Keywords

1 Introduction

The suffering of children is difficult to quantify as their cognition of emotion is still evolving. The same degree of pain, stimulus or surgery does not necessarily produce the same degree of pain [4]. Effective control of pain shall be evaluated from the perspectives of physiology, spirit, and mind comprehensively with tools varying according to age [3]. Many factors affect the accurate evaluation of pain, including the children’s mental and emotional state, behavior, and personality as well as the cultural background of their parents, such as, how do parents and children consider the influence on the processing of pain by their viewpoints on pain [5]. The absorption of information by children is significantly subject to their existing ideas and knowledge. Besides, children tend to have immature judgment and short attention and memory and fail to cover both reasons and consequents during their reasoning. Thus, it is difficult for them to comprehensively understand the process and reason of an event through logical thinking. Symbols refer to the exchange of items required through abstract patterns like lines, pictures, and characters, which can compensate for the weakness of language reception capacity of children and extract advantage competence through visual cues. The picture exchange system proposed by Bondy and Frost adopting pictures as the media for communication has been widely studied and applied [2]. For the reliability of the self-report of pain assessment, the priority is to design sound visual patterns, colors, and numbers in order to improve the accuracy of medical staff on clinical judgment [10].

Along with the improvement of the capacity and operational capability of mobile devices and the maturity of mobile communications network infrastructure, increasing functions of e-health can be applied to mobile platform so as to make mobile-health (M-health) service the key of the applications of e-health [6]. The development of electronic pain self-assessment tool can also be used in home care while protecting the privacy of patients’ information, recording the pain of patients, feed-backing to physicians during subsequent visits, and rendering convenient and appropriate communication between medical staff and patients after surgery or with chronic diseases [7]. The principle of the design of an app lies in easy operation, quick start, and simplified information. In addition, it shall streamline the commonly used functions of mobile phones, provide easy reading and easy touch operation, allow users with poor vision or reading disability, and contain all-round design [8]. This study referred to the information communication approach of AAC and EMS Symbol Board [1], centered on the icon-based understanding of the frequency of pain to develop app interfaces, considered user experience (UX), and facilitated the understanding of the feasibility, infeasibility, and effectual applicability of products [9].

This study referred to augmentative and alternative communication (AAC) to realize the four items of communication and interaction which were applied in the auxiliary communication system for medical staff and patients. The four items include (1) communicate symbol: Concepts are expressed with abstract symbols like specific vision, auditory sense, and touch. For instance, visual images and animations are adopted by a doctor to help him/her orally convey the message to a patient; (2) Communication aids: Images and animations are displayed with a computer screen to assist the conveying and communication of messages; (3) Communication strategy: The efficiency of information communication from a doctor to a patient is enhanced by images and animations which can assist the doctor’s verbal communication; (4) Technical system: High-tech auxiliary devices are integrated into a communication intervention program through the design of app graphical interfaces to assist effective communication on a case-by-case basis.

2 Method

To create a testable wireframe prototype, software architecture was planned in accordance with the design theory of visual information, the design principle of micro software, user experience design, and interface design. After the planning and collection of the information related to the pain of children and the consultation with experts of medical care, the content was summarized and recorded in the database to be set up.

Conceptual Development. At the stage of conceptual development, spiral and divergent thinking method was carried out with Mandala thinking method (Fig. 1) so as to find possible innovative solutions, followed by convergence and integration. Discussion was carried out with users. The products or service mentioned in the storyboard script was specified as prototype which would serve as a reference for follow-up communication, design, and evaluation (Fig. 2).

Fig. 1.
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Mandala thinking method

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Fig. 2.
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Interview with the users at the Show Chwan Memorial Hospital

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Fig. 3.
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Story board (produced by this study)

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Script Architecture and Sketch Development. The script was designed in the way of storyboard script to develop relevant people, things, time, place, and materials into a simulation scenario of users. “Visual communication” was used to “telling stories”. The images used were arranged in a chronological order (Fig. 3).

3 The Design and Evaluation of the Illustration of Children’s Pain

3.1 Design and Evaluation the Icons

In accordance with the information communication approach of EMS Symbol Board [11], this study focused on the faces rating scale of children, pain frequency, and illustration of time to explore the expression of pain by children. Ten children of three to nine years old were regarded as the subjects. The purpose of the measurement was to clarify the degree of understanding of image design elements by children. After the interviews with medical staff, images were painted in accordance with their suggestions. The icons designed in this study were then assessed cognitively by students at school. The questionnaire was designed in line with ISO/9186-1 [12] with 96 children of four to nine years old as subjects to observe their reaction and degree of understanding of pain. Through rigorous steps and objective assessment with 35 children of four to nine years as subjects, the overall design was improved to provide a new image system with effectiveness and consistency (Fig. 4).

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Images comprehensive assessment

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3.2 The Design of APP Interface

For children and caregivers, classification system must be clear with the function of rapid picture card formation, search, and conversion between images and characters. The interface design should not be too rich in case it might divert the attention of children. The interface design diagram was reflected 1:1 on a tablet computer and discussed with users. The features of concepts and conceptions were presented through the operation of simulation interface with animation so as to confirm if the design met their needs. This study also thought about how to apply the developed prototype to a tablet computer. It carried out cross-domain discussion and cooperation with the information engineering team. The actual operation of icons on a tablet computer and the functions of icon search and sentence-making could save the time to look for picture cards. The design of app interface: After entering the home page, one should select identity which contained children (or caregivers) and medical staff. After the confirmation of identity, one entered login and registration programs. After login and reading instruction, one might start to use the app by the functions on the list like selecting Faces Rating Scale, Pain Frequency, and Time (Fig. 5).

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APP prototype (interface design samples produced by this study)

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Early stage: UX research. Design draft and discussion with users were conducted. Intermediate stage: UX design. The data collected at the early stage and the features of UX was integrated in accordance with ACC to list some design characteristics which could help children and caregivers in terms of pain experience. For instance, in terms of caregivers, the interface design should not be too rich in case it might divert the attention of children. The interface design diagram was reflected 1:1 on a 7 inchs tablet computer and discussed with users. The features of concepts and conceptions were presented through the operation of simulation interface with animation. Later stage: UX testing. After the completion of interface design draft, cross-domain discussion and cooperation were conducted with the information engineering team. Icons were operated on a tablet computer while the interviews and interaction was conducted with users so as to fine tune and adjust. Lastly, the main functions of the icon assistant learning software were defined.

4 Conclusion

The combination of the digital advantages of a tablet computer with UX design could effectively enhance learning fluency. The integration of the concept of UX into the early, intermediate, and later stages of the design could not only render user-oriented design, but also design based on the operation and experience of users who provided many positive feedback and suggestions, which could serve as a reference for the designers and researchers of the auxiliary communication system between patients and medical staff in the future. The design of auxiliary and visual communication system between patients and medical staff could be applied in clinical doctor-patient communication so as to improve doctor-patient interaction, assist children in communication, and enhance the understanding of doctors’ inquires, enhance the accuracy of the information exchange between doctors and patients, and reduce their communication gap.