Appl Clin Inform 2019; 10(04): 597-609
DOI: 10.1055/s-0039-1694001
Special Topic: Visual Analytics in Healthcare
Georg Thieme Verlag KG Stuttgart · New York

Developing Infographics to Facilitate HIV-Related Patient–Provider Communication in a Limited-Resource Setting

Samantha Stonbraker
1   Columbia University School of Nursing, New York, New York, United States
2   Clínica de Familia La Romana, La Romana, Dominican Republic
Mina Halpern
2   Clínica de Familia La Romana, La Romana, Dominican Republic
Suzanne Bakken
1   Columbia University School of Nursing, New York, New York, United States
3   Department of Biomedical Informatics, Columbia University, New York, New York, United States
Rebecca Schnall
1   Columbia University School of Nursing, New York, New York, United States
› Author Affiliations
Funding The first author, S.S., was supported by the National Institute of Nursing Research of the National Institutes of Health under two awards (T32 NR007969 and K99NR017829). Expert participation in the design process was supported by the Precision in Symptom Self-Management Center at Columbia University (P30NR016587). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Further Information

Publication History

11 April 2019

20 June 2019

Publication Date:
14 August 2019 (online)


Background Productive patient–provider communication is a recognized component of high-quality health care that leads to better health outcomes. Well-designed infographics can facilitate effective communication, especially when culture, language, or literacy differences are present.

Objectives This study aimed to rigorously develop infographics to improve human immunodeficiency virus (HIV)-related patient–provider communication in a limited-resource setting. A secondary purpose was to establish through participant feedback that infographics convey intended meaning in this clinical and cultural context.

Methods We adapted a participatory design methodology, developed in a high-resource setting, for use in the Dominican Republic. Initially, content to include was established using a data-triangulation method. Then, infographics were iteratively generated and refined during five phases of design sessions with three stakeholder groups: (1) 25 persons living with HIV, (2) 8 health care providers, and (3) 5 domain experts. Suggestions for improvement were incorporated between design sessions and questions to confirm interpretability of infographics were included at the end of each session.

Results Each participant group focused on different aspects of infographic designs. Providers drew on past experiences with patients and offered clinically and contextually relevant recommendations of symbols and images to include. Domain experts focused on technical design considerations and interpretations of infographics. While it was difficult for patient participants to provide concrete suggestions, they provided feedback on the meaning of infographics and responded clearly to direct questions regarding possible changes. Fifteen final infographics were developed and all participant groups qualitatively confirmed that they displayed the intended content in a culturally appropriate and clinically meaningful way.

Conclusion Incorporating perspectives from various stakeholders led to the evolution of designs over time and generated design recommendations that will be useful to others creating infographics for use in similar populations. Next steps are to assess the feasibility of using infographics to improve clinical communication and patient outcomes.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. It was approved by the Institutional Review Board at Columbia University and by “Consejo Nacional de Bioética en Salud” (CONABIOS), the ethical review board in the Dominican Republic. Animal subjects were not included in this project.