“Infographing” Dementia Prevention: A Co-Design Approach

ABSTRACT

Designing effective public health messages is challenging, particularly when communicating complex and relatively new health messages such as dementia risk prevention which are still largely unfamiliar to the public. The accessibility of these messages, especially for individuals who speak English as an additional language, remains uncertain in large scale educational interventions. A key strategy to enhance the communication of evidence-based information is to co-design infographics that optimize the accessibility and impact of visual health messages. This paper reports on the co-design process of infographing dementia prevention messages. Qualitative data were analyzed using reflective thematic analysis to generate three themes reflecting the message design preferences of participants: “all hands on deck,” “charting the course,” and “get on board.” This work supports the crucial need to engage the target audience via co-design when creating visual messages as meaningful and accessible educational tools that will resonate with the intended audience. Doing so may help health communicators navigate the creation of visual messages across diverse health domains and populations.

Introduction

Dementia prevention messaging

Dementia risk prevention is a relatively new health message with which many people are unfamiliar (Cations et al., 2018). Compelling evidence indicates that the proactive management of 12 modifiable risk factors could potentially prevent or delay up to 40% of dementias (Livingston et al., 2020). However, this message has not yet gained traction and there is a lack of public awareness that reduction is both possible and feasible (Steyaert et al., 2021; Van Asbroeck et al., 2021).

Health education delivered online can enhance health-related knowledge and improve health literacy among the general public (Liyanagunawardena & Williams, 2014). The Preventing Dementia Massive Open Online Course (PDMOOC) is a free online health education intervention that communicates evidence-based content so participants can build their knowledge of dementia risk factors and develop risk literacy (Farrow et al., 2020). Since its first iteration in 2016, the PDMOOC has reached over 100,000 participants across 175 countries and has sustained a completion rate above the MOOC average (Farrow et al., 2022). While non-native English speakers have been shown to be able to complete dementia related MOOCs, those who do are likely to be highly educated (Kim et al., 2021). Accessibility of content for those with limited proficiency in English could be enhanced. Feedback data from course participants indicate that one notable way to improve PDMOOC content is by formatting information visually (Martinez Escobedo et al., 2024).

“Infographing” the PDMOOC

Informational graphics (infographics in short) are educational materials that visualize key health messages through a combination of text, pictures, or graphs (Houts et al., 2006; McCrorie et al., 2016). Infographics can effectively present complex health information in an innovative and engaging format which renders health messages more accessible than text or images alone (Houts et al., 2006). The elaboration likelihood model (ELM) posits that attitude change occurs by processing information such as health messages either via a central route, involving high motivation and ability to engage in critical thinking, or a peripheral route when motivation and cognitive ability are low (Petty & Cacioppo, 1986). Evidence suggests that well designed visuals in infographics may play a significant role in increasing individuals’ ability to engage in critical thinking and centrally process evidence-based messages (Lam et al., 2022; Lazard & Atkinson, 2015), which may also help message retention. Potentially, more creative and engaging visual materials may help to minimize language and literacy barriers to accessing messages about chronic health conditions such as dementia (Siette et al., 2023).

Within the dementia domain, tailored infographics have proved effective in providing Hispanic caregivers with adequate self-management health information while caring for people living with dementia (Arcia et al., 2019), showing that infographics can improve the understanding of health information by people who speak English as an additional language. Several studies on dementia prevention have investigated individuals’ awareness and knowledge about this topic (Bartlett et al., 2023; Heger et al., 2020; Van Asbroeck et al., 2021) but have rarely examined design elements that facilitate engagement with the intended message.

Given the importance of visual design in health messaging, the current study focuses on how to best “infograph” key dementia prevention messages currently delivered in textual format within the PDMOOC. To create meaningful dementia risk prevention interventions, Curran et al. (2021) propose their design and delivery should ideally incorporate co-design principles. A co-design approach facilitates close collaboration with the target group to generate new ideas and gather feedback to improve the product being co-created (Sanders & Stappers, 2008). Co-design allows researchers to understand which message elements are effective and which are not, and identify ways to improve the delivery of meaningful health messages to the targeted audience (Linda et al., 2021). Additionally, co-design offers an opportunity to involve linguistically diverse groups in the creation of health products tailored to their needs (O’Brien et al., 2021).

