The promise of tailored health communication

Abstract

This report describes the results of an Industrial Design (IPD) graduation project, that was carried out as part of the “Patient Centric Solutions for Participatory Health care” (PCS4PH) project, within the Human Interaction & Experience department of Philips Research. The PCS4PH project focuses on the decision-making part of the oncology care cycle (see figure), where this thesis focuses on prostate cancer patients. The user-centred design research resulted in a first framework to apply tailoring in the health care setting. To support prostate cancer patients in making their treatment decision, tailoring was identified as an interesting research focus. Tailoring means creating communications in which information about a given individual is used to alter message processing or behaviour relevant to the outcome goal. Since men respond to their diagnosis in different ways, tailoring could help men to better process information. To succesfully implement tailoring, understanding was needed on tailoring, the disease prostate cancer, prostate cancer patient behaviour and how this behaviour can be translated into design strategies for tailoring. Two types of tailoring were found in literature: content tailoring and style tailoring. A choice was made to focus on style tailoring, because creating valid content-tailored designs was not feasible within the time constraints of this thesis. Style tailoring also offered more design possibilities and has proven itself promising in current research. From user research and literature, the feeling of being in control, masculinity, coping style, information preference and opinions of others were important factors to take into account. Being widely used in social sciences, behavioural constructs were chosen as tool, since they offer the possibility to identify and assess men’s behaviour. Literature and user research at the “Prostaatcentrum Zuidwest Nederland” designated four key constructs relevant in the prostate cancer decision-making context: Health Literacy, Locus of Control, Coping Style and Need for cognition. From iterature, clear guidelines were extracted how to tailor for the chosen constructs. These guidelines were used to tailor the tool for each of the construct extremes. However, first ideation showed that these strategies did not suffice to create distinguishable tailored designs for each construct. The strategies were ambiguous and not actionable. To optimise design strategies, a quantitative study was performed among Dutch males to see which strategies could be merged or disregarded. Seventy seven males between the age of 45 and 85 participated in the quantitative study. Statiscial analyses were used to analyse the outcome. Since no illiterate participants were found in the sample, Health Literacy was dropped for further analysis. Two new behavioural components were found from the remaining constructs: “Trusting and accepting’ behaviour and “Autonomous and information seeking” behaviour. New strategies were created for these components and tested in a qualitative study. Strategies and tailored designs were created to test this first tailoring attempt. The evaluation interviews pointed out that the assessment of behaviour was accurate and that most of the design strategies matched the preference of the targeted group. Sometimes simplicity of the information or understanding what the information is about, was more important than the tailored aspects. Long-term goals like better perceived decision outcome are yet to be investigated. Although this thesis focused on prostate cancer decision-making, the principle of assessing someone’s behaviour and creating tailoring strategies accordingly, can also be applied to the general field of health care. This thesis can be seen as a first step towards the successful implementation of tailoring in health care.