Iowa State design researcher teams with Mayo Clinic to study medical decision aids

AMES, Iowa -- Debra Satterfield sat in yet another hospital room awaiting a diagnosis for the disorder that caused her eight-year-old son to suffer as many as 400 seizures a day. As she waited, Satterfield jotted down notes about her surroundings and experiences.

Three years later--her son's severe epilepsy under control--the design researcher is teaming up with the Mayo Clinic to transform those personal observations into a more satisfying health care experience for others.

Satterfield, an associate professor of art and design at Iowa State University, researches the social and emotional aspects of design. She looks at how experiences are created through the design of environments and information.

Her collaboration with Mayo Clinic's Knowledge and Encounter Unit focuses on the study of the medical decision aids used with diabetes patients. Medical decision aids are information tools, such as brochures or posters, physicians use to help patients make informed health care decisions. Satterfield's research will examine how design variables influence the decision-making process of patients using the decision aids.

"I often went into health care situations with my son with very difficult decisions to make," Satterfield said. "In those situations, there's a lot of social and emotional space that is very difficult for people. And they're asked to make decisions they aren't prepared for and don't feel empowered to make."

Satterfield works with colleagues at Iowa State's College of Design to apply new methodologies to the evaluation of design. They have received international attention for applying Kansei engineering and activity theory to design. Kansei engineering looks at people's social and emotional responses to design. Activity theory looks at the context of an activity.

The research team includes Sunghyun Kang and Fred Malven, both associate professors of art and design; Paul Bruski, assistant professor of art and design; and Nora Ladjahasan, assistant scientist, Institute for Design Research and Outreach.

"Sensory aspects of design can dramatically affect how a target audience perceives and reacts to a design," Satterfield said. "How I experience a product or poster is always contextualized within my environment and my personal, emotional response. You can't separate those."

A paper on teaching Kansei engineering, which Satterfield presented at a 2003 design research conference in Japan, caught the attention of Frito-Lay. Interested in finding a non-engineer who could apply Kansei engineering to product design, the company asked Satterfield and ISU colleagues Kang and Roger Baer, professor and chair of art and design, to research user experience of Tostitos chips.

At about the same time, she also led a study on how the physical space of Iowa State University's Thielen Student Health Center impacted student experiences. She looked at ways to improve health-related outcomes and communication by creating a patient experience that better targets the emotional, social and behavioral needs of college students.

"Even something as seemingly insignificant as not knowing where to wait can immediately set the tone for a student who already isn't feeling well, and may be managing his or her health care for the first time," Satterfield said.

When she presented that study at a design conference in Hong Kong last year, she was approached by researchers from Mayo Clinic's Knowledge and Encounter Unit. They wanted Satterfield to adapt her unique methodology to their study of medical decision aids for diabetes patients.

"Patients are often nervous and scared. They need support in their health care decisions," she said. "Decision aids put the patient back in the driver's seat. They present all the treatment options."

Satterfield said some evidence suggests that if patients help in the decision-making process, if they feel empowered to make their choices, they're more likely to follow through with the treatment.

"With my son, there were times I didn't know the options. And times I didn't want to ask because the situation was so frightening," she said. "But a decision aid gives you a comfort zone, a platform on which to build a meaningful discussion and a productive relationship with medical providers."

Although the content of decision aids is carefully developed according to international standards, the standards only address the semantic, linguistic and scientific clarity of information. That doesn't go far enough, Satterfield said.

"Our research will ask if the content breaks down because of the delivery mechanism," she said.

"Medical decisions are not made in a vacuum; there's a social context to consider," she said. "And we're learning from neurosciences that most of our decisions are actually emotional decisions first."

Satterfield's team will study how design variables of the decision aids--such as color, typography, use of icons, organization of material--affect patients' decision-making process. The researchers will look at how a patient's demographics affect his or her interpretation of visual information. For example, how does the illness influence visual perception? Are culturally based preferences, gender-based preferences and age-related preferences or limitations impacting their decisions?

They also will study the emotional and cognitive aspects of the decision aids. Do they seem honest, clear and relevant? Do the decision aids have a positive emotional association for both patients and medical providers? And they'll look at the memorability and accessibility of the information. Do patients find the information clear and easy to use? Do medical providers find them valuable, efficient and easy to use?

"No one else is looking at that. This is completely new territory for design research," Satterfield said.

The research is funded by Iowa State University through the Bailey Research Career Development Award, which fosters research that is innovative, increases knowledge and has practical applications. The funding of $50,000 a year for three years allows the faculty researcher to devote time toward high-risk, high-impact research addressing emerging scientific, technical and/or societal problems.