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Christy Bui DES 191c Designing Information Prof. Susan Verba Spring 2011 UC Davis

Hepatitis B Informational Graphics


Contents Introduction

2 The Process The Need 4 The Project 7 Mission Statement Production 8 Gathering Artifacts Interpretation 10 Finding connections Narrative 16 18 20 22 24

Prototypes: sketches The graph 1st page Color and Type Full spreads

26 The Narrative

12 Information Profile 14 Sources of Information

28 Next Steps


Edward Tufte Envisioning Information (1998)

“To envision information—and what bright and splendid visions can result—is to work at the intersection of image, word, number, art.”

* Edward Tufte, Envisioning Information (Connecticut: Graphics Press LLC, 1998), 9.

1


2

Mary Kelly, Post-Partum Document: Documentation VI, Pre-Writing Alphabet, Exergue and Diary, 1978 (detail). Perpsex units, white card, resin, slate, one of fifteen units in this section, 20 x 25.5 cm


introduction the need production interpretation narrative

Part way through my research, I learned of an artist named Mary Kelly and her seminal work Post-Partem Document from an art history class. As part of a feminist dialogue in the 1970s, Post-Partem Document consists of six sections with a total of 139 units, in which Kelly documents her relationship with her male child from birth to age five.1 Viewed as an “archaeology of everyday life,” it exists somewhere between an ethnographic field-report and a psychoanalytic case-study. In the context of this project, however, I was interested in the former, in the way Kelly archived her son’s entry into family, language, school, and social life through baby clothes, first letters and scribbles, and other personal objects, as quasi-scientific data combined with theoretical analysis.2 The stone tablet on the left consists of three registers: production, interpretation, and narrative. At the top, Kelly records the initial scribbles of the letter ‘e,’ followed by her interpretation of her son's process, and then analyzes it in terms of their relationship. Through in-depth analysis, the work embodied a very direct, obsessive process, yet a different, realistic perspective of the mother-child dynamic. Her seven-year process of reflection and visualization inspired how I thought about my research. I approached the information, for instance, as artifacts looking to be reinterpreted into a new narrative that the audience can experience in a new way.

The Process 3

Mary Kelly and son recording session, 1975.

IDEO research method LEARN: Secondary Research

1 Mary Kelly, “Preface to Post-Partem Document” (1982), in Theories and Documents of Contemporary Art, eds. Kristine Stiles and Peter Selz (Berkeley: University of California Press, 1996), 858. 2 Hal Foster et al., Art Since 1900, volume 2 (New York: Thames & Hudson, 2004), 572-575.


introduction the need production interpretation narrative

schedule 4

WEEK 1 Preliminary research WEEK 2 In-depth research & analysis Prototypes WEEK 3 User testing More prototypes WEEK 4 Refinement In-class critiques & user testing WEEK 5 Fine tuning before final presentation

The Project criteria Complex enough and challenging Opportunity for user research Addresses a need Fixes something confusing Something we are passionate about Creates something tangible Benefits an audience we care about

I begin this project with no particular direction. I know I wanted to work with Asian American health, a topic I am not familiar with, yet still have some connection to. After some preliminary research, I decide to focus on hepatitis B, one of the major health disparities between Asian and Pacific Islander Americans and the U.S. population today. Going further will require me to delve into the research without knowing where the project will take me. There are three key questions to answer: What is the need? Who is the audience? What form will the project take?


Sol LeWitt "Sentences on Conceptual Art" (1969)

• • • • • • •

research questions What is hepatitis B? How is it spread? Is it treatable? What are the symptoms? When would I start having symptoms? How many cases are there in the U.S? How prevalent is it globally? How can it be prevented? Can I get tested in Davis? Is it free or affordable? What is liver cancer? How prevalent is it? How can I help? Where can I get more information? Why should I care? Does socioeconomic status, immigrant background, and/or language barriers affect access to hepatitis testing or treatment? What are other examples of existing materials made for non-English speakers?

