Starting and Growing a Career in Web Design

Apr 8, 2022

Blue Flower

Visual digital health - Publicar II

Introduction & problem

In the context of healthcare delivery and drug development, patient-centeredness has gained increasing recognition as a hallmark of quality. Patients increasingly aspire to wield more control over their health conditions, aiming to grasp the intricate nuances impacting their well-being. This desire to comprehend their health state empowers them to devise strategies encompassing lifestyle changes and a comprehensive, multi-disciplinary approach that often challenges currently implemented medical protocols. At the same time, consumers have been showing great acceptance towards mindful and health-data collecting strategies encompassing writing practices, biometric wearables, and mobile health applications (mHealth apps) (Gunasekeran et al., 2021). Yet, despite the amount of data users can collect often doesn’t translate into a logical narrative of the multiple layers forming the whole of health and well-being. Furthermore, for data to have significant clinical value in the context of medical appointments, digital platforms must be designed to effectively convey data in information models that report different data sources and domains that are informative for clinicians.

This essay aims to explore and propose design strategies within the domain of human-computer interaction that can bridge this communication gap, thereby revolutionising the patient-healthcare provider relationship in the digital age.


Body

State of health communication

The establishment of effective communication between patient and doctor is a complex interactional system, crucial for facilitating the exchange of relevant factual information, and elicitation of patient preferences. Human interaction is a determinant factor in strengthening patients’ trust and satisfaction with healthcare entities and clinicians (Berry et al., 2021), and as patients are increasingly looking to become part of the decision-making process (Naseem, 2018), mutual agreement, empathy, and providing a meaningful answer that supports the role of patients in making informed and active choices, rather than remaining passive recipients of their care (Langberg et al., 2019; Mikesell, 2013) are important assets in establishing a solid foundation for successful clinical journeys rooted in patient-centred care (PCC) (Backman et al., 2019).

Consider a scenario where you're discussing an intricate set of physical or mental symptoms for the first time with your doctor. Were you prepared with a clear account of your symptoms, or did you find yourself struggling to articulate them on the spot? As the doctor asked questions, did you feel your responses accurately captured the full extent of your health issues? Was there a sense of genuine understanding, or did the limitations of verbal communication hinder the depth of this exchange?

Such interactions often leave patients wondering if they could express themselves clearly without missing important facts and if their doctors truly grasped the entirety of their health concerns. This scenario is not uncommon. It underscores the challenges many face in effectively conveying their health narratives within the constraints of a typical medical appointment.

These communication challenges in medical settings are the consequence of an interaction that relies heavily on a verbal communication model and can be described by two foundational limitations. Firstly, patients often struggle to articulate and convey their experiences and physical and psychological symptoms, with variations in intensity and frequency. Secondly, and perhaps more crucially, patients’ recollections of their health history are frequently inconsistent and inaccurate, regardless of individual communication abilities. These challenges are often compounded by missing details due to common memory gaps and memory consolidation, a process in which the brain combines multiple related experiences into a single, more general memory, or current state bias where a patient's reporting is influenced by their current physical and emotional state. This intrinsic limitation commonly results in patients inadvertently underreporting past symptoms and medical events (Barsky, 2002). insert references from - Draft IX/Patient-doctor communication limitations

The medical community has long acknowledged this limitation, and thus doctors frequently advise patients to keep a health diary to track quantifiable metrics like insulin levels, blood pressure, and weight, as well as taking note of symptoms when required.


Why do mHealth apps fail?

The past decade has proved users are willing to adopt digital health tools, but despite the number of new products launched every year, innovation seems to be low seemer. While many solutions excel as collecting platforms, data interconnection remains a gap to be widely explored (Yao et al., 2019). most fail to present information in context (Rowland et al., 2020). This is crucial. In the absence of context, information remains siloed and thus lacks meaning. This might explain why users’ inadequate comprehension of health information is still one of the persisting barriers associated with health-tracking devices (Rowland et al., 2020), something well represented in the disappointing user adherence rates (Lancaster et al., 2018) with reports showing most individuals discontinue their usage shortly after initial engagement (Lie et al., 2017; Meyerowitz-Katz et al., 2020).


This fragmented landscape hinders interoperability which is essential to establishing meaningful correlations between disparate data sources such as clinical and medical exams, physical activity, sleep quality, and life events. Without a common mapping platform, data resides siloed, resulting in fragmented information that lacks context and meaningful correlations. The true value is not about data collection but rather about the ability to translate this data into coherent and meaningful information that users can understand, communicate, and act upon.


Additionally, factors such as user motivation and existing health conditions are variables known to be associated with how diligent users are that we cannot control. However, we do have control over the implementation of information structures and, as such, we can influence the apps’ usefulness perception, ease of use, and facilitate interpretation across varying information density and health literacy levels.


Moving visual

A good place to start is by aiding the patient-doctor communication through visuals.

Vaughn et al. (2021)~ explored the effectiveness of data visualization in mobile health technologies for pediatric patients. It highlights the unique potential of visualising symptom data to enhance awareness, communication, and interpretability. The study demonstrates that effective visualisations can provide insightful snapshots of symptom occurrences and patterns/dynamics, improving patient and parent understanding by allowing the “symptom story” to “be seen”. Importantly, it also provides some valuable insights for future design strategies, revealing that clinicians prefer simple, interpretable visuals like pie and bar charts for ease of use in communication.


Data visualization strategies hold promise in assisting patients and caregivers in understanding overlapping events, including symptoms, external factors, and clinical records. Interestingly, the intimate nature of the interaction with smartphone-based self-monitoring and treatment interventions seems to empower patients to express their feelings and symptoms more effectively, resulting in more accurate assessments and better care through improved patient communication even in highly subjective settings like children and young adults with psychiatric disorders (Domin, 2021) (Melbye et al., 2020) (Lupton, 2021).