It is unknown how risk factors and mitigation strategies should be illustrated in an infographic format to maximize accessibility and reach in diverse groups. The aim of the current study is to co-design infographics as a first step to visually deliver key dementia prevention messages that optimize accessibility and effectiveness for people who speak English as an additional language.

Methods

Recruitment

Participants were recruited from the May 2022 iteration of the PDMOOC. Those who resided in Australia, spoke English as an additional language, and were over 18 years of age were invited to participate in this study via e-mail. The invitation e-mail linked participants to an online form which explained the project in detail and asked for consent digitally. A total of 41 participants consented to take part. Ethical approval was granted by the University of Tasmania Social Sciences Human Research Ethics Committee Ethics Committee (H0027152).

Procedure and data collection

The co-design method used in this project was based on the online co-design framework described by Kennedy et al. (2021).

Step one: Pre co-design

Recruitment

Two groups of participants were recruited during this step: Group A (n = 17) and Group B (n = 24). Group A participants agreed to participate in the co-design sessions and the online Infographic Survey. Group B participants chose not to be involved in the co-design sessions but wished to participate in the later online Infographic Survey in step three of the co-design process. Group A participants who responded to our communications were split into two groups based on their availability: Group 1 (n = 4) and Group 2 (n = 2). Despite multiple attempts to coordinate meetings with the rest of Group A participants, they were either unresponsive or could not attend the scheduled sessions. All participants in Group A were female, aged in their 50s and 60s, spoke different languages as their first language (Italian, Spanish, Polish, Filipino, Afrikaans, and Danish), and lived in Australia.

Development of infographic prototypes

The key risk prevention messages and corresponding mitigation strategies to be “infographed” were informed by the literature and existing PDMOOC content. As well as the 12 modifiable risk factors supported by Livingston et al. (2020), poor cholesterol management was included as a risk factor (World Health Organization, 2019). Air pollution was removed as the recommended mitigation strategies rely more on national and international policies to reduce air pollution rather than on actions taken by individuals (Livingston et al., 2020). However, avoidance of secondhand smoke was added under the smoking risk factor. The modifiable risk factors were divided into three categories:

1. Psychosocial risk factors: less education, low social contact, and depression.

2. Medical management risk factors: diabetes, high blood pressure, high cholesterol, and hearing loss.

3. Lifestyle risk factors: smoking, obesity, physical inactivity, excessive alcohol consumption, and head injury.

Three Version 1 (V1) prototype infographics, one per risk category, were developed by IME to present to participants during the initial co-design sessions. Prototypes were used as they have proven to be a time and cost-effective technique to present participants with an initial mock-up of the visual material to elicit immediate feedback (Blomkamp, 2018). V1 prototypes included simplified illustrations of risk factors similar to those previously used by dementia organizations such as Alzheimer’s Disease International. Two commonly used and differing design styles for illustrating people were included within one V1 infographic. Recommended infographic design principles such as accessible labeling and stoplight coloring also informed the creation of prototypes (Arcia et al., 2019).

Step two: Co-design sessions

Four online co-design sessions were administered in two rounds: two in round one (September 2022) and two in round two (December 2022). IME was the facilitator for all sessions. All sessions were video/audio recorded with consent from participants digitally obtained during recruitment and verbally confirmed prior to recording.

Round one of co-design sessions

V1 prototypes were presented to Group 1 (n = 4) and Group 2 (n = 2) through screen sharing. This was the participants’ first exposure to the infographics. Semi-structured interview questions were asked to stimulate the conversation amongst participants. Open-ended questions asked participants whether they liked or disliked the risk factor and mitigation strategy messages composed of images and words, and how they would improve any of these elements. Each session lasted approximately 90 minutes. Following each session, the investigators (CE, KD, IME) met to reflect on the experience, discuss insights, and make initial observations of the key design ideas brought up by participants. IME kept debriefing notes to assist during data analysis post co-design.

