Trauma-informed content design #522

MiriamVaswani · 2024-05-29T16:32:59Z

What

Guidance for trauma-informed content design, potentially added to the ‘clear’ section of ‘How we write’.

This is the proposed guidance.

Direct, action-oriented language

Stress and trauma change the way people understand words and sentences. Directive, unambiguous content is easier for people experiencing trauma or high stress to understand. We use a clear action word at the beginning of the sentence.

We would say:

Arrive 15 minutes before your appointment starts
Tell the doctor or nurse if you have an allergy

We would not say:

Plan to arrive 15 minutes before your appointment starts
Let the doctor or nurse know if you have an allergy

Leave no room for misunderstanding. If your users may be experiencing trauma or high stress and there is a correct or best course of action, do not ask them to decide. Tell them what to do and use clear key words.

We would say:

Describe your breathing on an average day
Get help with this task

We would not say:

Describe your breathing
Get help

Why

Me and my team have been applying trauma-informed design principles to our work on Wayfinder for 2 years.

We first noticed a pattern of misunderstanding in our usability testing for phase 1 (cancelling and rescheduling secondary care appointments).

Usability testing participants:

cancelled appointments they wanted to reschedule
believed that pending appointments were confirmed
mistook requests to cancel appointments for real-time cancellations

It happened when they were trying to achieve a goal while using our prototype and scenario.

For example, cancelling a diabetes clinic appointment.

Normally, we would iterate our design to make it more understandable. But patients weren’t getting stuck in the same places. It seemed more arbitrary. And, when we showed the same usability testing participants the same design without a scenario, they understood it easily. Some expressed surprise that they had struggled with it a few minutes earlier.

For example, after the task was complete and they looked again at the cancellation screen, most people easily understood the difference between real-time cancellations and requests to cancel.

In the same usability testing, we saw a pattern of stress linked to past healthcare experiences. People:

prioritised “getting through” the journey with as little damage as possible
were focused on not getting “trapped” or “stuck” in the journey
shared extremely difficult experiences of healthcare access and treatment

Patients shared experiences including:

not being believed about symptoms such as pain
being ignored or treated disrespectfully
discrimination and stereotyping
lack of informed consent
unnavigable processes
overwhelming processes

We saw a difference when we iterated the design to be more directive - telling people what to do rather than giving options or information that they had to interpret. We also removed ambiguity.

For example, we changed the instruction of a free text questionnaire for an asthma appointment from ‘describe your breathing’ to ‘describe your breathing on an average day’. In usability testing, 2 patients got stuck at ‘describe your breathing’ because of its ambiguity. As well as struggling with the meaning, they struggled with the fear of what would happen if they answered incorrectly.

We know Wayfinder users need it because we’ve collected evidence in usability testing that the specific process of accessing healthcare is, for many patients, a highly stressful experience. And, that past experiences add to patients’ cognitive load when they manage appointments in the present.

We believe that a trauma-informed approach would meet NHS patients’ needs across services because illness, injury, and healthcare often involve factors that contribute to trauma - pain, fear, vulnerability and loss of control.