“The concept and idea are different. The former implies a general direction while the latter are the components. Ideas implement the concept.“

• • • •

goals Contexualize the prevalence of hepatitis B and liver cancer in California, the United States, and globally, in comparision to the Asian American population To inform a community by representing statistical information visually to create impact through the presentation of researched data from credible sources To help raise awareness, improve understanding, promote community service in public health, and combat the stigma of hepatitis B Establish contacts for user testing and research guidance.

* Sol LeWitt, "Sentences on Conceptual Art" (1969), in Theories and Documents of Contemporary Art, eds. Kristine Stiles and Peter Selz (Berkeley: University of California Press, 1996), 826.

5


6


Mission Statement

To address the major health disparity of chronic hepatitis B between Asian Americans and the U.S. population through informational graphics, as part of a larger goal to improve people's knowledge of their health

7


introduction the need production interpretation narrative

Gathering Artifacts

schedule 8

I find it intriguing how Mary Kelly's analysis of personal objects was described as "the archaeology of everyday life," because I have always viewer archaeology as the study of old things, but according to the Webster dictionary, it is the study of human life through the analysis of materials. Since I cannot observe my parents, I talk to them instead about the kinds of materials they use for entertainment or identify as important to them. They primarily speak Vietnamese, so English is not a strong language for them. Because of this language barrier, they prefer to listen and read materials-t.v. shows, movies, music, newspapers, books, calendars- that are in Vietnamese. My mother, however, also likes to keep store ads from the mail, to see what is on sale, what their prices are, and when she can buy them. She does not read what the item is, but instead tries to match the image in the ad to the product in-store. While I only spoke to my parents, I imagine others with limited English-speaking skills are dependent on images for communication as well. Many ads, brochures, and fact sheets exist to inform the Asian and Pacfic Islander community about getting tested for hepatitis B, but I feel there is still something more that can be done, whatever form that may take besides redesigning what currently exists, in order to add more impact and immediacy. At this stage, more research is needed to find out.

WEEK 1 Preliminary research General facts about hepatitis B and Asians and Pacific Islanders Key statistics Gather and sort out sources

IDEO research method

WEEK 2 In-depth research & analysis

LOOK: Personal Inventory

WEEK 3 User testing More prototypes WEEK 4 Refinement In-class critiques & user testing WEEK 5 Fine tuning before final presentation

Hepatitis: Get Treated In many cases, hepatitis B can be managed effectively

If you think you could be infected with hepatitis B, consult your doctor immediately. If you have already been diagnosed with hepatitis B, talk to your doctor about the most effective treatment option for you. There are many factors that will affect whether you should start treatment and an open and honest dialogue with your doctor will help you make the right choice.

This is hepatitis‌ WHD_PosterVariationsjk.indd 19

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9

TEST for CHRONIC HBV!

10% of your Asian patients may be chronically infected with viral hepatitis B…

HAVE YOU IDENTIFIED THEM?

Liver cancer can be prevented. First you have to know. Who should you test for chronic HBV?

What HBV tests should you order?

What does the HBV test result mean?

• • • • • • •

Persons born in regions of high & intermediate HBV endemicity (HBsAg prevalence >2%) U.S. born persons not vaccinated or whose parents were born in regions with high HBV endemicity (>8%) Household, needle-sharing, or sex contacts of persons known to be HBsAg positive Injection drug users Men who have sex with men; persons with high risk sexual activity Patients who are HCV positive, HIV positive or on immunosuppressive therapy Persons with elevated ALT/AST of unknown etiology [For additional information on who to test go to: http://www.cdc.gov/hepatitis/HBV/TestingChronic.htm]

HBsAg and anti-HBs

(-) HBsAg and (-) anti-HBs (-) HBsAg and (+) anti-HBs (+) HBsAg and (-) anti-HBs

Websites for further information: aasld.org cdc.gov\mmwr hepb.org liver.stanford.edu sfcdcp.org sfhepbfree.org Revised January 2009 ref. MMWR 2008;57(RR-8)

VACCINATE (No immunity) IMMUNE (to hepatitis B / explain, explore possible risk behaviors)