Between round one and round two

From the data collected in round one sessions, IME collated participants’ comments to create Version 2 (V2) for round two sessions.

Round two of co-design sessions

V2 and V1 infographics were shown to participants for comparison. As in round one, semi-structured interview questions were asked. The questions were open-ended and asked participants what they thought about the V2 infographics in relation to the V1. They were also asked how they would improve any element in the new designs. Similar to round one, the investigators met after each session to reflect on the experience and discuss participants’ feedback.

Step three: Post co-design sessions

IME collated participants’ feedback and suggestions from sessions in round two to identify new design changes to be implemented into Version 3 (V3) infographics. The Infographic Survey was designed to collect feedback on the V3 infographics from Group A and Group B. This survey asked participants to rate the co-designed infographics on a scale from 1 to 5 against designed elements. The survey questions addressed design elements that particularly resonated with the co-design group with regard to accessibility and effectiveness of the messages. The survey also provided an opportunity for participants to give free-text responses on the infographics (see Supplementary File 1). A link to complete the online Infographic Survey was sent to all consenting participants (n = 41) who registered an interest in the study. This survey provided Group A with a final opportunity to share their views on the infographics (V3). For Group B, the survey gave participants the opportunity to provide feedback about V3 infographics. No demographic data were collected.

All co-design sessions were audio/video recorded and automatically transcribed by Zoom. IME corrected these transcripts to improve accuracy, verified transcription quality multiple times, and then shared verified transcripts with KD and CE to be reverified. In order to de-identify participants, transcripts were anonymized, and pseudonyms were assigned prior to analysis. The chosen pseudonyms are unrelated to the participants. All participant identifying information was removed. Throughout the co-design process, field notes and a reflexive journal were kept by IME to assist during data analysis.

Data analysis

Data collected from the co-design sessions were analyzed using reflexive thematic analysis (TA, Braun & Clarke, 2006, 2022). Data collection was underpinned by an ontological position that sees people’s knowledge, views, understanding, interpretations, and perceptions as the properties that make social reality (Mason, 2002) which is formed through communication (Harrington et al., 2022). The analysis was conducted from an interpretivist epistemological position which allows a meaningful way to generate knowledge about the ontological properties mentioned above (Mason, 2018).

IME coded the data using an inductive, data driven, style of reflexive TA and focused on latent themes (Braun & Clarke, 2022). After thorough familiarization with the data, IME generated initial codes through systematic identification of similar meanings and patterns across the full dataset. IME mapped early codes into potential themes to visualize them and develop broader connections between codes. Relevant data was collated into each initial theme to review their viability. A collaborative and reflexive dialogue between all authors resulted in the examination of each candidate theme to ensure they fitted together and were grounded in the data. As a consequence of this debriefing process, some codes were reassigned and certain themes were combined. For example, the initial themes “consumable” and “connected” were combined into “connection to self” to better reflect participants’ intention. This ongoing and deepening understanding of the data led IME to relabel some ideas into sub-themes and construct overarching candidate themes. These candidate themes were then refined, defined, and agreed by all authors to ensure they captured data meaningfulness. The final data analysis reports three overarching themes and seven sub-themes illustrated with vivid data extracts.

Results

Three themes were actively generated from the data collected from the co-design sessions (Figure 1). These themes illustrate the effort taken by participants in creating effective visuals to increase others’ ability to process information, and engage in critical thinking which may lead to greater elaboration of the health messages communicated in an infographic format. The theme “all hands on deck” captures data about the process of engaging in co-design and how this can inform creation of tailored health messages. The theme “charting the course” focuses on the content in the infographics, what is said and how it is said. And the theme “get on board” highlights the importance of creating infographics which engage users with the intended public health messages.

Figure 1. The three themes and seven sub-themes arising from co-design process. The figure illustrates the codes aligned with each of the sub-themes and themes.

Theme 1: All hands on deck: Co-designing the message

Co-designed

During the co-design sessions, participants comfortably engaged in meaningful ideation by voicing their opinions and exchanging feedback on the visual messages. While participants within a co-design session tended to agree about how to improve the messages in the infographics, they favored a collaborative approach and were supportive of other participants beyond the session contributing different perspectives for improving these visual messages: “It needs to have a few more people’s opinions on it” (Sarah).

