (ACT) in an attempt to increase the motivational aspects of the vicious circle diagram format.

Capturing and visualising colour choice history in document design

This paper outlines the development and applications of a web-based tool that enables design students and staff to access, annotate and share design histories of colour selection. The paper discusses the value of such a tool within a design education context and discusses its development with reference to the work of Josef Albers. It also discusses the challenges involved in visualising the design process and outlines future developments of the tool. The paper concludes with the results of an evaluative study demonstrating that design history capture may aid students’ reflective processes by revealing otherwise unseen design behaviour.

Developing and evaluating multimedia information resources to improve engagement of children, adolescents, and their parents with trials (TRECA study): Study protocol for a series of linked randomised controlled trials

BackgroundRandomised controlled trials are widely established as the best method for testing health interventions whilst minimising bias. However, recruitment and subsequent retention of children and adolescents in healthcare trials is challenging. Participant information sheets are often lengthy and difficult to read and understand. Presenting key information using multimedia may help to overcome these limitations and better support young people and their parents in deciding whether to participate in a clinical trial.MethodsThe TRECA (TRials Engagement in Children and Adolescents) study has two phases. The first phase involves a qualitative study with children and adolescents and their parents to inform the development of multimedia information resources and iterative user testing to refine the resources. The second phase will embed the use of the multimedia information resources into six host trials in the United Kingdom. Patients and parents approached to participate in the host trials will be randomly allocated to either use the multimedia information resource in conjunction with standard participant information sheets, the multimedia information resource alone, or the standard participant information sheets alone. The primary outcome will be the effect of the multimedia information resources on recruitment into trials. Other outcomes measured include the effect of multimedia information resources on retention of participants into the host trials and the impact on family members’ decision-making processes, when compared to standard participant information sheets alone.DiscussionThis study will inform whether multimedia information resources, when developed using participatory design principles, are able to increase recruitment and retention of children and adolescents into trials. There is also the potential for patients to make better informed decisions through the use of multimedia information resources. The multimedia information resources also have the potential to assist with providing information on other healthcare decisions outside of clinical trials.Trial registrationISRCTN registry: ISRCTN73136092 (doi:10.1186/ISRCTN73136092). Registered on 24 August 2016.

Can pictorial images communicate the quality of pain successfully

Chronic pain is common and difficult for patients to communicate to health professionals. It may include neuropathic elements which require specialised treatment. A little used approach to communicating the quality of pain is through the use of images. This study aimed to test the ability of a set of 12 images depicting different sensory pain qualities to successfully communicate those qualities. Images were presented to 25 student nurses and 38 design students. Students were asked to write down words or phrases describing the quality of pain they felt was being communicated by each image. They were asked to provide as many or as few as occurred to them. The images were extremely heterogeneous in their ability to convey qualities of pain accurately. Only 2 of the 12 images were correctly interpreted by more than 70% of the sample. There was a significant difference between the two student groups, with nurses being significantly better at interpreting the images than the design students. Clearly, attention needs to be given not only to the content of images designed to depict the sensory qualities of pain but also to the differing audiences who may use them. Education, verbal ability, ethnicity and a multiplicity of other factors may influence the understanding and use of such images. Considerable work is needed to develop a set of images which is sufficiently culturally appropriate and effective for general use.

Visual Design in Healthcare for Low-Literate Users – A Case Study of Healthcare Leaflets for New Immigrants in Taiwan

Healthcare material is an effective communication platform to offer an innovative professional care system which provides a more accurate, accessible and applicable educational platform for patients in a diversified society. However, immigrant populations are vulnerable to serious health disparities, and language barriers may further exacerbate their limited health literacy in accessing health information. Recent studies indicate that visual design might service as a powerful mean for the delivery of health information because vivid information combined with visual elements seems to affect both affective and cognitive processes to maximize comprehension. Yet, ways to identify the visual factors of healthcare material that best affect low-literate users to learn is a question that remains unanswered. The purpose of this study is to identify the visual factors of healthcare leaflet that affect low-literate users’ satisfaction, thus establishing guidelines for designing visual healthcare materials for low-literate users. The study was implemented in three stages, the first of which reviewed existing literature to survey current strategies to evaluate visual design in healthcare for low-literate users. Secondly, 36 appropriate leaflets from existing health educational materials in Taiwan were collected and analyzed. Thirdly, semi-structured interviews were conducted with 10 Vietnamese participants who were new immigrants with a low level of education in Taiwan. The results showed that the factors of healthcare material that affect low-literate users’ satisfaction range from creative ideas, design layout of cover, design layout of index, typeface design, color design, pictorial illustrations to realistic photos and cultural factors. A checking list for designing visual healthcare materials for low-literate users was also listed. Successful health communication depends on the health information properly coded by the providers and correctly decoded by the consumers. The findings of this study are expected to be valuable, not only for the providers and consumers of health information, but also for the designers of healthcare material.

Diagramming design: visualizing user interactions with colour palettes

This is a partly practical, partly theoretical paper regarding the uses and potential uses of capturing and visualising digital design moves. The paper-based sketch consists of ambiguous marks that evidence shifts in creative thinking over time. When the artist or designer uses digital technologies to design, only final polished digital marks remain at the end of a session. The processes by which the final design occurred are invisible. This paper presents visualizations of task-based and highly constrained design activities such as colour selection to indicate what can be learned by visualizing mechanical design processes. By visualizing how student designers move across two different designs of colour palette both artistically and empirically interesting results are found. Visualizing design moves enables the design researcher to discover patterns within design behaviour, enables the usability researcher to test interface usage, and enables the designer to create images with aesthetic potential through process alone.

Putting the ‘me’ in mechanical: lessons from the mechanical men of health 1928–1948

During the interwar years, health exhibitions and pavilions were commonplace in Europe and the USA. Within these exhibitions were a small number of life-sized or oversized mechanical men used to represent physiological processes. Although they received significant press attention at the time, little academic analysis exists to date. These mechanical men, I argue, all provide important insights regarding the way design could be used to heighten the appeal of physiology and crucially, in the formation of a new term—the Accessible Body. First, this study re-introduces three mechanical men of health to an academic audience, identifying provenance and unearthing key details of their performance and visual appearance. I argue that there is much to be gained by their analysis in comparison to the more notorious body representations that they orbited. Through detailed analysis of their forms, the three mechanical men are shown to challenge the dominant notions of the Ideal Body and Fordist Body embodied in the Dresden Transparent Man (1930) and ‘Der Mensch als Industriepalast’ (1926), respectively. The study examines and classifies these mechanical men as a new type of body— the Accessible Body. This term refers to representations that embody a sense of consciousness, the re-appropriation of popular culture and engagement with humour and visual appeal. The study concludes with discussion about the Accessible Body in contemporary health education. What tropes and approaches may remain significant today? By leaning on contemporary thinking about linguistic rather than visual metaphors in health, this study concludes with provocations for the alignment of other appropriate metaphors within a mechanical man and Accessible Body framework. Ultimately, I call for a reshifting of man/machine visual metaphors as a means of re-engaging the audience today.