Visual representations are not foreign elements in the medical field and have proven especially beneficial in pediatric care where verbal communication may be limited. An example of established tools are the Visual Analogue Scale (VAS) which has been widely adopted as a validated and subjective measure for acute and chronic pain, particularly in pediatric patients (Lee & Lim, 2016; Assad et al., 2016; Raina et al., 2017; Heijden et al., 2015), and the Facial Pain Scale (FPS) which enable patients in varied clinical settings to articulate pain intensity visually with enhanced accuracy and clarity despite its subjective nature (Haggard et al., 2013). Similarly, icons, shapes and textures have been explored as visual metaphors for different types of pain (Lalloo et al.), which compound greater interest when combined with virtual body maps, which allow mapping physical experiences in an interactive diagram with anterior, posterior, and lateral views of the body insert references.


Beyond visuals: Building Personal Health Stories

By a large number, health-tracking apps haven’t been seriously explored to become communication mediums with narrative-building abilities to deliver personal health stories aiming to promote an intuitive ground for mutual understanding - one that is seen, not just verbally explained - to better correspond with the present and define the future through the lens of the past. There is a lack of guidelines and so this is a design exploration.

  • users can easily learn from them without the restrictions of learning new skills to engage with them. And that might be the tool that patients need.

  • Thus, the participating user and data are not separate but in correspondence (Tim Ingold).


In exploring the patterns for this medium we shouldn’t aim to design something that retroactively fits the current patient-doctor communication model. There is more to gain by exploring beyond the counters of the established limitations. Otherwise, the very issues that spurred the need for digital intervention in the first place, linger, unresolved, perhaps unnoticed, beneath the surface of these well-intentioned adaptations.

  • It seems undeniable that digital health-tracking solutions need to adopt dynamics able to establish a dialogue with the users both at the primary level of events recording and later in information transmission.




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Proposal: "Cluster Reports" for Enhanced Health Storytelling

Objective:

To implement a strategy within health apps that leverages the concept of symptom clustering, combined with the capabilities of natural language processing, to create detailed, contextual, and multidimensional narratives of patients' health journeys.


Methodology:

  • Symptom Clustering: Develop an algorithm or interface where users or their healthcare providers can select and cluster symptoms based on their co-occurrence or relatedness. This could be augmented by natural language models capable of recognising semantically or contextually related events.

  • Causal Relationship Mapping: Enable the establishment of causal relationships among clustered symptoms. This feature would allow users to not only see which symptoms cluster together but also understand potential causative factors or triggers.

  • Bothersomeness Characterization: Include an option for users to characterize the severity or bothersomeness of each symptom cluster. This adds another dimension to the cluster, providing more detailed insight into the impact of these symptoms on the user's daily life.

  • Multi-Dimensional Visualization: Design visual representations of these clusters that incorporate various dimensions – such as time, severity, frequency, and causality. This could be in the form of dynamic graphs, interactive charts, or other innovative visualization methods.

  • Context-Rich Reports: Utilize natural language models to generate "cluster reports" – narrative summaries that provide a contextual understanding of the clustered symptoms. These reports would offer a comprehensive view, linking symptoms to potential environmental, lifestyle, or medical factors.

  • User-Centric Interface: Ensure that the interface for symptom clustering and report generation is user-friendly, intuitive, and customizable to cater to a wide range of user preferences and technical literacies.


Application:

This approach is designed to transform health apps into more effective communication mediums, presenting health data not as isolated metrics but as part of an interconnected story. By offering a richer, more nuanced view of health data, "cluster reports" aim to enhance patient-clinician communication, improve self-understanding of health conditions, and aid in decision-making processes.

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Through visual health narratives derived from self-reports and other collected artefacts, these apps can offer an intuitive ground for mutual understanding - one that is seen, not just verbally explained (remember we are not great at recalling and rebuilding events). In short, approaching health apps beyond a product and thinking of them as ‘communication mediums’ that ‘weave data’ to shape visual narratives for personal health storytelling, providing the users (patients and clinicians) with anchoring elements to help them develop “a greater sensitivity to cues in the environment and a greater capacity to respond to these cues with judgment and precision” (Ingold, 2015: 47) in anticipation to conditions in the future.


Future fatigue (Loizeau & Ward, 2009)

By focussing on futures, the distant horizon, the long now, many believe that CSD neglects the near and direct urgency of now – a call to action to affect our collective present. By searching for an alternative, we fail to examine and address the inequalities of the here and now. Some see this as deferment in our responsibilities, but many critical speculative designers see their work as operating in the now – aiming to shift perceptions to make way for change.


the strange fatigue felt in the narratives of CSD’s futures are a result of what Berardi and Fisher call the slow cancellation of the future (Berardi & Fisher, 2013); a cultural moment where it’s impossible to understand temporal difference through our cultural production, where we are “assailed on all sides by zombie forms” (Fisher, 2014). Maybe this slow cancellation is what makes CSD cause rupture and friction – the future it aims to project never feels fully new, more a cultural assemblage of our troubled pasts.


notes

Currently, the scarce amount of well-studied design frameworks to shape new experiences in mHealth apps is certainly a constraint, however, it doesn’t need, and perhaps shouldn’t, constitute a barrier to the development of new digital tools. I would even argue we can learn by practicing, and practicing through designing. Imagining new dynamics in apps like Apple Health and others from big tech companies it seems very likely that a top-bottom iteration approach could rapidly provide compounding real-world insights towards a progressive understanding and evolution of improved patterns for information visualisation.