title: Sometimes more is more: iterative participatory design of infographics for engagement of community members with varying levels of health literacy.
abstract: OBJECTIVE
  To collaborate with community members to develop tailored infographics that support comprehension of health information, engage the viewer, and may have the potential to motivate health-promoting behaviors.
  
  
  METHODS
  The authors conducted participatory design sessions with community members, who were purposively sampled and grouped by preferred language (English, Spanish), age group (18-30, 31-60, >60 years), and level of health literacy (adequate, marginal, inadequate). Research staff elicited perceived meaning of each infographic, preferences between infographics, suggestions for improvement, and whether or not the infographics would motivate health-promoting behavior. Analysis and infographic refinement were iterative and concurrent with data collection.
  
  
  RESULTS
  Successful designs were information-rich, supported comparison, provided context, and/or employed familiar color and symbolic analogies. Infographics that employed repeated icons to represent multiple instances of a more general class of things (e.g., apple icons to represent fruit servings) were interpreted in a rigidly literal fashion and thus were unsuitable for this community. Preliminary findings suggest that infographics may motivate health-promoting behaviors.
  
  
  CONCLUSIONS
  Infographics should be information-rich, contextualize the information for the viewer, and yield an accurate meaning even if interpreted literally.
  
  
  CONCLUSIONS
  Carefully designed infographics can be useful tools to support comprehension and thus help patients engage with their own health data. Infographics may contribute to patients' ability to participate in the Learning Health System through participation in the development of a robust data utility, use of clinical communication tools for health self-management, and involvement in building knowledge through patient-reported outcomes.
authors.affiliation: School of Nursing, Columbia University, New York, USA adrianaxarcia@gmail.com.
authors.forename: Adriana
authors.initials: A
authors.lastname: Arcia
authors.affiliation: School of Nursing, Columbia University, New York, USA.
authors.forename: Niurka
authors.initials: N
authors.lastname: Suero-Tejeda
authors.affiliation: Department of Biomedical Informatics, Columbia University, New York, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Bales
authors.affiliation: School of Nursing & Department of Biomedical Informatics, Columbia University, New York, USA.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Merrill
authors.affiliation: School of Nursing & Department of Biomedical Informatics, Columbia University, New York, USA.
authors.forename: Sunmoo
authors.initials: S
authors.lastname: Yoon
authors.affiliation: Department of Biomedical Informatics, Columbia University, New York, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Woollen
authors.affiliation: School of Nursing & Department of Biomedical Informatics, Columbia University, New York, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bakken
mesh_terms: D000328:Adult; D000368:Aged; D001296:Audiovisual Aids; D005260:Female; D006266:Health Education / Q000379:methods*; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: audiovisual aids; comprehension; health communication; health literacy; patient participation