Designer’s perspective on health communication research

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This week I watched some conveniently relevant news reports on health and advertising (perhaps this could be considered a priming effect?) while reading on health information effects. The videos, special reports put out by Vox, covered the effects of today’s advertising on public health — specifically the use of nicotine by minors and young adults, which had been nearing zero until e‐cigarettes started being marketed and framed separately from smoking cessation (Vox, 2018, “How Juul made nicotine go viral”), as well as prescription drug ads (Vox, 2016, “How Americans got stuck with endless drug ads”).

Initially, these reports interested me because they touch on what effect the interpretive aspects of an ad’s visual vernacular have on the audience — like model ages, gestures/poses, scenery, facial expressions, and other visual connotations or cues that build “expectancy.” These reports and the media effects literature on health follow‐up on areas of my interest that were last influenced by Jean Kilbourne and Sut Jhally. They also provide some scholarly sources that I can add to a growing selection of literature I’ve been collecting — searching for a perspective to address “graphic design effects.”

But, back to health. Messages related to health and medicine are particularly worrisome for the fatal implications of being misinformed and worrisome for the realities of medical research: null results are not published while news reporting exaggerate and misconstrue the underlying medical literature.

The media effects perspectives on internet health resources are particularly interesting, for both their positive and negative outcomes. This makes me wonder to what extent media effects researchers can investigate historical periods. I want to know if the spread of public libraries (“Carnegie libraries”) in towns across the US had similar consequences for public health as digitally democratized sources.

Randolph and Viswanath’s treatment on public health effects (2004) was slightly bizarre to read. It is the first paper that I’ve read to directly discuss practical, goal‐directed applications of media effects research — applying the models and research toward achieving some specific outcome. Even though the discussion is directed toward theory‐based campaigns for the public good, I nevertheless found it alarming. This reaction is somewhat hypocritical, of course, because that process — create an intervention, evaluate the resulting behaviors, then revise and repeat — is a design process by the most fundamental definitions of design.

Message design is also discussed by Anket et al. (2016), though there is a misunderstanding behind their discussion of Noar (2006b) and of message design. Noar can’t be specific related to message design because that’s not how design solutions work — they are nearly always one‐offs. This is true of all design, but is especially true of communication design. You’re working with people; messy, complicated, and intensely irrational in one moment then intensely rational in the next. Worse, your only tool is language, which is both imprecise and endlessly descriptive. Even that word, language, makes my point for me because it is so ubiquitous and abstract that how I use it here may call up unintended understandings in a reader. All of this is to say that repeating campaigns and messages can ignore hidden contexts that allowed the initial ones to be successful, and it risks the message becoming stale, or worse, subverted with each use. There is nothing inherently wrong with the three message elements that they lay out (use of celebrity, community members, and audience participation), but there is nothing inherently right, either. The biggest factor ignored by their meta‐analysis is novelty, which I argue was a major contributor to the success of The Truth tobacco cessation campaign.

To the authors, or anyone hoping to evaluate such public health campaigns, I would offer this advice: Anker et al.’s three “inclusion criteria” are a good starting point for a design brief, but if you are searching for replicability between campaigns then I’m sorry, but communication design is not a social science. Design by committee, by formula, and by template will fail you, and there are so many confounding variables to deal with that you will have to rely on intuition. That’s not to say that you shouldn’t be informed, but establish your intent, research prior campaigns, research unrelated (even commercial) campaigns, and above all else work to gain an understanding of your target audience — their social, media, health, and internal contexts — and then try to do something different than what other people are targeting these people with. Your message will stand out by contrast. From this mindset, craft many, divergent versions of your message and then test and iterate on them. Helen Armstrong’s book, Participate, offers valuable insight on the practicalities of user testing. But also take inspiration from unexpected places. Paul Bennett, a partner in the design firm IDEO which has a prolific history of design within health contexts, discusses the mindsets necessary for this in his talk, “Design is in the Details.” Stanford’s Design program hosts a resource that might be helpful in creating better models for the design of public health campaigns (see “A Virtual Crash Course in Design Thinking”).