CHRONIC Hepatitis B infection

• • • •

EVALUATE status of HBV using expert guidelines VACCINATE against hepatitis A DO SURVEILLANCE for HCC at 6-12 month intervals in at-risk patients COUNSEL Patient to: o o o o o o

Seek health care from hepatitis B experienced clinician Have household members & sex partners tested and vaccinated if appropriate Protect non-immune sex partners Avoid sharing razors, toothbrushes or personal injection equipment; clean up blood spills with bleach Cover cuts and skin lesions Minimize consumption of alcohol

HBV and Liver Cancer Facts As many as 1 in 10 Asians is chronically infected with HBV. Without appropriate monitoring or treatment, 1 in 4 will die from liver cancer or liver failure.

What is hepatitis B?

Hepatitis B is a serious infection of the liver caused by the hepatitis B virus (HBV), and can lead to premature death from cirrhosis (scarring of the liver), liver failure or liver cancer.

HBV is a global epidemic • • •

HBV and liver cancer is the greatest health disparity

2007 Physician’s Guide

to

between Asian and white Americans.

Hepatitis B a silent killer

Although a safe and effective recombinant hepatitis B vaccine has been available since 1986, HBV still kills 700,000–1 million people every year worldwide. About 1 in 20 people in the world (370 million individuals) are living with chronic HBV infection. Without appropriate monitoring or treatment, 1 in 4 of those chronically infected will die from liver cancer or liver failure. Every 30–45 seconds, one person dies from this vaccine-preventable disease.

Geographic Distribution of Chronic Hepatitis B Virus Infection – Worldwide, 2005

HBsAg prevalence ≥8% = high 2%–7% = intermediate <2% = low

Opposite page: 2009 Poster, worldhepatitisalliance.org Hep B brochure (Vietnamese), asianliver.com

Centers for Disease Control and Prevention. Available at http://www.cdc.gov/mmwr/PDF/rr/rr5416.pdf

HBV disproportionately affects Asian and Pacific Islanders (APIs) • • • • • •

Developed by the Asian Liver Center at Stanford University

3

Of all the people with chronic HBV infection in the world, approximately twothirds live in Asia, with 130 million in China alone. As many as 1 in 10 Asians and foreign-born Asian Americans is living with chronic HBV infection, compared to 1 in 1000 in the non-Asian U.S. population. Although Asian Americans make up only 4% of the U.S. population, they account for over half of the estimated 1.25 million individuals with chronic HBV infection. Liver cancer caused by chronic HBV infection is the second leading cause of cancer death for Asian men living in the United States. Liver cancer incidence is up to 9 times higher in Asian American men than in their white counterparts. Hepatitis B and liver cancer constitute the greatest health disparity between Asian and white Americans.

This page top: San Francisco Hep B Free ad & testing flowchart, sfhepbfree.org Bottom: 2007 Physicians Guide, liver.stanford.edu


introduction the need production interpretation narrative

10

Schedule

initial sources

WEEK 1 Preliminary research

Asian Liver Center, Stanford, CA San Francisco Hep B Free World Hepatitis Alliance Asianliver.com Asian Pacific Health Center, San Diego Asian American Health Initiative, Maryland Centers for Disease Control and Prevention The Office of Minority Health World Health Alliance World Health Organization National Cancer Institute California Health Interview Survey, UCLA UC Davis Cancer Center Asian American Network for Cancer Awareness National Center for Reducing Asian American Cancer Health Disparities UC Davis Shields library online databases

General facts about hepatitis B and Asians and Pacific Islanders Key statistics Gather sources WEEK 2 In-depth research & analysis WEEK 3 User testing More prototypes WEEK 4 Refinement In-class critiques & user testing

Finding connections

WEEK 5 Fine tuning before final presentation

One of the greatest hurdles I am facing is knowing where to start.I am surprised at how much material I have found concerning hepatitis B and Asian Americans, and yet I have never heard of this problem. I am using post-it notes to organize them and have rearranged them into categories. One in ten Asian Americans have chronic hepatitis B. Now the question is: where did this statistic come from?


