6/27/2022

Visuals in Health Education: The Positive Impact Is Easy to See

Ellie Opdahl, Healthwise Medical Illustrator

In a 2021 survey of healthcare organizations, 58% identified health equity as a top priority. Health equity is core to Healthwise’s mission to help people make better health decisions. So, we’ve been asking ourselves what we can do to help patients attain their full health potential and increase their health literacy. How do we present health information that’s inclusive to all patients and accessible, regardless of their different circumstances or racial and ethnic background?

Over the past decade, countless studies show that visuals help improve health literacy. Healthwise has always taken a visual approach to health education. We have an in-house multimedia studio that produces award-winning patient education visuals. Our videos have an 80% completion rate—and our newest videos are achieving 90%. Healthwise’s user testing data shows that patients prefer videos that are short and digestible (under 2 minutes).

We created a library of icons which we use throughout our discharge instructions, videos, and other content. We know icons increase patient satisfaction by improving comprehension and recall, which are hallmarks of health literacy. When it comes to reaching racial, ethnic, and vulnerable groups and improving health equity, icons with simplified text are the most efficient and effective tool to improve discharge education for older adults with low literacy skills.

 

Low-Text, High-Visual Patient Instructions

If you’ve ever put together a piece of IKEA furniture—whether it was easy for you or felt impossible—you know the value of clear, visual instructions. Plain-language, picture-based education materials can help patients and caregivers from multiethnic and low socioeconomic backgrounds adhere to medication regimens.

Healthwise is taking a closer look at how we can support patients who have low literacy, are English language learners, have limited English proficiency, or have learning or developmental disabilities—all factors that affect health literacy. Visuals in patient education can support and enhance written language and create new opportunities to increase health literacy. That’s why we are developing Low-Text, High-Visual Patient Instructions (PIs).

This image is a mock-up to give you a general idea of how the patient instructions will look.

Through user testing, we’ve found that users who are at greater risk for low health literacy prefer less text and more visuals. We’ve also learned that visuals help users understand tasks better than words alone. These findings align with a review of research that shows patients with very low literacy skills benefit from educational materials with pictures and very simply worded captions.

Some of our Low-Text, High-Visual Patient Instructions (PIs) use our new didactic-color medical illustration style. Healthwise developed this style for specific use cases—such as step-by-step, instructional, and medical device content—where reduced detail and focused communication are necessary. Didactic color’s strong line art and high contrast are more accessible to patients with low vision. Like our full-color medical illustrations, we develop each image following accessibility guidelines to ensure the image prints clearly in black and white to accommodate varying printers in clinic facilities.

 

Equal Representation in Images

Our visuals efforts go beyond improving health literacy. We aim to represent all patients—all identities—in our content. As Healthwise continues to assess, improve, and expand our medical illustration library, we’re seeking opportunities to increase representation of people who historically have been marginalized in medical images. We want to represent patients of all ages, skin tones, body types, and racial, ethnic, and gender identities. When people see themselves in our content, they feel empowered and represented.

We recently updated the images in the Patient Instruction article titled “Learning About Breast Cancer Surgery” to include people from different racial backgrounds, showing a variety of realistic bodies. We want patients to feel that this content represents them, that their experience is valid. This can help them visualize their successful health journey.

This image is a mock-up to give you a general idea of how the patient instructions will look.

Healthwise recently updated and expanded the library of images in our Pulmonary content. We also refreshed the visuals in our Dental content. And we’ve begun work on our Ear, Nose, Throat (ENT) content.

 

 

For some of our clients, as well as their patients and members, this is the first time they’re seeing themselves represented in medical images, and that has evoked emotional responses. For us, this is bittersweet—Healthwise is making progress toward health equity. But it also reveals how far the field of healthcare has yet to improve. Inclusive content is still the exception rather than the rule.

In our content, Healthwise aims to represent a diversity of real people with varied identities. We know this leads to content that patients find genuine and trustworthy. Folks have asked, “Why don’t you show more gender-neutral bodies—isn’t that the way to be inclusive?” Some of the people you see in our content have a neutral gender expression (they express themselves as neither masculine nor feminine), or an androgynous appearance. Healthwise images also show male and female appearances, and masculine and feminine gender identities; we hope patients who identify as gender neutral or have an androgynous appearance feel represented in our visuals as well.

Inclusive Written Education

Healthwise is finding ways to make our written content more inclusive, so that a person of any gender identity can use it and feel included. The content team has reviewed and removed binary gendered terms from content areas that have heavy binary gender bias, such as women’s health, men’s health, sex and sexuality, screenings, growth and development, and LGBTQ+. Our content uses second-person voice (“you” and “your”) whenever possible.

For some conditions that predominantly affect women or men, like breast diseases or prostate problems, we may have to use “women” or “men.” But throughout these topics, we acknowledge nonbinary or transgender people who may be affected.

Some examples of this inclusive verbiage include:

Breast cancer
“Breast cancer can occur in people who don't identify as female but have breasts.”

Who should be screened for HIV?
“If you or your partner(s) don't identify with the sex you were assigned at birth, talk to your doctor about your risk.”

What is ovarian cancer?
“Ovarian cancer can occur in anyone who has female pelvic organs, even people who don't identify as female.”

Health Education for All Is Here

To help people make better health decisions, Healthwise must constantly assess and improve our health education. And by making our education more accessible and inclusive, it becomes more effective for everyone who uses it—while also increasing health literacy and improving health equity. The health education updates outlined in this blog will be available across all Healthwise patient education solutions, but if your organization uses Epic, be sure to check out our new FHIR-enabled solution, Healthwise® Advise.