This week I watched some conveniently relevant news reports on health and advertising (perhaps this could be considered a priming effect?) while reading on health information effects. The videos, special reports put out by Vox, covered the effects of today’s advertising on public health — specifically the use of nicotine by minors and young adults, which had been nearing zero until e‐cigarettes started being marketed and framed separately from smoking cessation (Vox, 2018, “How Juul made nicotine go viral”), as well as prescription drug ads (Vox, 2016, “How Americans got stuck with endless drug ads”).

Initially, these reports interested me because they touch on what effect the interpretive aspects of an ad’s visual vernacular have on the audience — like model ages, gestures/poses, scenery, facial expressions, and other visual connotations or cues that build “expectancy.” These reports and the media effects literature on health follow‐up on areas of my interest that were last influenced by Jean Kilbourne and Sut Jhally. They also provide some scholarly sources that I can add to a growing selection of literature I’ve been collecting — searching for a perspective to address “graphic design effects.”

But, back to health. Messages related to health and medicine are particularly worrisome for the fatal implications of being misinformed and worrisome for the realities of medical research: null results are not published while news reporting exaggerate and misconstrue the underlying medical literature.

The media effects perspectives on internet health resources are particularly interesting, for both their positive and negative outcomes. This makes me wonder to what extent media effects researchers can investigate historical periods. I want to know if the spread of public libraries (“Carnegie libraries”) in towns across the US had similar consequences for public health as digitally democratized sources.

Randolph and Viswanath’s treatment on public health effects (2004) was slightly bizarre to read. It is the first paper that I’ve read to directly discuss practical, goal‐directed applications of media effects research — applying the models and research toward achieving some specific outcome. Even though the discussion is directed toward theory‐based campaigns for the public good, I nevertheless found it alarming. This reaction is somewhat hypocritical, of course, because that process — create an intervention, evaluate the resulting behaviors, then revise and repeat — is a design process by the most fundamental definitions of design.

Message design is also discussed by Anket et al. (2016), though there is a misunderstanding behind their discussion of Noar (2006b) and of message design. Noar can’t be specific related to message design because that’s not how design solutions work — they are nearly always one‐offs. This is true of all design, but is especially true of communication design. You’re working with people; messy, complicated, and intensely irrational in one moment then intensely rational in the next. Worse, your only tool is language, which is both imprecise and endlessly descriptive. Even that word, language, makes my point for me because it is so ubiquitous and abstract that how I use it here may call up unintended understandings in a reader. All of this is to say that repeating campaigns and messages can ignore hidden contexts that allowed the initial ones to be successful, and it risks the message becoming stale, or worse, subverted with each use. There is nothing inherently wrong with the three message elements that they lay out (use of celebrity, community members, and audience participation), but there is nothing inherently right, either. The biggest factor ignored by their meta‐analysis is novelty, which I argue was a major contributor to the success of The Truth tobacco cessation campaign.

To the authors, or anyone hoping to evaluate such public health campaigns, I would offer this advice: Anker et al.’s three “inclusion criteria” are a good starting point for a design brief, but if you are searching for replicability between campaigns then I’m sorry, but communication design is not a social science. Design by committee, by formula, and by template will fail you, and there are so many confounding variables to deal with that you will have to rely on intuition. That’s not to say that you shouldn’t be informed, but establish your intent, research prior campaigns, research unrelated (even commercial) campaigns, and above all else work to gain an understanding of your target audience — their social, media, health, and internal contexts — and then try to do something different than what other people are targeting these people with. Your message will stand out by contrast. From this mindset, craft many, divergent versions of your message and then test and iterate on them. Helen Armstrong’s book, Participate, offers valuable insight on the practicalities of user testing. But also take inspiration from unexpected places. Paul Bennett, a partner in the design firm IDEO which has a prolific history of design within health contexts, discusses the mindsets necessary for this in his talk, “Design is in the Details.” Stanford’s Design program hosts a resource that might be helpful in creating better models for the design of public health campaigns (see “A Virtual Crash Course in Design Thinking”).

