Participatory design of mass health communication in three languages for seniors and people with disabilities on medicaid

Objectives. We used participatory design methods to develop and test guidebooks about health care choices intended for 600000 English-, Spanish-, and Chinese-speaking seniors and people with disabilities receiving Medicaid in California. Methods. Design and testing processes were conducted with consumers and professionals; they included 24 advisory group interviews, 36 usability tests, 18 focus groups (105 participants), 51 key informant interviews, guidebook read-ability and suitability testing, linguistic adaptation, and iterative revisions of 4 prototypes. Results. Participatory design processes identified preferences of intended audiences for guidebook content, linguistic adaptation, and format; guidebook readability was scored at the sixth- to eighth-grade level and suitability at 95%. These findings informed the design of a separate efficacy study that showed high guidebook usage and satisfaction, and better gains in knowledge, confidence, and intended behaviors among intervention participants than among control participants. Conclusions. Participatory design can be used effectively in mass communication to inform vulnerable audiences of health care choices. The techniques described can be adapted for a broad range of health communication interventions.