Great item on the radio news today. The British NICE (that's the National Institute for Healthcare and Clinical Excellence, which seems to have carelessly mislaid an initial H somewhere) has recommended that pregnant women who smoke should be breath tested during pregnancy. This is to test whether they're really quitting. And the people to do this should be ... midwives!
Genius!
Happily a midwife was able convincingly to squash a NICE guy, pointing out what a great message it sends when a mother-to-be announces that she's down to 5 cigarettes a day, and the midwife says "Oh really? Just blow into this tube..."
As the midwife pointed out, the people most likely to be pissed off by this sort of behaviour (and, frankly, who wouldn't be?) are the very people who need most care and support - that is the poorest, the least healthy, and the most likely to smoke.
Sure, there's evidence that breath tests are the best evidence of smoking status. And yes, midwives are the front-line professionals in pregnancy care. But did the makers of the guidance think for one minute about what really happens, to real people, when their respected guidelines are put into practice?
Well, er, apparently not. Duh!
Thursday, 24 June 2010
Thursday, 17 June 2010
What is a regulator's role?
In the UK, there is a debate about the regulator's role in the financial industry. Could they have prevented a global crash? probably not ... but if they'd kept their eyes on the big picture, says our chancellor, rather than get involved with details, they might have seen the worst coming.
I've been thinking about regulators in the industry we deal with most - medicines and healthcare. Of late, they have been intervening at an ever more detailed level in the process and craft of information design and leaflet editing. Well, that's OK in itself: it's an important part of medicines, and it's bound by law.
But too many interventions are uninformed, and go against the research evidence. One example: a friend working in mainland Europe was told that hand-made mock-ups of booklets were not acceptable - machine-finished specimens had to be used for patient testing. I am not aware of any evidence to support this insistence, which will slow user tests down by weeks, and cost much, much more, even if print factories will take it on.
I do know of evidence (and I've told the regulators about it) that the quality of the mock-up barely matters, versus the design and wording. Here, different standards seem to apply. Various European regulatory assessors are happy to change wording that has arisen from user testing, because they disagree with it – even though the law says that leaflets must reflect the results of such testing. So (arguably) they're acting outside the law – to which their reply is, effectively, "we're the regulator, so what we say goes".
Now I've come across some research (not yet published: I'll link to it when it is) analysing the content of 40-odd patient leaflets. Five altogether fail to give important warnings, and the leaflets vary wildly in their references to important side effects typical of the drugs. Patients getting different versions of the same medicine (eg generics) will get very inconsistent advice. Isn't this the sort of big picture that the regulators should be concentrating on?
I've been thinking about regulators in the industry we deal with most - medicines and healthcare. Of late, they have been intervening at an ever more detailed level in the process and craft of information design and leaflet editing. Well, that's OK in itself: it's an important part of medicines, and it's bound by law.
But too many interventions are uninformed, and go against the research evidence. One example: a friend working in mainland Europe was told that hand-made mock-ups of booklets were not acceptable - machine-finished specimens had to be used for patient testing. I am not aware of any evidence to support this insistence, which will slow user tests down by weeks, and cost much, much more, even if print factories will take it on.
I do know of evidence (and I've told the regulators about it) that the quality of the mock-up barely matters, versus the design and wording. Here, different standards seem to apply. Various European regulatory assessors are happy to change wording that has arisen from user testing, because they disagree with it – even though the law says that leaflets must reflect the results of such testing. So (arguably) they're acting outside the law – to which their reply is, effectively, "we're the regulator, so what we say goes".
Now I've come across some research (not yet published: I'll link to it when it is) analysing the content of 40-odd patient leaflets. Five altogether fail to give important warnings, and the leaflets vary wildly in their references to important side effects typical of the drugs. Patients getting different versions of the same medicine (eg generics) will get very inconsistent advice. Isn't this the sort of big picture that the regulators should be concentrating on?
Tuesday, 8 June 2010
Arts, crafts and sciences
Usability of documents is part craft. The typographic tradition, the sense of design - these have their roots in the work of stonecutters and engravers in centuries past. Sometimes, we may even think it's an art: the creation of beautiful objects should be looked at that way, even where they are strictly functional in intent (for which insight I am indebted to William Morris, Mr Arts and Crafts himself).
But the craft itself has elements of science. A lovely sense of proportion in a document is itself functional: if the headings relate to the text harmoniously and consistently, for example, the finished article will be easier to grasp, and simpler to use. These effects are real and measurable.
A recent example shows the strength of simple touches. In reproducing a second copy of a booklet with a different cover identical text, the firm that was supplying us bound the booklet slightly differently, reduced the line feed fractionally and altered the line breaks in one paragraph (to avoid a "widow" - a single word left alone on the last line). The end result was a lot less white space around the text and a denser, more fraught paragraph of text, which was trying to tell a complex story.
The changes were subtle: even our team hadn't spotted them initially. Somewhat to our surprise, the earlier tests of this complex text had led to no problems. But when we tested the new version, the results were markedly worse than before. We compared everything - time of day, profiles of test respondents - before looking again at the booklet. When I spotted these barely perceptible changes, I shook my head ruefully. How many times had I written that small changes can make a big difference? And here was the indisputable truth.
The journeyman craft element: checking the space you have, blank area, letter size - these may be the skills of the letter-cutter, but they will still fix an awful lot of your document problems!
But the craft itself has elements of science. A lovely sense of proportion in a document is itself functional: if the headings relate to the text harmoniously and consistently, for example, the finished article will be easier to grasp, and simpler to use. These effects are real and measurable.
A recent example shows the strength of simple touches. In reproducing a second copy of a booklet with a different cover identical text, the firm that was supplying us bound the booklet slightly differently, reduced the line feed fractionally and altered the line breaks in one paragraph (to avoid a "widow" - a single word left alone on the last line). The end result was a lot less white space around the text and a denser, more fraught paragraph of text, which was trying to tell a complex story.
The changes were subtle: even our team hadn't spotted them initially. Somewhat to our surprise, the earlier tests of this complex text had led to no problems. But when we tested the new version, the results were markedly worse than before. We compared everything - time of day, profiles of test respondents - before looking again at the booklet. When I spotted these barely perceptible changes, I shook my head ruefully. How many times had I written that small changes can make a big difference? And here was the indisputable truth.
The journeyman craft element: checking the space you have, blank area, letter size - these may be the skills of the letter-cutter, but they will still fix an awful lot of your document problems!
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