Researching how a reader expects a health task to go

Mapping a reader’s context of care identifies expectations about when and where a health task happens, who participates and what is used, then uses those expectations to develop and test usable instructions.

Mental models and usability

Usability is the ability to use items easily and effectively. ¹ By 2021, wearable devices and telehealth were placing more healthcare activities in patients’ hands and involving a wider range of nonmedical professionals; failure to use content effectively could cause complications, injury or death. ¹

A writer explaining how to use a blood-pressure cuff draws on a mental picture of the process and describes its activities so that readers can recreate that picture and perform the task. ² Such cognitive or mental models are learned through experience rather than innate. ² Repeatedly seeing blood pressure checked in a kitchen, for example, associates that setting, its people and its objects with when, where and how the task is performed. ² Different experiences can give writers and readers different models of the same process, affecting how they create and use content. ²

A context of care is the location where someone expects to perform a healthcare process and what that process involves in that setting. ² Understanding readers’ models, or their absence, requires collecting information about where a process happens, what it involves and who participates. ³

Misalignment and comprehension

Two major usability problems can arise when writers’ and readers’ models diverge. ⁴ Misalignment means that the writer and reader have different models of the same situation. ⁵ Readers may perceive the content as:

• Explaining a process differently from what they expect.
• Conflicting with their expectations and therefore seeming incorrect.
• Missing essential elements of their own model.

⁵

They may doubt the content’s credibility or fill apparent gaps with information from their own experience, affecting whether and how they use it. ⁵

Comprehension problems can arise when readers have no prior model and the writer’s account does not give them enough information to recreate the process. ³ They may:

• Avoid content they cannot understand, or guess its meaning and act on inaccurate assumptions.
• Misinterpret information and perform the activity incorrectly.

³

Consequences can range from worsening a condition to permanent injury. ³

Mapping the context of care

Mapping contexts of care is a five-step method for researching, designing and testing materials against an audience’s expectations. ⁶

1. Audience identification

The first step gathers information about who audience members are and what they know. ⁷ Two location-related factors are also considered:

• Healthcare options, such as clinics, hospitals and pharmacies, available where people live and reachable with their transport options.
• Insurance affecting which treatments people can afford and where they can obtain care, such as a physician’s office or a free clinic.

⁷

These factors shape location-based experiences and mental models of healthcare activities. ⁷

2. Data-collection method

Data on expectations, assumptions and associations can be collected through:

• Individual interviews about where and how care is provided.
• Focus groups of 5–10 audience members answering together, which may help them remember or clarify details.
• Mixed methods combining interviews and focus groups and comparing individual with group responses.

⁸

All three approaches use the same questions, and the number of interviews and groups depends on the time and funding available. ⁸

3. Questions in sequence

Questions should establish time before place because the people, objects and activities in a location change with the time; asking only where a task happens may prompt a model of that place at the wrong time. ^{9, 10} The questions follow this order:

1. When is the task performed, such as checking blood pressure?
2. Where is it performed, and what is that location like? The participant can sketch and label the space, or the writer can sketch from the description and invite corrections and additions.
3. Who helps with the task? Identify what patients do themselves and what they expect family members or carers to do, such as using a sphygmomanometer to take blood pressure.
4. What happens step by step, who performs each task and what does each person use?
5. What items are used, and what do they look like? Identify the characteristics the audience needs to recognise and use them.

^{10, 11, 12, 13, 14}

4. Initial materials

Once data collection is complete, responses are compared to identify common expectations. ¹⁵ These can be represented as:

• A depiction, such as an image, of where the process happens, what is used, who uses it and how.
• A checklist of location-related factors, people, items and tasks that the content should address.

¹⁵

Both are draft representations of the audience’s models that can guide content creation. ¹⁵

5. Testing, revision and finalisation

The depictions or checklists should guide draft text, visuals or online material that new audience members use to perform the task in its context of care. ¹⁶ Participants should not have taken part in earlier interviews or groups, to avoid bias from familiarity with the project. ¹⁶ Two testing approaches are available:

• Talk-aloud protocols: observe participants using the draft while they explain what they are doing, why and their impressions. After the task, ask what needs revision, how it should change and what should be added or removed.
• Follow-up interviews or focus groups: participants first use the draft to perform the task, then suggest revisions, additions or removals that would improve usability.

¹⁶

Findings guide revisions to both the content and the materials used to create it. ¹⁶ Revised content is tested with further new audience members, repeating the cycle until a final version is confirmed or time and funding run out. ¹⁶

Recruitment, change and additional audiences

Recruiting enough participants depends on their availability and willingness, and recruitment channels can affect group size and representativeness. ¹⁷

Contexts change, so materials guiding content creation should be reassessed and tested regularly against the audience’s experiences and expectations. ¹⁷ A mismatch may require reviewing or redefining the audience and collecting new data before drafting and testing again. ¹⁷ Researching expectations and testing materials can also help address social, economic and other changes affecting healthcare practices. ¹⁸

Answers about helpers, tasks and equipment may reveal that carers, friends or relatives perform essential activities and need their own content. ¹⁷ Their models should then be mapped through the same research, drafting, testing and revision process. ¹⁷