A co-design approach allowed participants to reflect on their own attitudes about health messages and to become aware of the challenge of illustrating certain health topics. For example, participants debated whether the original mitigation strategy for the risk factor depression (Figure 2a) conveyed the desired message of “Find help if I feel depressed.” One participant stated: “Does that mean finding friends, or going to a doctor?” (Kim). In response, another participant said: “Usually a person with depression needs professional help” (Amy). However, this then prompted another participant to voice their concern about immediately seeking professional help, stating: “Seeing a psychiatrist, a psychologist would not be good for everyone. For some it would be good to see, uh, to talk to a trusted friend, just to … be able to just share that” (Sarah). While openly discussing this difficult risk factor and drawing on their prior knowledge and beliefs, participants worked collaboratively to co-design a mitigation strategy that might potentially avoid stigmatizing people and show that “It’s first talking to somebody, and then finding the help that you need” (Rose) (Figure 2b).

Figure 2. Mitigation strategy for “depression.” Dotted lines highlight main changes discussed in text.

The second co-design session allowed participants to fine-tune other elements within the images that may still cause some confusion. For example, the thought bubble in Figure 2b was seen as an intention to do something but not actually doing it. Participants suggested changing it to a speech bubble to emphasize the action of calling someone for help (Figure 2c).

Theme 2: Charting the course: Delivering the message

Connection to self

To decide how to best illustrate the health messages, participants were presented with two options within V1: images composed of simplified black stick figures and icons, and an image illustrating people in a more detailed and realistic manner. When shown to participants, one stated: “We’re so used to seeing those things [black stick figures] for all kinds of signs. But this one [realistic] it’s making it more real that, like okay, real people” (Jane). The realistic image was perceived as “More personable this [realistic image] because you can relate to that. Because they are real people, real images” (Rose). Based on this preference, all V2 images were redesigned to be more detailed and realistic so participants could easily process and form a connection with the health messages.

Participants requested that the infographics illustrated practical and manageable mitigation messages, ones that could be easily adopted and achieved by a wide range of individuals: “But it could also be a bit drastic for some people who can’t run (Figure 3a). So, what about adding a dog and just making them walk?” (Rose) (Figure 3b). This tailoring of the message to a broader audience was perceived as a positive cue for viewers to engage in effortful thinking.

Figure 3. Mitigation strategy for “physical inactivity.” Dotted lines highlight main changes discussed in text.

A feature that resonated particularly well with participants was the use of more colors in the realistic images of people enabling them to recognize diverse groups. This prompted participants to reflect on the importance of diversity and connect the infographics to themselves. They recommended that people should be portrayed with different skin and hair colors to be more inclusive of different ethnic and age groups (Figures 2c–5c).

Figure 4. Risk factor “high blood pressure.” Dotted lines highlight main changes discussed in the text.

Figure 5. Risk factor “physical inactivity.” Dotted lines highlight main changes discussed in the text.

Clear

Participants preferred visuals that clearly represented both risk factors and mitigation strategies to increase the likelihood that health messages were delivered effectively. When the original risk factor image for high blood pressure (Figure 4a) did not clearly indicate it was “high,” it caused confusion amongst participants: “Is it high pressure like that, it being leveled like that, or does it mean it’s leveled?” (Kim). To clear this confusion and explicitly illustrate high blood pressure, it was suggested that “the reading could be red or something, so that you know it’s clear when you see it you say ‘oh, there’s something wrong,’ right?” (Jane) (Figure 4b). Additionally, this change may allow viewers to elaborate on the messages and clearly interpret the risk factors as risks.

Correct

V2 images helped to correctly illustrate the health issues. For example, the stick figure in V1 for “physical inactivity” was perceived to be “too fit” and not in “too much trouble” (Figure 5a). To fix this, a realistic and detailed visual allowed us to portray a person that participants felt would be accurately associated with physical inactivity and highlight the health issue: “It [person] looks very athletic, perhaps he should be fatter!” (Mary) (Figure 5b).

