Health literacy can be described as: “the degree to which individuals have the ability to find, understand and use information and services to inform health-related decisions and actions for themselves and others”.[1] Understanding the diagnosis of urodynamic studies (UDS) and the underlying (patho)physiology that explain lower urinary tract symptoms (LUTS) is an import aspect of urological health literacy. However, explaining this message to patients in an understandable way remains a difficult task for clinicians. Illustrations improve knowledge, understanding and recall of health information.[2] We aimed to develop patient-specific visualisations that support clinicians in explaining urodynamic findings and diagnosis, with the goal of improving patient understanding of their symptoms, diagnosis and treatment.

This study used a qualitative needs assessment approach based on semi-structured interviews with six patients, four urologists and one urodynamicist as a basis for the design requirements. Patients were interviewed after UDS on the understanding of LUT function and their own LUT dysfunction, information needs after UDS and perceived added value of visualisations. The clinicians were asked about their current explanation content, which dysfunctions should be visualised, difficult concepts to explain and what the important characteristics of a visualisation tool are. Analysis was done using the Framework Method that funnels and condenses interviews.[3] Interview transcripts were structured into a matrix-based framework that charted questions and summarised answers. Answers were given codes such as barrier, risk, preference, scope, constraints, value, etc. Themes were derived from recurrent codes by multiple individuals. Design requirements resulted from translating the themes into statements specifying what the visualisation should do, show or avoid.
Based on these requirements an in-house designer created a concept tool capable of showing visualisations of specific urodynamic diagnoses that will be accessible through a web application. Visualisations were drawn using Adobe Illustrator.

Must-have requirements were mentioned by both patients and clinicians and are listed in figure 1, with the level of evidence based on how many people said this. Nice-to-have requirements were omitted from this abstract. Figure 2 is a snapshot of the visualisation tool in storage mode, where a menu allows the user to select features specific to their patient. Patient-specific (dys)function and normal function are shown side-by-side. Storage and voiding have a separate menu and layout, and you can toggle gender and textual information.

The proposed tool meets almost all requirements from the qualitative study, due to practical constraints it is currently not feasible to have a dynamic visualisation. After manual diagnosis of UDS, which could be automated in the future, clinicians can input this diagnosis into the tool and use it as a visual aid during the follow-up consultation. Future research will reveal if this concept tool leads to improved urodynamic health literacy, or if a next iteration requires dynamic visualisations.

In conclusion, this study presents a concept, qualitative research-based visualisation tool that supports clinicians in explaining urodynamic findings and may enhance patient understanding.

Santana S, Brach C, Harris L, Ochiai E, Blakey C, Bevington F, Kleinman D, Pronk N. Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health. J Public Health Manag Pract. 2021 Nov-Dec 01;27(Suppl 6):S258-S264.
Edwards M, Wood F, Davies M, Edwards A. The development of health literacy in patients with a long-term health condition: the health literacy pathway model. BMC Public Health. 2012 Feb 14;12:130.
Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013 Sep 18;13:117.