Designing for Language Barriers in Indian Healthcare — Part 2: Ideation

7 min readJan 9, 2019

In case you haven’t had a chance to check part 1 of this article.. just a quick background. I recently completed my Pre-thesis project at college under the guidance of my project guide riyaz sheikh. It has been quite an insightful journey through these last 3 months. I have learnt things not only about healthcare as a domain but about my design process as well. So I thought this would be a good time to start writing about my work.

Part 1 of this article spoke about my entire research phase including my learnings at the end of the research study. In this part, I will be taking you through my ideation phase where I was iterating on ideas and their usage in context.

Ideation:

From my findings from the research phase, I had 3 main ideas that looked at different scenarios and problems. In order to depict each one of them, I made storyboards so that I could take this back to the users and gain concept level feedback at the initial stage itself. By communicating my ideas through these artifacts (storyboards) it was easier to have a more engaging conversation and these sessions served as further research on the context as well.

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

Learnings from this phase:

In most of my previous projects, I has gone through an iterative ideation process but due to time constraints the choice of one idea over the other was usually driven by my own evaluation or maximum by peers and faculty. However, this time it was a great learning to see true perspectives of the users themselves on my idea. It also was a great means of carrying out further conversations about the context in general making this a sort of extended research study as well.

I also realised the importance of tools to communicate your ideas to others and how representation of your thoughts is sometimes as important as the thought itself.

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)

Notes from the sessions and finding affinities

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

“ 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

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.

There are 3 main types of terms that are useful:
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
Gestures, sketching and verbal communication work together to form any kind of conversation and cannot be looked at independently
Relevance to ongoing conversation is important for the resources to be totally useful
Explaining pronunciation is an integral factors that needs to be considered

Learnings from this process:

The experiments were quite an eye opener for me because it gave me such interesting insights. It made me realise that being an observer to the actual interactions you were talking about gives you so many things to see that would not have been told to you in any interview.

The knowledge to be found in the contextual role-play activity was another level richer than what I could have possibly read, asked or heard about.

To know how I took all of these learning and built my final product- Subhasha, read the third and final part of this article here.

What do you think of this project ? Please, share your feedback in the comment section below. I would love to discuss your ideas and thoughts on my project!