Module 4: Creating Effective Visual Literacy Tools

Currently, a significant number of clinics in the Global South rely on written materials or doctor-patient consultations to educate patients about diseases, procedures, and possible treatments. This can be a very ineffective means of reaching patients, particularly in regions where most of the population has low-literacy skills or is illiterate. Visual communication tools can be used to reach patients who lack formal education or may be reluctant to ask additional questions of the healthcare provider. When designing visual materials, one must choose the most appropriate medium to convey the medical information, whether this be video, audio, or visual diagrams. It is important to focus on the audience to ensure that the materials are understood by the patients. An object or depiction that is used commonly in high-income countries, for example, may not be recognized in the low-income countries. Similarly, a visual aid developed for a rural population could be misunderstood by an urban population within the same country. It is important to remember that educational materials need not be complex, elaborate, or “high-tech” to have favorable outcomes; however, similarly "simple" educational materials will not be effective unless they are designed through close collaboration with local residents.(1) Throughout the process of designing educational materials, it is important to remember to incorporate educational messages to fit the three most basic components of teaching: the communicator (teacher), the instructional material (message), and the learner (receiver). It is important to ensure that visual communication materials are developed with the input of local community members and that local depiction of objects and procedures are incorporated into visual communication aids on a region-specific basis. (2) For example, symbols or depictions developed by an urban Indian woman may not be understood by her rural counterpart, even if the rural woman lives less than ten miles away.(3)

Guidelines for Effective Design

Good design cannot improve the content that it intends to present, but it can make the content more understandable, simple, and therefore more effective. Good design contributes to the creation of better experiences and improved comprehension of difficult-to-understand material.(4) One way to overcome the challenge of discussing topics that may be culturally taboo or infrequently discussed is to use metaphors to depict the subject matter. Just as metaphors are commonly used to discuss unfamiliar concepts in literature, designers can make previously unapproachable concepts more palatable through the utilization of symbolic representations. Metaphors are especially useful in making use of culturally significant symbols. For example, the HIV virus is thought of as a monster in many regions of Africa, and monsters are often represented by depicting snakes. Thus, in a South African video pilot study, snakes were used as metaphors for the HIV virus.(5)

Cultural Specificity

Involving Public and Local Experts

“Know your audience” is a well-known guideline in the media and entertainment industries, as well as in the world of advertising. Market research is an essential starting point in establishing a business, launching a product, or writing a book. This process enables the researcher to understand the background, composition, needs, and strengths of the target population. This type of information has traditionally been gathered in high-income countries through market surveys (direct interviews, questionnaires, telephone surveys) or through focus groups. The strategies employed to collate and summarize the information acquired through these techniques is known as qualitative research, which provides information about the public’s attitudes, opinions, and aspirations, all of which are fundamental in understanding the target population for an educational intervention.

Establish A Profile About the Target Population

Public health researchers should next develop a population profile based on income, level of literacy, cultural, religious and linguistic compositions, and healthcare needs and existing barriers to care, whether financial, social, cultural, or otherwise. This profile will also provide insight into the population’s preferred method of communication and ways in which designers can maximize their audience’s receptiveness to the intended message.

Understand Social Norms and Culture-Specific Issues

Many studies articulate the desire of underrepresented minorities to have educational materials specific to their culture. In a study by Herek, a culturally specific video was rated by African Americans as more credible, attractive, and of higher quality than an identical video with a multicultural cast and message. Cultural specificity was defined by Herek as a function of source, message and receiver. For example, the source (communicator) should be perceived as credible and attractive to the specific audience member, while the message should have content that is directed towards the needs of the viewer. Culturally-sensitive visual materials should not only be well received, but should also lead to a greater retention of knowledge. In a study by Stevenson and Davis, there was a significant increase in African American adolescents’ knowledge of HIV two weeks after they had viewed a culturally-appropriate educational film.(6)

Language and Dialect Variations

If there is a caption or written aspect included along with a visual image, attention must be paid to the nuances of language and dialect. Language is integral to culture; subtle aspects of a message, such as humor and implied meaning, cannot be appropriately conveyed unless the messages are developed based on local cultural beliefs.

Focus Groups

Substantial literature details the use of focus groups to successfully obtain data about populations whose needs have not been previously been researched. The focus group method allows researchers to better assess the language, values, and thought processes of the target group, all of which are essential to developing culturally-competent and effective visual communication material. Focus groups are flexible and inexpensive methods for collection data about populations, regardless of whether they are literate, low-literate, or illiterate. The focus groups can better understand pre-existing cultural beliefs and understand locally-significant metaphors. For example, Wong's study that represented HIV as a monster demonstrated that it is highly feasible in South Africa to utilize focus groups to develop culturally-sensitive educational materials using familiar metaphors. The visual resource had a statistically significant effect on patients’ baseline knowledge of HIV medication and the importance of adherence. Focus groups were a key element in creating culturally-sensitive materials because their open-ended format of asking questions allowed the researchers to understand perceptions and barriers to adherence experienced by their patients. (7)

Examples of Smart Design Programs

There are now many programs and institutions dedicated to creating innovative educational tools that are culturally competent and focus on themes such as public policy, global healthcare, sustainable development, and social entrepreneurship. Designmatters, a program at the Art Center College of Design in California, is an educational department that partners with every discipline at Art Center to focus on art and design education with a social impact agenda. Their “real-world” projects are implemented through a series of unique partnerships and alliances with global development agencies, government groups, academic institutions, and local and national non-profits. In their design strategies, Designmatters students familiarize themselves with the population for which they are designing materials. They listen to their personal stories and anecdotes, and they research the cultural, economic, and political dynamics faced by patients in the Global South.(8)

Footnotes

(1) Jacobson, T. et al. “Use of a Low-Literacy Patient Education Tool to Enhance Pneumococcal Vaccination Rates: A Randomized Controlled Trail.” JAMA. (1999). 282(7): 646-650.

(2) Hugoa, J., Skibbeb, A. “Facing visual illiteracy in South African health education; a pilot study.” The Journal of audiovisual media in medicine. (1991). 14.2: 47-50.

(3) Vikalp Design. "Why Communication Fails." https://www.vikalpdesign.com/communication_fails.html.

(4) Poggio, N. “Making Sense with Design: A Taxonomy of Designed Experiences.” Presented to the Faculty of Graduate School of The University of Texas as Austin in Partial Fulfillment of the Requirements of the Degree of Master of Fine Arts. May 2006. 1-3, 6.

(5) Wong, I. “The Development & Assessment of an Innovative Video to Introduce Concepts of Adherence in Soweto, South Africa.” A Thesis Submitted to the Yale University School of Medicine in Partial Fulfillment of the Requirements for the Degree of Doctor of Medicine. 2004. 2, 5-7, 11-14, 16-31, 38-42, 44.

(6) Ibid.

(7) Ibid.

(8) Designmatters. Art Center College of Design, 2017. http://www.artcenter.edu/academics/interdisciplinary-programs/designmatters/overview.html.