Designing for Language Barriers in Indian Healthcare
This project aimed to understand the existing scenarios of healthcare communication with an intention of designing technology artifacts that could elevate the healthcare experience and strengthen the social threads.
This project was done as part of my Pre-Thesis project at college. To know more about the detailed thought process within every step of the process, please read my Medium articles about it here.
PHASE 1: Research
The primary research study was done through Contextual Enquiry and Telephonic Interviews. You can find the questions planned for the interviews here.
Consolidation and Analysis of Data
Research Findings:
1) Situations where the problem of a language barrier exists
2) The implications of the language barrier
3) The ways in which this problem is being handled at the moment
Screenshots from the research report
PHASE 2: Ideation
Idea 1: Technology for access to interpreters & terms
- Technology as a tool to connect humans and create collaboration
- Access to interpretation services on demand and based on severity of need
- Building upon existing knowledge base of professionals
Idea 2: AR in community health programs
- Using existing posters to create more interactive communication
- Dynamic visual & multi-lingual content act as aid to the conversations
- Common representations for both actors (community health personnel and villager) thus improving knowledge transfer
Idea 3: Communicative Prescription Making Process
- Providing resources to make this a more interactive process that would help enhance this conversation of explanation of diagnosis and treatment.
- Prescription as an artifact that helps the communication inside and outside the clinic
- Mix of visual and written content that also facilitates better verbal communication between actors
- Standardised record, more transparency and easier for patient to understand
Storyboarding the ideas for concept evaluation
Concept Evaluation:
As a means of gaining early stage feedback on the ideas being explored, the storyboards were taken to doctors and patients and a means to have further conversations about the existing situation and such possibilities. The concept evaluation sessions were carried out with 6 doctors and 2 patients.
*Unfortunately due to logistical difficulties, I was not able to do a session with the community health personnel to gain feedback on the idea for that space. (Idea 2)
These interactions included:
- Explaining the storyboard
- What could work and what won’t?
- What other factors should be considered?
- Conversations about the problem space that arise out of engaging with the concepts
- Interacting with artifact and talking about it
Drawing and Explaining:
A major part of the communicative prescription making process was to build upon the activity of the doctor sketching and explaining while trying to communicate about the diagnosis and treatment to the patient. Using Google Keep as a tool while carrying out this exploration, the doctor was provided the doctor with stylus and the Google keep app on my phone. The doctor was asked to explain to me as a patient ‘What is the most common illness you come across?’ Assume I have this illness and you have just diagnosed it. You can use this medium to sketch and explain to me the problem and treatment.
Role Play Experiments:
At the end of this phase, for each of the ideas I had some feedback which helped me decide what idea or parts of an idea I can take forward. I wanted to explore the idea of visual aids as a means of communication a little more in detail before I could go ahead with the concept. For me to evaluate the actual usage I decided to conduct some role play experiments.
Pilot session:
To evaluate how effective visual means of communication is to explain diagnosis and treatment,
(1) when there is a complete language barrier between doctor and patient
(2) language is common but some communication barriers exist due to patient background
(1) when there is a complete language barrier between doctor and patient
(2) language is common but some communication barriers exist due to patient background
INSIGHT:
"People create their version of understanding by stitching together the few terms they understand in an otherwise alien conversation"
Modification to experiment: Visual + Verbal Aids?
Since visual aid did not seem to work independently, the possibility of the doctor having access to a specific list of terms relevant to the diagnosis along with the visual aids was explored.
Experiment Session: Visual + Verbal Aids
These experiments were aimed to evaluate 2 main factors:
(1) Impact of availability of terms in patients language along side sketching tools while talking to the patient
(2) Influence of sketching from scratch vs sketching using base images on the communication process
(1) Impact of availability of terms in patients language along side sketching tools while talking to the patient
(2) Influence of sketching from scratch vs sketching using base images on the communication process
Details of actors:
- Dr Manjari is trying to understand symptoms, explain diagnosis and treatment to a patient who doesn’t share a common language with her
- 4 patients who were all part of the housekeeping staff at Srishti Institute were recruited for these sessions.
- Sujatha, the nurse, helped act as the interpreter to recruit and communicate to me how much the patient actually understood
Main Learnings:
These experiments showed that the access to visual and verbal resources did help the doctor and patient understanding was increased. However, there were some more nuanced observations that led to insights for the concept to be developed further.
1) There are 3 main types of terms that are useful:
a) General terms common to all diagnosis — left, right, pain, how many
a) General terms common to all diagnosis — left, right, pain, how many
b) Organ and system names — kidney, urethral tube, etc
c) Terms specific to that diagnosis- Stone, water, flushing out, etc
c) Terms specific to that diagnosis- Stone, water, flushing out, etc
2) Gestures, sketching and verbal communication work together to form any kind of conversation and cannot be looked at independently
3) Relevance to ongoing conversation is important for the resources to be totally useful
4) Explaining pronunciation is an integral factors that needs to be considered
PHASE 3- Conceptualisation and Prototyping
Final Concept- Subhasha
Subhasha aims to provide local colloquial language and image based intelligent assistance for doctors and patients. It hopes to enhance verbal communication despite the language barrier between a doctor and patient during the diagnosis and treatment phase for diseases of moderate severity.
Desired characteristics of the application:
Main Features:
- Locally crowd sourced terms to make sure they are colloquial and chances of patients understanding them is higher
- Background algorithms with reinforced learning for continuous improvements with prolonged us
- Visual resources and terms relevant to the stage of conversation i.e. pre diagnosis questions and post diagnosis explanation of the problem and treatment
- Glanceable interface with limited interactions unless the user wants to, so that the conversation is not disturbed
- Dynamism created by various factors including on going conversation (voice input), interactions with the screen (taps and sketching) and previous records of that patient
- Share with the patient to improve patient understanding outside the clinic as well.
Actor Algorithm Interaction Architecture
The actor algorithm interaction architecture was made to clearly define the interactions between the actors using the system and the system back-end via the medium of the application interface. This has been presented in the form of the four main layers:
- Interaction and conversation between the actors (Doctor and patient)
- User facing interface
- Immediate backend system
- Constant learning core
Task Flow of the application
UI Design - Iterations
Prototype version 1
In order to be able to simulate the flow and interactions of the user with the interface in the context, an interactive prototype was made using Adobe XD. Most of the interactions were simulated within the prototype. For live data based dynamism, representative animations were made based on dummy content.
The prototype was made on the assumption that the doctor is a gynaecologist who speaks Hindi and English and the patient speaks only Kannada. The diagnosis worked on was PCOS (Poly Cystic Ovarian Syndrome).
User Testing - Cognitive Evaluation (Adapted)
Tasks were given to users and they interacted with the prototype to try and complete those tasks. They were imagining the scenario because it wasn’t an actual working prototype to test with patients but since it was a usability testing of the interface I could still gather insights for improvements in the UI. The misunderstandings and gaps between their conceptual model and the proposed conceptual model match were evaluated.
Prototype 2- Changed Screens
I hope to use this prototype to carry out more longitudinal studies to evaluate its usage within the context. At the same time I have also looked at the technology development bits to look at understanding the working of the back end system.
