Evaluating and refining a pain quality information visualization tool with patients and interpreters to facilitate pain assessment in primary care settings

ABSTRACT

Information visualization (InfoViz) tools offer a potential solution to pain communication challenges. Incongruencies in communication styles between patients with limited English proficiency (LEP), interpreters, and providers contribute to significant disparities in pain care and outcomes. This study’s purpose is to evaluate and refine a culturally appropriate InfoViz pain quality assessment tool for LEP Hmong patients. We conducted a three-part iterative user-centered study with LEP Hmong, bilingual Hmong, and Hmong interpreters with (1) participatory design sessions to evaluate and refine pain infographics for inclusion on the tool, (2) card-sorting to organize the infographics to match the mental models of LEP patients, and (3) a tool assessment to identify which tool accurately represented LEP patients’ mental models and was preferred in clinical settings. Fifty-five participants provided three common themes for pain infographics refinement: culturally-relevant colors, infographics resembling human anatomy, and action-specific squiggle lines. The card-sorting sessions revealed three organizational themes: sensation (n = 15; 71.4%), localization (n = 6; 28.6%), and severity of pain quality (n = 5; 24.3%). Most participants selected the localization as the most accurate tool and preferred it in clinical settings. Using a multi-step, user-centered approach resulted in a culturally appropriate pain InfoViz tool for LEP Hmong patients.

KEYWORDS:

• Information visualization
• pain
• communication
• user-centered design
• participatory design
• card-sorting

Acknowledgments

We want to thank the Hmong organization Milwaukee Consortium for Hmong Health, Inc. for their assistance in recruiting participants and using their space. We also want to thank Bao Xiong for assisting with data collection, Mai Joua Yang for creating the infographics, and Dr. Nora Cate Schaeffer for providing feedback on the card sorting and the tool development and evaluation data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ These numbers add up to be more than 21 LEP and bilingual adults because some adults created more than one category.

² Note: Two interpreters did not participate in the tool and text preference due to poor internet connection during the WebEx virtual meeting.

Additional information

Funding

The research reported in this publication was supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number K23NR019289. The content is solely the authors’ responsibility and does not necessarily represent the official views of the National Institutes of Health.