When developing programs to support consumers/patients in any area of health - especially in mental/behavioral health - it is essential to consider the needs of all of your users, including disenfranchised and historically marginalized individuals who may have previously not been included. In a previous article , we discussed strategies for recruiting underrepresented individuals for research studies to help uncover their needs.
In this article, we are going to take a deeper dive into neurodiversity and why it is important to consider when designing health services.
Neurodiversity is an umbrella term that interestingly has made it into the Oxford English Dictionary but not yet into spell check, which recognizes the natural range of brain variations, arguing against the idea that there is a ‘normal’ or ‘healthy’ type of brain or one ‘right’ style of neurocognitive functioning.
Daniel Aherne, Founder & Director of Adjust uses this analogy: “We think of neurodiversity like biodiversity - we have all different kinds of plants that thrive in all different environments. And we need this diversity. It's the same way with neurotypes, except that a lot of people blame the neurodivergent trait as the problem, not the environment. Think about a cactus. It's a plant, but if you put it in an environment that isn't a desert, it will struggle and not thrive. But no one blames it for being a failure as a plant, we know it's the wrong environment for it to thrive."
The recent societal shift towards recognition and destigmatization of neurodiversity is fueled largely by the candor of social media influencers and activists. The transparency with which they have shared their real-life personal struggles has empowered individuals to do the same. This increased dialogue has highlighted the broad spectrum of neurodivergent traits to a wider audience, oftentimes allowing others to finally realize that their struggles or differences have a name and that there is a community to lean on for support.
That said, many people are misdiagnosed, undiagnosed, or self-diagnosed, so the actual number is undoubtedly higher than reflected in current statistics. Now more than ever, we recognize that cognitive differences and challenges are not just for those with a formal diagnosis and genetic condition.
But neurodiverse users shouldn’t be viewed as edge cases. Cognitive challenges could present themselves temporarily for any number of individuals for a wide range of reasons, especially during stressful situations such as illness, loss or change of job, societal events, environmental impacts, etc. For example, the Covid-19 pandemic caused many cognitive changes such as zoom fatigue, depression related to layoffs and isolation, social anxiety, and “brain fog,” which is a long-term effect of Covid-19. In fact, anxiety and depression have increased by 25% since the beginning of the Covid-19 pandemic.
While not directly linked, mental health and neurodiversity often go hand-in-hand. Neurodiverse individuals are at risk of suffering from mental illnesses or overall poor well-being. This can be due to a lack of support and the stress of 'masking' — acting neurotypically in order to avoid negativity. Healthcare companies, especially in the mental/behavioral health space, must realize that many people engaging in their services are part of the neurodiverse community.
While diagnosed, genetic neurodivergent conditions such as ADHD (attention-deficit/hyperactivity disorder), autism, dyslexia, OCD (obsessive-compulsive disorder), or bipolar disorder, come with many strengths like exceptional creativity, excelling under pressure, and being highly empathic; individuals may also require support in areas such as executive functioning (memory, context switching, time management) and sensory processing (how we experience the world around us through the senses).
Given the number of people considered neurodiverse, to be genuinely patient-centric, it’s critical to address cognitive differences within your audience that can create potential barriers to certain segments using a service, tool, or product. Broadening your research to ensure you are including these patient segments and applying more inclusive design principles will yield a better, more effective solution, particularly for those most in need.
At Mad*Pow, we implement the following fundamental principles when thoughtfully designing inclusive digital solutions to support cognitive variances:
1) Create reassurance to reduce anxiety and ease uncertainty
Uncertainty is at the root of anxiety which directly impairs our cognitive processes like working memory. Creating a sense of certainty is critical when engaging neurodiverse individuals within an experience.
- Outline processes and use accompanying visual aids to ensure clarity and to assist with transitions.
- Manage expectations by being upfront about what to expect next, reducing uncertainty and anxiety.
- Include timeframes for each step, which is respectful of a patient/user’s time and can help aid in time management.
2) Use plain language & reduce bias
Some neurodivergent individuals interpret language more literally, and figurative expressions may be hard to understand. Paired with the complexity of the healthcare system, it’s no wonder neurodiverse people can have difficulty understanding the content.
- Write at a 6th-8th grade reading level (the current US average) to address gaps in health literacy.
- Avoid jargon, slang, and idioms that can be misinterpreted or hard to understand.
- Avoid ableist language, such as words or phrases that discriminate against people with disabilities. For example, saying someone is “so OCD” when you mean they are organized or calling someone a “spaz” instead of saying “clumsy.”
3. Reduce the cognitive load (mental processing power needed to complete a task)
Making critical medical decisions can be stressful and overwhelming. Not only might someone’s executive functioning be compromised by the task, but they are also searching for solutions for the most vulnerable part of themselves. The individual can then focus on their health instead of the challenges they might otherwise face while using a digital platform.
- Utilize multiple choice options due to difficulty recalling (draws upon what is already familiar) vs. recognizing (requires the brain to retrieve details from memory).
- Make layouts and text easier to read by avoiding walls of text. Take advantage of bulleted lists and group information as much as possible.
- Apply intentional friction to help a patient/user slow down before moving forward.
- Avoid unnecessary motion and endless scrolling to reduce distraction, thus increasing completion rates for long forms or large amounts of information.
Even with all these suggestions, neurodiversity is not a monolith. Even within the same condition, neurodiversity can present itself in vastly different ways and require vastly different stimulation and support. We cannot capture the complete human experience without understanding that our most significant assets as human beings are our fascinating and complex brains. Inclusivity isn’t just a trend, process, or best practice; it is a movement. It is the realization that if a space is inaccessible to some, the space itself needs to change, not the people.
Want to learn more? Schedule a half-hour call with Mad*Pow to learn more about how we can help you design more accessible experiences for your audiences.
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