During the co-design sessions, participants expressed a strong desire to craft messages that were non-judgmental. However, participants acknowledged the importance of conveying the correct message regardless of how provocative it might be for some users. For example, illustrating “less education” caused debate among participants. While prioritizing correctness, participants felt the image needed to be sensitive as well. Displaying “5 × 5” on the risk factor was seen as a potential trigger for some (Figure 6a). To correct this risk factor, it was suggested that the image should illustrate “somebody who’s just sitting … bored just sitting” (Rose) (Figure 6b). During the second co-design session, the addition of closed books highlighted the risk factor of lack of education: “It’s not just boredom, like this tells you that, you know there’s opportunity. But you know, you didn’t use the opportunity” (Jane) (Figure 6c).

Figure 6. Risk factor “lack of education.” Dotted lines highlight main changes discussed in the text.

Complete

Participants preferred viewing a full depiction of the health message to understand the connection between each risk factor and its corresponding mitigation strategy. For example, the risk factor for lack of education was not fully understood by itself, participants felt they needed to see both images: “Now I can put the two together” (Sarah). The full message also allowed participants to process the message at their own pace and see similarities between risk factors and specific elements that they felt connected the messages: “And all of them have the exclamation mark and the little thing that it shows the red, that is too high” (Amy) (Figure 7).

Figure 7. Risk factors using the same red exclamation mark to draw attention to the health issues.

Theme 3: Get on board: Hearing and understanding the message

Catchy

V2 images were perceived as “eye catching” and the first step to grab the reader’s attention and interest long enough to get the messages across: “I’d say the colors and the fact that it’s attention grabbing. Yeah, you know, it’s something you would like to, um, read. Otherwise, um, you’re not going to take much time on something that’s purely black and white. And yeah, I’d go through this. I’d read it” (Rose).

Participants were enthusiastic to create friendly and refreshing visuals, seeking to differentiate these graphics from the generic and impersonal imagery previously encountered in other health messages: “The new one, it’s especially done for dementia. Like it’s a new campaign kind of thing” (Jane). They also favored the size distinction between the risk factor images and the recommendation images to make the latter stand out and catch people’s attention: “The bottom picture looks so much more attractive. It’s compelling. And psychologically people will be drawn to this” (Mary).

Easily communicated

By co-creating messages that are easy to communicate, participants felt equipped with a tool to promote and spread dementia reduction information. Participants were not only motivated to address their own health concerns but also to help and encourage others to adopt similar practices: “I’m trying to take on board myself and my husband, and everybody that I know. I’m telling everybody ‘You need to do this, you need to do that.’ So, it’s good and trying to make this more friendly” (Amy).

In addition, participants felt the infographics could be used to communicate health messages with hard-to-reach groups and persuade hard-to-engage groups that usually do not get involved in health promotion interventions. For example, participants believed that the mitigation strategies for the medical management risk factors should feature men: “Because, normally, women they do. They do want to be checked. But men are a bit, you know? They need to be encouraged pretty often” (Kim).

Online infographic survey

The survey provided a means to assess the extent to which the co-designed infographics resonated with individuals beyond those who actively participated in the co-design sessions. Twenty-two participants provided a response to the online survey (54%). All respondents agreed that the messages in the infographics were clear and easy to understand. In addition, over 95% of respondents agreed that the infographics were interesting and grabbed their attention. Finally, 97% of participants agreed the infographics helped to improve their understanding of the depicted health messages.

Survey respondents liked that the messages were clear, complete, catchy, easy to remember and share. One participant stated, “[infographics] present the information in a friendly, clear, and easy way to understand. They present the problem and the solution.” Another respondent suggested that the infographics conveyed a “simple and clear message, easy to remember and easy to share/pass on the message to other people.” Further, respondents felt they could connect with the messages and encouraged message uptake, with one participant commenting “the poster [infographic] is colorful and has a positive feel. It is kind and helpful. It has no sign of judgment but encourages to change.” Although no specific element emerged as collectively disliked among respondents, the depiction of a single mitigation strategy per risk factor was not always considered sufficient “head injuries occur so much in sport, car accidents etc., maybe include multiple graphics?”