11


introduction the need production + interpretation part 2 narrative

Information Profile

schedule 12

WEEK 1 Preliminary research WEEK 2 In-depth research & analysis Narrow down information

IDEO research method LEARN: Activity Analysis

After additional research, I am recording possible information and design elements to consider on strips of post-its and again I am rearranging them into general categories. The highlighted strips signify those that I will use in the final version. It is at this point I want to focus on the original studies behind the statistics.

WEEK 3 User testing More prototypes WEEK 4 Refinement In-class critiques & user testing WEEK 5 Fine tuning before final presentation

general info about hepatitis B


IDEO research method LEARN: Secondary Research

Hans Haacke's extensive data collection and eventual visual bar graph of gallery goer's birthplaces and residences has informed me of the idea of creating individual parts to make up a whole, as a way to organize my information. The cityscape-like form may also influence how the final version will develop. Hans Haacke, Gallery Goersâ&#x20AC;&#x2122; Birthplace and Residence Profile, 1970-71. 2005 retrospective. Photo installation,190 cards, typescript text on paper, 12.7 x 17.7 cm each, 738 b & w photographs, vintage prints, baryta paper, 12.7 x 17.7 each

additional info

possible forms and visuals

specific studies about hepatitis B among Asians and Pacific Islanders in the U.S.

13


introduction the need production + interpretation part 2 narrative

Sources of Information

schedule 14

WEEK 1 Preliminary research WEEK 2 In-depth research & analysis Narrow down information

Taking into consideration the size and format of the presentation, I chose eight studies for the final piece. I took notice that they encompass a variety of geographical areas across the U.S. as well as diversity among the Asian population. I did encounter more significant studies, but due to lack of accessibility, they were not considered.

WEEK 3 User testing More prototypes WEEK 4 Refinement In-class critiques & user testing WEEK 5 Fine tuning before final presentation

*Centers for Disease Control and Prevention (CDC). (2006). Screening for chronic hepatitis B among Asian/Pacific Islander populations—New York City, 2005. MMWR Morbid Mortal Weekly Report, 55(18), 505–509. *Chao, S., Le, P. V., Prapong, W., Su, J., & So, S. (2004). High prevalence of chronic hepatitis B (HBV) infection in adult Chinese Americans living in California. Hepatology, 40(Suppl), 717A. *Hsu, C. E., Liu, L. C., Juon, H. S., Chiu, Y. W., Bawa, J., Tillman, U., et al. (2007). Reducing liver cancer disparities: A community-based hepatitis B prevention program for Asian American communities. Journal of National Medical Association, 99, 900–907. *Lin, S. Y., Chang, E. T., & So, S. K. (2007). Why we should routinely screen Asian American adults for hepatitis B: A cross-sectional study of Asian American in California. Hepatology, 46, 1034–1040. *Lee, H., Levin, M. J., Kim, F., Warner, A., & Park, W. (2008). Hepatitis B Infection among Korean Americans in Colorado: Evidence of the need of serologic testing and vaccination. Hepatitis Monthly, 8, 91–96. *Lee, J., Lok, A. S., & Chen, J. (2010). Hepatitis B prevalence among Asian Americans in Michigan: An assessment to guide future education and intervention strategies. Journal of Community Health, 35, 534-542. *Sheikh, M. Y., Mouanoutoua, M., Walvick, M. D., Khang, L., Singh, J., Stoltz, S., & Mills, P. K. (2011). Prevalence of Hepatitis B Virus (HBV) Infection Among Hmong Immigrants in the San Joaquin Valley. Journal of Community Health, 36, 42-46. *Tsai, N. C. S., Holck, P. S., Wong, L. L., & Ricalde, A. A. (2008). Seroepidemiology of hepatitis B virus infection: Analysis of mass screening in Hawaii. Hepatology International, 2, 478–485.


