Last week I started diving into my project with AME, the hospital’s specialist unit for outpatients. To refresh, my task is to create educational materials to increase understanding of hypertension. Such materials already exist, and it would be so easy to take one of the many pamphlets from the American Heart Association or CDC and translate it into Portuguese, but the tricky part is that my design has to not only be Portuguese speaker friendly, it has to be understood by people who are illiterate*. Initially, I dove into brainstorming and sketching designs, an amateur mistake that I quickly realized I was committing. I was just really excited to get to work.
Pulling in the reigns, I thought back to the human factors class taught by Dr. Philip Kortum at Rice, one of the most useful classes I have taken. In that semester, everything we learned was focused around user centered design, a term we used so much it was abbreviated to UCD. By jumping into my project without anything other than the vision AME provided me, I had no idea who my target user was, and I was violating the first principle of UCD. It dawned on me that I can’t think of a healthy adult person I have met who can’t read (which is a huge marker of the privilege I have living in the United States and attending Rice University), so I had no idea how to reach low literacy people without speaking to them in person. I started on my homework.
Literacy measured for demographic collection purposes encompasses people 15 years of age and older. In Brazil, there are about 161 million people in this age range, and 7.4% of these people cannot read or write. The prevalence of hypertension in Brazil is slightly more difficult to nail down, but the general consensus around the hospital is that about 1/3 of the Brazilian population has hypertension. This means that of this population, more than 53 million have hypertension, and if people who are illiterate are affected proportionally, which is doubtful, almost 4 million Brazilian adults with hypertension also cannot read or write. I present this final number with caution, as I suspect it is an underestimate. Although more research is required, illiteracy is usually correlated with worsened health, so I suspect adults who are illiterate are at a higher risk for hypertension than adults who are literate. (Another link on the relationship between illiteracy and poor health is here.)
With a better, albeit imperfect, understanding of how many users I want to reach, I then set about learning how to reach them. The scholarly articles on improved communication with people who are illiterate have so far been limited, so I invite any readers with knowledge and/or sources on the subject to email their experiences and/or articles to glj2@rice.edu. I did find a helpful article published to LinkedIn by Jose Moriano, whose profile introduces him as a Communication for Development Specialist. Jose’s article had lots of interesting and helpful advice, but the take home message for me was that illiteracy may correlate with an inability to learn and understand hierarchical information due to a lack of the structured learning provided in a formal education, so the designer should revise her assumptions based on visual learning skills. Under that umbrella, Jose also presented more specific tips.
Reduce visual complexity with …
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- Hand drawn cartoons rather than photorealistic images
- Lots of white space
- Short, clearly separated chunks of information
- Simple grids
- Descriptive pictures instead of icons (think about the different ways urban versus rural residents may interpret icons)
I plan to continue my research, but from here I have a starting point, and I feel my sketches have a little more direction. I have a feeling that as the research continues, there will be many revised drafts of my project.
*Personal preference: I feel it is important to put the word “people” before the word “illiterate,” and you will not read “illiterate people” in this blog post other than right here. This is because I don’t feel right defining a group of people by what they lack, and I want to make a point of presenting people as people before considering what makes them different from me.