Discussion

In this study, we set out to co-design infographics that illustrate key dementia risks and mitigation strategies with PDMOOC participants who speak English as an additional language in Australia. In addition to infographics being the direct outcome of the co-design process, our findings highlight important design elements for presenting complex evidence-based information in a format that delivers appealing and accessible messages.

Design criteria for translating complex health information into effective visuals that facilitate message processing are rarely the primary focus in existing infographic guidelines. These guidelines place an emphasis on data visualization and graphic design elements such as graph choices, color restrictions, typography, and headings rather than image appeal and ease of understanding the messages (Hernandez-Sanchez et al., 2021; Smiciklas, 2012; Stones & Gent, 2015). Additionally, these guidelines have not been formulated in close collaboration with the intended audience. It has been suggested that designers should build a “design persona” to imagine the intended audience or research their preferences without directly involving them in the design process (Stones & Gent, 2015). Alternatively, we suggest co-design is a key design element for infographics depicting health messages. Our participants evaluated basic graphic design aspects like text alignment but prioritized the visualization of elements such as personal relevance and comprehensibility to increase effortful thinking about the infographics by their peers. These considerations echo the idea of the ELM (Petty & Cacioppo, 1986) that effective imagery can help increase elaboration by the viewer, thereby possibly improving critical thinking and message retention. These findings emphasize the importance of bringing designers and intended audiences together in meaningful ways to facilitate the co-creation of effective messages with and not simply for end users.

Co-design may provide an opportunity for people to collaborate on an equal basis and minimize power imbalances between designers and end users of the product being created (Iniesto et al., 2022). Our findings support this idea, with it being apparent that participants felt they were on equal footing and comfortable to work with each other and IME throughout the co-design sessions. This facilitated the co-creation process by motivating participants to carefully consider how to best format messages to be relevant, empowering, and convey the idea that risk reduction is possible. In addition, our results align with Petty and Cacioppo’s (1986) original postulation that personal relevance is an essential component affecting the likelihood that a person will engage with the messages. Participants in our study had the opportunity to reflect on the design of the images and provide as much feedback as possible to make the messages more personable and relatable. Improvement suggestions varied from simple solutions (e.g., adding a dog to differentiate walking from running) to more comprehensive ones (e.g., redesigning the look of people). This also highlights the notion that personal relevance of educational materials may be increased even with minimal tailoring of health messages (Noar et al., 2009).

Participants recognized the challenge in visually conveying certain risk factors and mitigation strategies that would accommodate people from different backgrounds. They were mindful of their responsibility to contribute their ideas and experiences to create relevant illustrations so others could form a connection with the messages. Additionally, participants were mindful of creating imagery that elicited positive attitudes and worked together to visualize less confronting visuals with the intention to avoid negative attitudes. For example, the challenge of illustrating the concept of depression and less education encouraged an open discussion between participants in order to find visuals that would be inclusive and easily understood by most people. We note that while the co-designed images resonated with our participants, they are not a “one size fit all” tool and some messages might still not be clear enough to people unfamiliar with the topic. Future research is underway to explore how people unfamiliar with dementia reduction would interpret the infographics in order to find ways to improve them for a wider cohort.

Recommendations for the image style (simple vs realistic) to represent people in infographics are present in some design guidelines. Stones and Gent (2015) recommend the use of easily available simple shapes to generalize populations but note that they lack detail and may be perceived as impersonal. Lonsdale and Lonsdale (2019) report that icons work better for data visualization while drawn illustrations help to tell a story in narrative infographics. Our results indicate that striking a balance between simple and realistic images was preferred by participants. Doing so allowed us to co-create colorful images that illustrated more detailed, accurate, relatable, and easily understood messages. There was a shared sentiment that images should be the primary focus of the infographics to convey messages with minimal text, particularly in an effort to accommodate individuals with limited English proficiency and reduce the need for translation. In addition, the co-designed images were perceived as unique, not recycled from overused generic styles (e.g., stick figures), and especially made for them, all of which may result in increased attention and recall of the messages (Petty et al., 2009). Participants believed that the more detailed illustrations would engage their peers and motivate them to fully grasp and recognize the urgency of the messages. Although our findings suggest a possible connection between visual design and language proficiency, this aspect remains relatively unexplored in existing message elaboration literature. Future research could investigate how varying levels of English proficiency impact the processing of visual health messages.