H. Lee, S.-Y. Baik / Applied Nursing Research 24 (2011) e9–e15

4. Data disparities in AAPIs Although national health survey studies, including Nutritional and Health Survey Examinations (NHANES), have been conducted since the middle of the 20th century (U.S. DHHS, 1992), the health status of AAPIs is largely unknown due to the lack of reliable and valid data. The

e11

NHANES is the principal source of information about the health of the civilian noninstitutionalized population of the United States, and its data are used widely throughout the U.S. DHHS to monitor trends in illness and disability and to track progress toward achieving national health objectives. The data are also used by the public health research community for health policy analysis of such timely issues as

Table 1 Hepatitis B Virus Infection prevalence in the United States Author, Year of publication

n

Settings and ethnicity

Probability studies: NHANES II (1976–1980) and NHANES III (1988–1994) Coleman et al., 1998 NHANES IIa White (n = 16,618) Black (n = 1,488) Mexican (NA) Others (n = 895): Hispanic (77%; AAPI: 20%) McQuillan et al., 1999 NHANES IIIb White (n = 6,648) Black (n = 5,907) Mexican (n = 6,101) Others (n = 846): AAPI (56%)/AI and AN (31%) Nonprobability studies: Health fair in community setting Goodman, 1984 849 SE Asia refugees CDC, 1991 – SE Asian refugees Hann et al., 2007 6,130 Eastern United States Korean male Korean female Chao et al., 2004 1,311 CA Chinese Guane et al., 2004 5,341 Metropolitan cities Cross-sectional survey Lee et al., 2005 270 CO White (n = 82), AAPI (n = 161) CDC, 2006b 925 NY Majority born in China or Korea Hsu et al., 2007 380 MD Asian Indian (n = 89) Chinese (n = 241) Korean (n = 200) Vietnamese (n = 108) Lin et al., 2007 3163 CA/Country of birth China (n = 1,016) E Asia (n = 1,072) S Asia/PI (n = 298) United States (n = 153) Lee et al., 2008 609 CO Korean Tasi, Holck, Wong, & Ricalde, 2008 2,226 Hawaii White Chinese Japanese Filipino Pacific Islanders Others

HBsAg (+)

HBsAb (+)

0.33%

5.5% 3.6% 13.7% NA 25.3%

0.42%

4.9% 2.6% 11.9% 4.4% 19.1%

99 (11.7%) 11.7% to 15.5%

49 (87.5%)

– (8%) – (4.4%)

41.2% 40.4%

152 (11.5%) 558 (10.8%) 1 (1%) 7 (4%)

13 (21%) 97 (60%)

137 (14.8%) 36 (4.5%) 0 (0%) 13 (5.4%) 8 (4%) 7 (6.5%) Total: 8.9% 113 (11.1%) 103 (9.6%) 40 (13.4%) 1 (0.7%)

496 (53.6%) 380 (47.1%) 27 (30.3%) 108 (44.8%) 105 (52.5%) 58 (53.8%)

24 (4%)

332 (55%)

4/280 (1.4%) 42/699 (6%) 2/418 (0.5%) 14/564 (2.5%) 9/90 (10%) 1/165 (0.6%)

CA = California; CO = Colorado; MD = Maryland; NY = New York SE = South East; PI = Pacific Islander; AI = American Indian; AN = Alaskan Native. a NHANES II specimens were tested for antibody to hepatitis B surface antigen or hepatitis B core antigen and for hepatitis B surface antigen. b NHANES III specimens were first tested for antibody to hepatitis B core antigen, and positive specimens were tested for hepatitis B surface antigen and antibody to the surface antigen.

Lee, H., Baik S.-Y. (2011). Health disparities or data disparities: sampling issues in hepatitis B Virus infection among Asian American Pacific Islander studies. Applied Nursing Research, 24:2, e9-e15.

After many hours of research I come across this article which provides a now more solid jumping-off point. As a result, the research process has become much easier and faster. Previous research experience gave me the knowlege to find related articles in the reference section of each possible study.