Literature reviewed

Noise, sensory toys, and ADHD

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What is the nature of noise? Is it the murmur of twenty people talking, the roar of a hundred cars, the hum of a thousand air conditioners?

Is it an annoyance; a distraction? An unidentified squeak, an overheard phone call, a flash of movement outside the window? Noise is everywhere, and for someone with ADHD, distraction is an ever‐present obstacle.

These questions are born out of a design evaluation of headphones. Their form, their use, the experience of buying and using them, and the role they serve in my life.

I am quite attached to my headphones — and they are nearly always attached to me. But, it may be interesting to note that I rarely, if ever, listen to music. I listen to podcasts, a habit which came out of a difficult transition in my early career, when the workload of several publications was consolidated into my responsibilities. With multiple, overlapping and conflicting deadlines, I could not afford to become distracted, and in trying to navigate that problem I found that listening to podcasts allowed me to stay focused and entertained while doing tedious work.

I used to think of my headphone use as a habituated, anti‐social behavior, but in studying the function that they serve for me, I saw, as Paul Bennett puts it, “the blinding glimpse of the bleedingly obvious” that they are a productivity tool. This led me to researching attention and distraction, then ADHD coping mechanisms and cognitive behavior therapy, and finally the therapeutic function of fidgeting and sensory toys.

Current understandings of ADHD model it as a deficit in the neurotransmitter, dopamine, and an under‐stimulated brain will seek out immediate stimulation while the person’s higher‐functions are fairly helpless to intervene. Exerting will‐power to stay on task doesn’t stimulate like the squirrel outside the window, so even with the ADHDer in their own driver’s seat, they are left to drift out‐of‐fuel and dozing at the wheel.

But the squirrel isn’t the answer either. Squirrels are never the answer! (Sorry, Mr. Squirrel.) While distraction is a loud impediment to focusing attention, it is not actually noise and that is the problem.

White noise and ambient sounds are not distracting because they have no content while drowning out the signals that do. Instead of an impediment, true noise is a loud nothingness which fades into the background.

But it also occupies a sense, and this is its true value. It puts parts of the brain not needed for higher cognition to work and floods the brain with dopamine!

In 2015 a school in Pasadena, Texas was facing a test‐score crisis. Third and fourth graders at Turner Elementary were failing in huge numbers. While it concerned everyone, it surprised no one. These kids were picked out as an unusually hyperactive group every year since kindergarten. But with the start of the 2016 – 17 school year, Turner Elementary started using standing desks, balance boards, and foot pedals to engage the students with a physical activity while learning in a classroom. And the results have been tremendous. Other school districts which have used “fidget furniture” have seen higher grades and greater engagement from students. One school told the Houston Chronicle they had seen an improvement for 50 percentage points in math scores since adopting physical activity and fidgeting aids into the classroom in 2014.

Inspired by my research, “My Whole Life” is a design project telling a person’s experiences with ADHD through expressive typography and his own words.

Just Let Them Fidget” is a new idea in education, but some preliminary studies back the idea.

Fidgeting, it is thought, aids learning because stimulating the motor cortex and moving around releases epinephrin and dopamine. In fact, ADHD children are naturally fidgety. So much so that it is a diagnostic criteria of the disorder. The authors of the 2016 study suggest that fidgeting is a learned behavior for coping with the disorder’s symptoms.

And just like listening to white noise, fidgeting occupies a sense or portion of the brain with a mindless task. The extra activity in the brain allows the person to stay attentive while reducing the potential for external and internal distractions.

Because the difference between ADHD sufferers and a neuro‐typical person is the frequency and intensity of problems everyone has, I can derive broader conclusions from investigating ADHD. And as a designer, investigating the ways that people fidget, self‐soothe, or cope with sensory issues provides valuable insight into the ways senses can be engaged in other applications to a desired effect. Things like leading people through a composition or a space, attracting attention without overwhelming, and imbuing design work with elements that reinforce or make natural the desired outcomes.

In my design work, these have manifested as an interest in wayfinding and directing action, as attempts to combine type and image into succinct — not redundant — meanings, and as a profound, if also obsessive, understanding of noise and texture.