While restricting color in infographics has been recommended (Hernandez-Sanchez et al., 2021; Stones & Gent, 2015), our study found that colorful visual messages did not impede understanding nor appeal. On the contrary, participants expressed that the new illustrations made the messages “catchier” and improved message comprehension. The realistic and colorful representation of people allowed us to take a step toward developing culturally competent educational materials that could strengthen the value and respect of different ethnic groups (Myers et al., 2019). Participants pointed out that the illustrations should demonstrably reflect the age of the intended audience since the infographics were intended to be added to the PDMOOC to support the uptake of behavior change across the life course (Farrow et al., 2022). Future investigations could explore how to best incorporate additional culturally inclusive elements while avoiding stereotypes. In addition, while our participants did not consider it an issue, additional research could consider how to best represent people with diverse abilities in dementia prevention messages intended to the general public.

Results from the Infographic Survey indicate the visual messages in the co-designed infographics were generally successful in grabbing the target audience’s attention, providing clear information, facilitating understanding, generating interest, and improving knowledge. While the Infographic Survey was created for this study, it provided a baseline evaluation of the accessibility and effectiveness of the co-designed infographics. The seven design elements identified in this study could be used to establish a more comprehensive measure that enables researchers to compare the effectiveness of visual health messages used in health communication. Implementation of the infographics in a large-scale intervention will provide an opportunity to gain further feedback on additional message design aspects from a broader cohort. The benefits of co-designed infographics may extend to other underrepresented populations such as individuals with limited literacy skills, less education, and health literacy (Devine & Wathen, 2021; Houts et al., 2006). Further, Fair et al. (2023) suggests that PDMOOC participants share course information within their social networks, but are selective with whom they share this information due to the stigma surrounding dementia. Individuals may experience a higher level of comfort when presented with dementia risk reduction information in engaging and accessible formats. Perhaps, as observed in our co-design sessions, visual messages may offer a friendly and approachable means of communication, encouraging greater receptiveness to dementia risk reduction strategies.

Limitations

While we used a comprehensive co-design approach to create health promotion infographics, this research is not without limitations. It is important to acknowledge that while the original prototypes were an advantageous starting point for steering group discussions (Sanders & Stappers, 2014), participants might have felt inclined to adhere to the proposed design of the prototypes. Despite the number of participants involved in this study reflecting those used successfully in similar research (Hawke et al., 2023; Van Hecke et al., 2020), a larger and more diverse cohort might have offered additional insights into the visual elements that could potentially influence the design of dementia prevention messages. Further, co-design participants were recruited from PDMOOC enrollees who consented to the research and were already familiar with dementia prevention messages. This allowed participants to understand the intended messages and provide an informed perspective about whether that message was adequately expressed. However, while the identified visual message design criteria may echo other participants’ design preferences, further investigations are required to confirm this and perhaps explore supplementary elements to enhance the co-designed infographics in this study.

Conclusion

This study presents an all-hands-on-deck process that enabled participants to chart the course of health educational products, purposefully aiding them and their peers to get on board and assimilate health information. Although this study focused on infographing dementia prevention messages, our findings may be applied by researchers to navigate the creation of visual messages across diverse health domains and populations. Moreover, empowering individuals not only as consumers but as co-creators of health messages can significantly enhance future health communication efforts. In this way, co-designed infographics may hold the attention of users and provide accessible content to those who might otherwise be less inclined to engage with such information.

Acknowledgements

We wish to thank all participants for their contributions to this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data are not publicly available due to restrictions imposed by the University of Tasmania Human Research Ethics Committee.

To access the full version of the co-designed infographics, please visit and enroll in the PDMOOC.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10410236.2024.2350257.

Additional information

Funding

This work was supported by the University of Tasmania under a Tasmania Graduate Research Scholarship.