15


introduction the need production interpretation narrative

Prototypes: sketches

schedule 16

WEEK 1 Preliminary research WEEK 2 In-depth research & analysis WEEK 3 User testing Prototypes Possible formats Color Typefaces WEEK 4 Refinement In-class critiques & user testing WEEK 5 Fine tuning before final presentation

IDEO research method TRY: Paper Prototyping

The final format is a three-fold mailer sent to residents, so I do several sketches. I write down ideas of what kind of information will be in the inside spread and how they will be represented visually. I finally settle on a survey of studies spread horizontally next to each other, similar to Hans Haacke's residence profile. Once I begin digital prototypes, I will have a more confident idea of the proposed format. and the narrative I want to portray.


17


introduction the need production interpretation narrative

Prototypes: the graph

schedule 18

WEEK 1 Preliminary research WEEK 2 In-depth research & analysis WEEK 3 User testing Prototypes Possible formats Color Typefaces WEEK 4 Refinement In-class critiques & user testing WEEK 5 Fine tuning before final presentation

I first begin with the design of one graph, which derives from a study that reveals how many people had tested positive for hepatitis B in the San Francisco Bay Area. Here I show the progression from the first sketch to the final design. With the layers of information that needed to be conveyed, several steps are necessary to get to the end result.


area of focus and condensed source

19

caption detailing other interesting conclusions or statistics from study

I consider stroke width and color to bring information forward or back.


introduction the need production interpretation narrative

Prototypes: 1st page

schedule 20

WEEK 1 Preliminary research

IDEO research method ASK: Narration

WEEK 2 In-depth research & analysis WEEK 3 User testing Prototypes

The first third of the spread is the most difficult section solve. Struggling to identify what information to include, prior to user testing, I intentionally exclude information or present it unclearly to better understand what users want to know or clarify further.

main statement meant to tie studies together

Possible formats Color Typefaces WEEK 4 Refinement In-class critiques & user testing

percentage difficult to decipher

WEEK 5 Fine tuning before final presentation

white stroke divides each study


21

Position of 3.6 does not clearly relate to the graph. User testing also reveals that the large condensed numbers need to be tied more directly to the main statistic and to the graphs to clarify their meanings.

What do these lines mean?


introduction the need production interpretation narrative

Color and type

schedule 22

WEEK 1 Preliminary research

IDEO research method LEARN: Secondary Research

WEEK 2 In-depth research & analysis WEEK 3 User testing Prototypes Possible formats Color Typefaces WEEK 4 Refinement In-class critiques & user testing WEEK 5 Fine tuning before final presentation

Nicholas Felton, The 2010 Feltron Annual Report

Nicholas Felton is a large inspiration for the overall design, but I did not try to mimic him. I took after his clean and refined approach to data, but carefully chose the color, typefaces, line strokes, and bar length and width according to what is most appropriate to the information.


Univers Light Ultra Condensed 28 pt

Nobel Light Italic 7/9.5

23

Garamond 10/12

Nobel Regular 7/10

Nobel Light 7/9.5 Nobel Regular 18/25


introduction the need production interpretation narrative

Prototypes: full spreads

schedule The final format would be mailed to residents, with the shown spread in the inside. To limit the focus of the project, the outside of the mailer when folded was not crucial. Assuming this becomes a regular correspondence to residents, the outer design would remain consistent, while the inside information varied according to topic. My intention for the mailer is to helpt bridge the gap between people and their access to health information.

WEEK 1 Preliminary research WEEK 2 In-depth research & analysis WEEK 3 User testing Prototypes WEEK 4 Refinement In-class critiques & user testing WEEK 5 Fine tuning before final presentation

12" wide

Number of participants

Hawaii

California

San Joaquin Valley, CA

San Francisco Bay Area

Colorado

Michigan

Maryland

Results from TSAI ET AL., 2008. Tested 3989.

Results from CHAO ET AL., 2004. Tested 1311 Chinese.

Results from SHEIKH ET AL., 2010. Tested 534 Hmong.

Results from LIN S. ET AL., 2007. Tested 3163.

Results from LEE ET AL., 2008. Tested 609 Koreans.

Results from: LEE J. ET AL., 2008. Tested 567.

Results from HSU ET AL., 2007. Tested 380.

