Research Top 6 Discoveries

Breast cancer is associated with some pretty strong taboos that can make a public campaign difficult. First, “breast” is often associated with sex, and displaying images of breasts can be a problem. Second, “cancer” is often associated with death, making it a topic that for many is difficult to talk about, leaving many people avoiding it altogether. These materials remove the “sex” and “death” from the message of breast cancer through using a visual metaphor of a lemon to represent the breast. Because it is similar in appearance but separate from the body, it can be a powerful tool for illustrating signs of breast cancer in a very specific way, while avoiding censorship. This is a completely new way of educating the public about breast cancer, that makes it possible to reach more people than ever before. It also reaches those who may have difficulties with reading or are embarrassed about the topic.

So how does one show something that can’t be displayed in public? Simple! Find a friendly, familiar substitute—the lemon.

More than just a friendly looking fruit, lemons resemble the shape of a breast on the outside and resemble the anatomy of a breast on the inside. And amazingly, a cancerous lump often feels hard and immovable—just like a lemon seed. Have a look at just how similar it is in the image below:

Words are usually the way that the public is educated about health messages. However, this is a problem for a few reasons:

• It’s estimated that 1 in 5 patients have literacy issues (1), making reading difficult.
• Most wordy educational materials are never read (Beaumont PhD, p. 249).
• The information is in one language which is a problem for educating multicultural audiences.

Images can communicate to people of any language, are more engaging and can communicate information in a specific way that words cannot (imagine navigating a new town without a map, or building a house without blueprints). However, getting the right image can be difficult. And when most health materials are developed without designers, with limited budgets and lack of time, words are the easier way of communicating. In fact, in a review of over 100 breast cancer detection materials and websites, less than 10% of them used educational images at all. Despite this, 89% of patients prefer visual materials to non-graphic material.

In a comprehensive review of breast cancer detection materials in print and online, no single resource provided all of the key information necessary for a patient to be fully aware of the detection process. Information like, “What does a lump feel like?” “What does breast cancer look like?” “What steps do I take to detect breast cancer?” were often not answered. By testing the message and materials with patients, it was possible to create a simple two-page leaflet that delivered these key messages in a single resource in a powerful and memorable way. The only one of its kind.

Over 4,000 people have downloaded and shared this leaflet.

Most health materials are rarely tested with their audiences to determine if they work before the money is spent on printing. To make sure that the these Worldwide Breast Cancer materials were done right, several studies were done to get the visuals and the messages just right. Here are some results from those studies.

Designing began by doing a general survey of the public, to find where the gaps in education were and what the materials needed to inform the public about. Over 200 people took part in this survey.

It was found that half of patients didn’t know what a cancerous lump felt like. So a poster illustrating what the anatomy of a breast felt like was designed. This poster was tested alongside a traditional line drawing of anatomy which was common in education materials. The results were dramatic:

Interestingly, most people didn’t read the text in the second poster. Their knowledge was based mostly on looking at the images.

“Does seeing breast anatomy in this visual way improve your understanding 
of what to feel for when you are doing a breast self-exam?”

97% said yes.
65% said it also made them feel more confident in their ability to recognize breast cancer.

It was also discovered that many people didn’t know that breast cancer could be presented in other ways besides a lump. A poster was designed to illustrate these signs. One study with 67 people looked at how accurately they could interpret the symptoms without any text. This would determine if this poster could communicate to more people across the world despite language differences.

 

Testing revealed that people could identify most of the signs by appearance alone. This led to improvements in the appearance of the images to increase their ability to communicate accurately. It also identified which symptoms needed a simple text label to help them interpret what they saw more accurately.

After improvements to the image were made, another patient group was used to test the text labels with the image, bringing the interpretation of the signs of breast cancer to near perfect levels, resulting in the finished poster:

“Would you be able to recognize these signs on yourself better now that you’ve seen this image?” 
89% said yes.

To understand the process of detection, the designer went through the full detection process herself. She acted as a patient in several clinics, got a mammogram, and interviewed several healthcare professionals in the US and UK in their environments to compare different systems. This was done to understand how to communicate the process to patients in a way that was simple yet specific enough to help patients participate in the process and catch errors when certain steps or options weren’t offered.

An example of this is demonstrated in the design of a patient pathway chart below, with the top one using text and lines, and the bottom one using images of people in a simple step-by-step view:

By illustrating the steps of breast cancer detection as a series of interactions with people and results, it provides the patient with a “big picture” view of the whole process. This helps them understand where they currently are in the process and the options that are available to them. When patients clearly understand the detection journey, they are more likely to participate in it and anxiety over the unknown in reduced—all through the help of good design!

The woman figure, known as “The Mayor”, used to illustrate breast cancer events and act as a source of the friendly, approachable voice in the materials, is a unique concept and contribution in breast cancer detection materials to date. The Mayor has been found to be a relatable female image for most patients spanning across a range of nationalities. When people were asked, “Could this woman be seen as someone from you country?” 98% of respondents, representing countries such as Columbia, USA, Britain, South Africa and the Middle East, said yes.

When tested with women in Qatar, one participate wrote: “I love the idea that the woman has no features and black hair, which could make her Indian, Pakistani, Asian or Arab.”

So why is this important? Often in materials, a woman is needed to illustrate a breast cancer event, such as getting a mammogram. If the materials are to be used in a variety of countries, it’s important for the reader to feel that the woman standing at the mammography machine is representing her, instead of representing a foreigner. If a patient makes a connection with the woman in the materials, they are more likely to visualize themselves participating in screening and seeing the information as being relevant to them, in their time. Here is an example of why using an illustrated figure is a benefit over using photographs:

You can also find The Mayor on Facebook. Add her as a friend!

These materials are designed to promote collaboration between patient and physician. Through using these materials developed by Worldwide Breast Cancer in the health environment, patient–physician encounters can become teaching moments as well as diagnostic events. In particular, the risk assessment form allows a physician and patient to understand their risk while at the same time developing a screening plan. A copy can then be made for the patient chart that records the patient’s risk level and screening plan. The other copy is for the patient to take home as a reminder of that conversation.