69 Designing with and for people with limited health literacy 3 through a smartphone app demonstrating data on inhaler use and asthma control. The system allows the user to zoom in on the lungs and explore relations between respiratory concepts. Simplistic icons and illustrations are used to visualize the more complicated underlying physiological processes. For example, a blue arrow that depicts a person’s asthma state is presented as the amount of air that can flow through the bronchi. Inhaler data, a proxy for underlying respiratory inflammations, are visualized as respiratory cilia being “in- or out-of-balance,” depending on the frequency of maintenance inhaler use. Hence, the maintenance medication is framed as a “helper” to bring back balance to the disturbed respiratory system. An animation video describing the concept, its functionality, and scenarios of use was developed by the first author with Adobe Premiere Pro (Adobe) (58). The video communicated the concept in a concise and engaging way to the participants. In addition, the first author developed paper-based visual prototypes of the key interface screens that would facilitate the discussion afterward. For the evaluation sessions, Pharos, an expertise centre familiar with developing and evaluating education material for people with LHL invited five people with LHL to participate in 1.5-hour interview sessions during which the prototype was discussed. A trained and experienced employee of the expertise centre conducted the interviews. Each interview started with displaying the video-prototype, after which the participants were asked about their opinion and if they had any questions. Subsequently, the interface screens were presented and discussed following an interview topic guide. Interview questions included “what do you think they mean with this?” or “what do you think is presented here?” Whenever an element was unclear, we asked the participant to provide suggestions for improvement. The representative of Pharos provided a summary with recommendations for improvement after the last session. In addition, observations and participant responses by the investigator were collected in a written report. Overall, the participants were positive about the concept as they felt that it would help them gain awareness of being non-adherent to their maintenance medication and the consequences for their lungs. The visual presentation style was understood, and the overall system was perceived as useful and innovative. However, some interface details were unclear, confusing some of the participants. For example, colours were deemed confusing when they were unrealistic (i.e., a blue lung). In addition, a colourcoded performance bar was suggested to visualize the improvement of the cilia.
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