People facing medical decisions often look beyond their physicians to media such as websites, social networks, video, and mobile apps. Unfortunately, much of the health information these people find does not succeed in getting the information across or lead to healthy change. (Photo credit: Michael Evans, MD/Health Design Laboratory) The nonprofit Health Design Laboratory brings together health care researchers, designers, artists, and others to devise compelling and innovative ways to deliver health messages. A new nonprofit initiative in Canada called the Health Design Laboratory brings together health care researchers, designers, artists, and others in an effort to improve the way health messages are delivered (http://www.hdlab.ca/). The goal is to give people the right information at the right time, in the right place, and in the right format. “Patient education—like pamphlets handed out in a waiting room—has been very generic, pretty boring, and not compelling or emotional,” said Mike Evans, MD, the group's director, who is an associate professor of family medicine and public health at the University of Toronto and a staff physician at one of the university's affiliates, St Michael's Hospital. “Our lab seeks to rethink how we engage patients, to innovate, and to test out what works and what doesn’t.” Designing better ways to deliver health messages The Health Design Laboratory is based at St Michael's Li Ka Shing Knowledge Institute, which was completed in 2011 and seeks to link patient care with education and research and to promote the ethical generation and use of knowledge. The laboratory was conceived as one approach to help the institute bring reliable medical information to patients quickly and effectively. Like any laboratory, it is a place for inquiry and discovery, but there are no test tubes or laboratory coats. Instead, filmmakers, designers, tech-savvy digital media experts, usability advocates, patients, writers, health care professionals, and scientists seek innovative ways to connect medical advances, new media, and patients' needs and wishes. “Today people are more informed, in part because the health care system has become more patient-centered and less paternalistic and in part because people love the web; however, they don't often know what's good and what's bad on the web,” said Evans. “We want to curate the high-quality stuff and create evidence-based health media to fill the gaps.” Take the whiteboard-style video “23 and ½ Hours: What Is the Single Best Thing We Can Do for Our Health?” produced by Evans in collaboration with a director, an illustrator, and a sound editor. Uploaded to YouTube in December, it quickly went viral and had racked up more than 2 million views by the end of February, with 25 000 people watching it every day (http://tinyurl.com/8a4jvv9). Evans and his colleagues admit their focus was on creating a compelling presentation; they had no dissemination strategy. In fact, Evans decided to upload it and send the link to a few close contacts while watching one of his children's hockey practices. The video describes how exercise, even just walking for 30 minutes, does more for individuals' health than any other intervention, bringing benefits in areas such as arthritis, cognitive function, diabetes, heart disease, anxiety, depression, fatigue, quality of life, and longevity. The message is simple and familiar, yet its delivery is innovative and entertaining. At the end, Evans poses this question: can you limit your sitting and sleeping to just 23 and hours a day? The video has already been translated by viewers into Spanish and Italian, and 5 more translations are in the works. “We now have a format that makes behavior contagious, and we are going to stick with it and partner appropriately to make a series for other health conditions,” said Evans. The key is that instead of coming from an institution, the message is coming from a friend—what Evans calls peer-to-peer health care. More than 15 000 people posted the video on their Facebook pages, and countless more have e-mailed the link to their social networks, he said. “The trick was to develop engaging media that the patients themselves and the media wanted to distribute.” A similar video, which is geared toward youths, addresses the importance of recognizing—and doing something about—concussions (http://tinyurl.com/6qe74xh). Evans' group is also putting the finishing touches on a whiteboard-style video about multiple sclerosis, explaining the results of a systematic review of a controversial potential cause (vein abnormalities) and treatment (venoplasty) (Chafe R et al. Nature. 