Bf TRITACE@ Prevent 10.
Ramipril

Bf TRITACE' 25.5
Ramipril

¢Aventis

Questa é una bozza di testi. Le figure sono puramente indicative del fatto che, nelle 4
| facciate, qualcosa -in i di pazienti e medici)

Ci sara uno slogan

GLI ANTIBIOTICI SONO UNA RISORSA
PREZIOSA PER TUTTI

NON USIAMOLI A SPROPOSITO

Perché? ...

* | potrebbero non funzionare pitt
quando serviranno davvero
€ possono dare effetti indesiderati

Figure 3 Package insert for a pharmaceutical product:
6 pt type set solid, printed in blue ink, challenges the
best sighted people. Two sides of a 16 x 30 cm paper.

involves an improvement of something tangible

or intangible for the interested parties, a change

that centers on people. This often involves

changes in objects, habits and behaviours, and

represents the most difficult challenge design-
ers confront. The only way to face this chal-
lenge is by involving representation of all people

involved in different aspects of a project, so as to

capitalize their collective intelligence, because

as designers we do not work for clients and users;

we work with them. [24]

To do this, we apply a wide variety of design
and research methods that support the work at
four stages: 1) generation of ideas through an
understanding of the problem, the objective, the
users and the situation of use; 2) development
of prototypes; 3) Implementation; and 4)
Evaluation. [25] [26] [27] [28] [29] [30].

AN INFORMATION DESIGN EXAMPLE

Working in Italy with Guillermina Noél for a
campaign to reduce antibiotic abuse, the client
gave us a model to use as a basis for our design.
The key message of this model was: “Let's leave
the physician decide when (the antibiotics) are
necessary.” (Figure 5) This type of message
positions the doctor as an authority, turning the
patient into a passive receiver of an order.

Our cover’s text (Figure 6) was simplified,
to explain clearly which was the problem to
contend with, as opposed to the mixed messages
of the proposed cover. Our type of solution keeps
present the limitations of people's cognitive
capacity. However, making things easily
understandable is not only a cognitive choice:

Figure 4 Railway timetable from the UK. Easy to read
and understand printed on good paper, it folds down
to 7.5 x 10.5 cm and shows all the fast trains from
London Paddington to Oxford and back. (Red bits in the

original facilitated navigation)

it is also an ethical choice, because it allows the
user to feel competent and comfortable, and
therefore respected and confident, in front of
the information. This is emotionally important
for the reader, because, deep inside, not
understanding a text is like not understanding
one’s environment, an indispensable condition
for survival.

Unfortunately, we were not able to convince
the client to use just one message, not two: “The
antibiotics can be good, but they can also be bad.”
Defenders of antibiotics in the client's group did
not allow that. At least we managed to simplify
the cover's message.

With regards to the inside, the proposed
solution was as figure 7.

We changed the brochure into a shared
decision-making tool, something that supports
a conversation between patient and physician,
helping patients see that there were three possi-
ble scenarios: 1, when the antibiotics are useless;
2, when it is better to wait two or three days to
assess whether the infection is viral or bacterial;
and 3, when antibiotics are required. Explana-
tions follow each heading.

The patient, in conversation with the physi-
cian, is to understand under which conditions
the antibiotic should or should not be used. Our
final design (Figure 8) showed these three sce-
narios clearly, as opposed to the sketch that was
proposed to us, which had 14 paragraphs. This
change brings to mind the concept of the design-
er as “transformer,” coined by Michael Macdon-
ald Ross and Robert Waller when working at the
Open University in England in the late 1960s [31].

QUANDO SERVONO

Figure 5 "There will be a slogan’

"Antibiotics are a precious resource for everybody’

"LET'S NOT USE THEM WRONGLY '

“Why? 2.2"

"Because they might no longer work when they would
really be necessary, and could produce undesirable
side effects’

"LET'S LEAVE THE PHYSICIAN DECIDE WHEN SHOULD THEY
BE USED'

Our solution was designed in the context of
seeing the relation of the physician-patient
as a social exchange, instead of a top-down
authoritarian situation that requires obedience
instead of v. This alternative mode of
communication based on mutual understanding
is ethical, has deep implications for human
relations, personal responsibilities and social life,
with all the sharing that it implies. In addition,
research shows that when patients understand
the reasons for their therapy, adherence to
treatment and health outcomes improve.

This design process can be summarized as
follows:
1. Define with clarity and precision the main
objective of the project (in this case, reduction
of antibiotic abuse aimed at reducing the
development of resistant bacteria).
2. Understand why the problem comes to
exist (in this case why physicians prescribe
an antibiotic even in cases where they know
that it is not necessary or useful. This requires
understanding social and other factors that
affect their decision).
3. Understand the needs, perceptions and
expectations of the full spectrum of users (in this
case healthcare providers, patients and families).
4. Plana set of tools (Figure 10) that make use
of the different opportunities that exist to make
an impact on the current situation and achieve
the stated objective (in this case: a) a brochure/
prescription fold-out to help the dialogue
between physicians and patients, b) a pocket
size brochure to leave in waiting rooms and

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