Health Communication Design for Low-income and Low-literacy People in China - Designers as a core organizer contributing the whole process

Zhang, Linli and Tsekleves, Emmanuel and Pollastri, Serena (2024) Health Communication Design for Low-income and Low-literacy People in China - Designers as a core organizer contributing the whole process. PhD thesis, Lancaster University.

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Abstract

Health communication design has attracted increasing research attention in recent years. When designed effectively, health information can be disseminated to specific groups and bring major benefits by promoting healthy behaviours. In mainland China, the maternal and child health (MCH) communications sector has thrived as a result of the steady relaxation of the country’s fertility policy (from the abolition of the one-child policy in 2015 to the implementation of the three-child policy in 2021). There is now an abundance of products related to health knowledge dissemination, as well as the emergence of internet influencers discussing health issues. In the field of academia, research in this area primarily focuses on specific health issues, such as obesity, cervical cancer, diabetes etc., and mainly adopts a medical research perspective. Design research in this field often focuses on the quality of graphic design and users’ experience of communication artefacts. However, the primary focus of such studies tends to be on middle-class, well-educated, urban users. As a result, the needs of low-literacy and low-income users tend to be largely overlooked, both in research and in communication product development. This study investigated the development of the dissemination of MCH knowledge designed for low-income and low-literacy groups within the context of mainland China. Focusing on this demographic, the study examined three main components: health behaviour, health needs, and the design and development status. The outcome of the research was the development of health communication strategies and recommendations tailored to the social and cultural circumstances of low-income and low-literacy Chinese users in non-urban communities. These strategies are informed by preliminary research on the influence of culture and social environment on the ways in which low-income, low-literacy people perceive health issues and adopt health behaviours. Methodologically, three types of qualitative methods were applied. Firstly, questionnaires were employed to understand the general health preferences of different groups (based on gender, age, marriage status, etc.). Secondly, semi-structured interviews were conducted to uncover the specific motivations behind certain health behaviours and users’ opinions on existing MCH strategies/designs. Finally, users’ preferences for MCH design products were explored in practice in three co-design workshops. The discussion starts with analysis in the context of the preferences and behaviours of low-income, low-literacy participants based on survey results. These aspects were subsequently analysed. The findings indicate a preference for social media rather than specific apps to access health information, as well as feelings of doubt and distrust regarding the health information to which users are exposed, especially when disseminated through commercial platforms. Finally, possible strategies and media design directions for MCH communication are discussed based on analysis of the outcomes of three co-design workshops conducted with the target audience. The main output of this research is the proposal of a health communication framework, which revolves around three dimensions: designer attitudes, cultural inclusion, and visual design. Keywords: health communication design; health design; low-income; low-literacy; China