2011;472:410-411); he looks forward to seeing how patients will react to a video on a topic more “specialized” than exercise or concussions. For another project, “The Truth of It: Unscripted Stories of Cancer Survivors,” a diverse group of Canadians diagnosed with cancer were asked to share their experiences on video so others could learn from them (http://tinyurl.com/6nlrodo). The patients address issues such as body image, getting the news of their diagnosis, and talking to their kids. The Health Design Laboratory and the Canadian Partnership Against Cancer have embedded the series in a variety of settings, such as clinics, self-care sites, YouTube, and other media. In addition to helping patients, survivors, and others with a personal connection to cancer, the videos are meant to support health care professionals as they strive to improve cancer care. Mini med schools In addition to such video-based initiatives, the Health Design Laboratory has also created a variety of other attention-grabbing products such as “5-minute med schools,” which are short documents tailored to busy patients. One focuses on physical activity and includes summarized information on the scientifically proven benefits of exercise; tips on how to incorporate walking into one's daily routine; and recommended resources, including the best websites, online tools, mobile apps, and books. Another presents 5 key things people should know about insomnia as well as steps to take if they are having trouble sleeping. “It's a very simple concept,” said Evans. “There may be 100 things you could do about a condition, but we make it manageable and provide the few important ones that people might be able to focus on.” Hockey cards and comic books The laboratory also produces medication “hockey cards” modeled after Canada's equivalent of baseball cards, which were developed by Lori MacCallum, PhD, a pharmacist at St Michael's Hospital and an assistant professor at the University of Toronto. MacCallum fused her clinical knowledge with media design to help people learn about a relatively complex topic—diabetes treatment—in a new way. The product is an illustrated story that uses the analogy of picking a winning hockey team to characterize choosing a medication to lower blood glucose. Each diabetes drug has an accompanying card that highlights the key information patients want to know when starting a medication, including how it works, how effective it is, its benefits and adverse effects, how often it should be taken, its other names, and its coverage by health insurance. The format enables patients to weigh the risks and benefits of medications and make quick comparisons among them. Children are the focus of The Adventures of Medical Man comic book, which explains everything youngsters need to know when an illness or injury occurs. Each chapter is structured around a movie or comics genre and features a common illness or injury—from nut allergies to strep throat—with characters explaining the causes, symptoms, and cures. While Evans' YouTube success shows that he is reaching millions of people, he has no real data to demonstrate whether his videos or other projects are changing patient behavior. “Does it have any impact beyond a quick hit? It's an important question, but we don't know the answer,” said Arthur Slutsky, MD, who is vice president of research at St Michael's Hospital and who, along with the Li Ka Shing Knowledge Institute's executive director, Andreas Laupacis, MD, helped recruit Evans to head the Health Design Laboratory. The group is currently working to design studies that will address the question, but rigorous study designs are not easy. “How do you assess the long-term clinical impacts of YouTube videos such as ‘23 and Hours' that may be viewed in dozens of countries by millions of people over prolonged periods of time?” asked Slutsky. Also, not surprisingly, the laboratory is discovering that some initiatives may appeal to certain populations but not others. For example, according to focus group studies, products like the medication hockey cards have not been popular with older patients, who say they would rather receive medical information in a more “serious” format. Promoting small changes While the laboratory is still on a learning curve, Evans' experiences have revealed a few key insights into how to get people to pay attention to health messages, which is important in its own right. Sparking conversation—a concept tied to peer-to-peer health care—is crucial to reaching people in a meaningful way, said Evans. The “23 and ½ Hours” video has more than 1000 comments on YouTube, many of which are parts of back-and-forth conversations among viewers. “Commentary is not something that we are used to in academia; most articles get 1 or 2 comments,” Evans said. Also, Evans noted that individuals want to know more than just what they should do: they also want to know why, and they want to see evidence. He added that messages should promote small changes that are doable, not challenges that could seem insurmountable to some. Obviously, taking advantage of technology and the Internet can expand a message's reach. “We don't know how social media like Twitter, Facebook, and YouTube will end up impacting health, but if we want to reach the current generation, we have to get into the game,” said Slutsky.
JAMA – American Medical Association
Published: Apr 25, 2012