Supporting patient understanding of diabetes through graphic design & user experience
In South Africa, 7% of adults aged 21 to 79 — that’s about 3.85 million people — have diabetes.
As summarised in the article linked above, here are some of the issues diabetes brings in South Africa:
- Lives have become more sedentary and work environments are not conducive to physical activity. In South Africa in particular, patients often quote crime, road safety concerns and poorly maintained parks and recreational areas as reasons for not exercising outdoors.
- Diabetes is a complex condition which causes a person’s blood sugar level to become too high. There are many people in the population with blood sugar levels above what is considered to be the ‘normal range’, but not high enough to be diagnosed as having diabetes. Their risks of developing full-blown diabetes are therefore greatly increased — and this is where diabetes gets its nickname from — “the silent killer.”
- It’s incredibly important for diabetes to be diagnosed as early as possible because it gets progressively worse if left untreated. Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. Early intervention cam prevent and/or reduce the risk of all these complications.
- Low levels of literacy, a lack of funding, resources and maladministration often result in poor treatment quality. Drug shortages are common in the public sector. Insulin is expensive, and in South Africa, many people don’t have private medical aid.
In South Africa, along with many other countries — self-management education is limited and the role of diabetic nurse educators is underrated and not utilised to its full potential. Secondly, healthcare facilities are in dire need of improvement and medical practitioners often lack the resources they need to provide the correct assessments and treatment.
In the words of Dr. G. Podgorski, a Physician (with special interest in the management of diabetes) in Port Elizabeth, South Africa:
“The complexities of the epidemic require a multi-pronged response.”
Current examples of NHS questionnaires
During a Seminar in the UK, Dr. Podgorski gathered some examples that are currently used by the NHS in England:
The brief
I was asked to re-design and combine these different elements into something that could easily fit a two-sided A4 sheet, and could be used by the Diabetic Educator at the practice (Hannie Williams) to collect data from patients.
In Dr. Podgorski’s words:
The idea is, that before each consultation my Diabetic Educator will sit with the patient and help him/her to answer all the questions. She will calculate the final score and put it on the bulls’ eye with the date of the consultation — to give to the patient an idea about their progress, and allow me to address the most important concern (s) during the consultation.
The challenge
- Content layout and hierarchy of the current worksheets: to make the newly combined questionnaire more user-friendly for data collection and Patient-use.
- Readability and ease-of-use: keeping fonts at a legible size but fitting in all the relevant content (sourced from four different A4 pages)
- Aesthetic consideration: introducing a simple and cleaner design while retaining certain colours or elements which serve a functional purpose, and couldn’t be removed or altered.
The process
I re-worked the way the questions & scoring columns were initially designed to try and reduce the potential for error when scoring. I introduced a clear question & answer hierarchy, with a new score column on the right hand side. The total score can now be seen quickly, for more efficient data collection. The questionnaire itself is filled out with the Diabetic Educator and the Patient. I decided to put this at the back of the A4 because the patient will only refer to this in-session.
On the front of the sheet, we put the items which the Patient might come back to often — the Diabetes Consultation Chart (DCC) — which allows them to work out their own HbA1c scale using a glucose-level ratio, situated below the bull’s eye diagram. They can re-take this test on their own, and so plot down their results using the same worksheets two more times after their initial visit.
The design
What happens next…
The questionnaire is now ‘live’ and Hannie is working along with the Patients (who give their consent) to collect data. In six months time Dr. Podgorski hopes that the results will speak for themselves and all Patients will see improved results in their health & wellbeing.
Six month update: the results are in!
Overall, there was a significant improvement in the Patient’s understanding, when using this method.
Measuring stress (DDS2) and HbA1c levels using the graphic representation of results with bull’s-eye for diabetic patient helped to focus the consultation and significantly reduced both stress level (by 1 point), and HbA1c level (by 0.3%) after 6 months.
More about the results here!
Thanks to Dr. Podgorski for asking me to be involved in this wonderful UX/Design project, and to Hannie Williams who is carrying out the work with Dr. Podgorski.
Thanks to Kings College London for the source materials & worksheets from which we were able to create this Diabetic Education questionnaire.