Cue cards for improving health communication

People with mental health issues often carry a double burden, with significant gaps in physical health outcomes between themselves and the general population.
 
‘The decrease to life expectancy is between 14–23 years less than the general population,’ Jade Ryall, a community mental health worker, told newsGP.
 
One of the major contributors to this situation is the challenges people with mental health concerns face in accessing primary healthcare, something Ms Ryall is working to address as program manager of the Back on Track Health (BOTH) program for Flourish Australia, a New South Wales mental health support service.
 
‘We really want people with mental health issues to be able to detect health risks early, and then respond to that by connecting with a GP,’ Ms Ryall explained.
 
The BOTH team consulted with people with lived experience, their families and carers, and health professionals to devise a way to help people recognise when to see a GP about health concerns. This resulted in a health-needs checklist that included reflexive questions regarding health concerns; for example, ‘Do I have difficulty sleeping? Do I often wake up? Do I find it hard to fall asleep?’
 
However, when BOTH evaluated the checklist with users, they found it required further modification.
 
‘People said it was helpful, but the length of the written text made it very difficult for them to utilise as best as they could,’ Ms Ryall said.
 
This feedback also led the BOTH team to consider other populations that could be helped by their resources.
 
‘We thought about people with literacy needs, but also people from culturally and linguistically diverse backgrounds where imagery would be a really helpful way of improving communication and identifying aspects of health,’ Ms Ryall said.
 
These considerations led to a more image-based designs, finally resulting in visual health cards.
 
‘We looked at the prompt questions people found useful, and used a visual prompt on one side of the card and then prompt questions on the reverse side,’ Ms Ryall said.
 
‘The visual image can plant the seed and get people thinking; and then the prompt questions on the reverse side helps them or family members, carers or friends supporting them at the doctor’s visit.’

Some health problems can be challenging to represent in a visual fashion, and the BOTH team had to juggle this as well as making sure pictures used on cards were strength-based and trauma-informed.
 
‘For example, we have a card around personal safety which looks at issues like violence and questions around, “Do I have respect for relationships with others?”, or “Do I feel physically safe in my relationships with others?”’ Ms Ryall said.
 
‘So we used an image of caution barriers, a scene where there could be physical safety concerns, rather than imagery of people engaged in a violent type of act.
 
‘As another example, we had an image of someone with chest pain, which was a photograph of someone who is really distressed, and that’s not trauma-informed. So instead we used things like vectors to visually show someone holding their heart and experiencing pain, but it’s not an actual photo of a person.’

The Back on Track Health team worked hard to ensure their visual resources were strengths-based and trauma-informed.
  
When using the cards, people sort through them to identify which issues they want to address, and place them in the order of importance they feel is relevant. The feedback Ms Ryall and the BOTH team received from their pilot trial proved users found this method to be a helpful and effective health communication tool.
 
‘People said they felt comfortable using the cards and really in control of what they wanted to talk about, what they wanted to say and who they wanted to speak to about it,’ she said.
 
Some users even found the cards, and their alternative to traditional ways of discussing health concerns, enjoyable.
 
‘You put them into your pile, there are images on the back; it’s quite a tactile activity,’ Ms Ryall said.
‘Young people have said they are “less boring” than the typical Q&A-type written form.’
 
But, most importantly for Ms Ryall, users also found the cards have expanded their health knowledge, a key goal for BOTH.
 
‘People have said the visual images have been very helpful to help them recognise different health topics; things they may not think about when someone asks how well they feel, physically,’ she said.
 
‘I know the SNAP risk factors [smoking, nutrition, alcohol and physical activity] are incredibly useful for GPs to have that conversation to address important aspects of preventive health. But the cards build on those, looking at things like legs and feet and weight and appetite and digestion, going to the toilet – those important sorts of questions, and it’s quite interesting watching people think about issues they’ve never really thought about before.’
 
The cards have also boosted people’s experience of seeing the GP, another outcome Ms Ryall is very happy to see.
 
‘About 80% of people said they see the GP regularly, and they reported that after using the cards, they identified a new health concern they wanted to discuss with them,’ she said.
 
‘And all those people who indicated they wanted to see the GP after using the cards, went off to do so.’
 
Ms Ryall and the BOTH team are happy with the results of the pilot, and hope the cards may prove to have a wider application in the future.
 
‘We see a lot of potential for people to sort through the cards in the waiting room before their appointment and make sure they’ve thought in detail about their health concerns,’ she said.

Flourish Australia mental health