28

9 3

33.3

7

25.0

11.5

152

1072

298

153

15

609

609

8.9

16.7

4.0

306

27

52

11.1 9.6

26

4.0

24

5.5

290

69

10

14.8

121

10 17 2

3.8 2.2

1

Korean

Hmong

Chinese

Korean

Other

Asian Americans born in East Asia, Southeast Asia, or the Pacific Islands were 19.4 times more likely to be chronically infected than those born in the United States.

6.5 5.4 4.0

13

7 8

13

4.6

3

0

0 Unknown

SE Asia/Pacific

China

United States

1 East Asia

Other

No response

Laos

Thailand

United States

Chinese

Pacific Islander

Filipino

Vietnamese

4.5

566

3

11.1

103

0.7 Country of birth

Results from CDC, 2006. Tested 925.

108

40 113

4.3 1

Other Asian

Japanese

Ethnicity

200

21.4

13.4

7

8 3

241

69

11.3

29

5

White

2.8 1.4

89

53

5.8

7.8 85

5.8 4.7

129

0 Korean

16.4

12

1016

3

20.0

10.7

15

Other Asian

11.5

62

U.S. born Asian

3.6

420

Chinese

1311

112

Korean

1% In the U.S., an estimated 10% of foreign-born Asian and Pacific Islander Americans have chronic hepatitis B, compared with less than 1% in the overall population.

80

Vietnamese

169

Chinese

1029

Asian Indian

517

Other Asian

1477

Vietnamese

361

New York City

10" tall

Percent of participants who tested HBsAg-Positive

Chinese

24


36" wide tri-fold

12" wide as mailed

25

arranged from West Coast states

to East Coast

Asian Americans born in East Asia, Southeast Asia, or the Pacific Islands were 19.4 times more likely to be chronically infected than those born in the United States.

Hawaii Results from TSAI ET AL., 2008. Tested 3989.

California

San Joaquin Valley, CA

San Francisco Bay Area, CA

Colorado

Michigan

Maryland

Results from CHAO ET AL., 2004. Tested 1311 Chinese.

Results from SHEIKH ET AL., 2010. Tested 534 Hmong.

Results from LIN S. ET AL., 2007. Tested 3163.

Results from LEE ET AL., 2008. Tested 609 Koreans.

Results from: LEE J. ET AL., 2008. Tested 567.

Results from HSU ET AL., 2007. Tested 380.

New York City Results from CDC, 2006. Tested 925.

Total number tested 420

28

9 3

33.3

7

25.0

153

15

609

609

8.9

306

27

52

11.1 9.6

5.8

26

4.0

5.5

24

290

69

4.5

10

14.8 121

10 17 2

3.8 2.2

1

6.5 5.4 4.0

Korean

Hmong

Chinese

Korean

Other

13

7 8

13

4.6

3

0

0 Unknown

SE Asia/Pacific

China

United States

1 East Asia

Other

No response

Thailand

Laos

United States

Chinese

Other Asian

Pacific Islander

Filipino

Japanese

566

3

11.1

103

0.7 Country of birth

108

40 113

4.3 1

Vietnamese

White

Ethnicity

200

21.4

13.4

7

8 3

241

69

11.3

29

5

Chinese

2.8 1.4

89

53

4.0 7.8

85

5.8 4.7

129

0 U.S. born Asian

152

298

Korean

16.4

11.5

12

1072

16.7

Number who tested

10.7

1016

3

20.0 Percent of participants who tested HBsAg-Positive

15

Other Asian

11.5

62

Chinese

3.6

1% In the U.S., an estimated 10% of foreign-born Asian and Pacific Islander Americans have chronic hepatitis B, compared with less than 1% in the overall population.

1311

112

Korean

80

Chinese

169

Vietnamese

1029

Asian Indian

517

Other Asian

1477

Vietnamese

361

Asian Americans born in East Asia, Southeast Asia, or the Pacific Islands were 19.4 times more likely to be chronically infected than those born in the United States.

Hawaii Results from TSAI ET AL., 2008. Tested 3989.

California

San Joaquin Valley, CA

San Francisco Bay Area, CA

Colorado

Michigan

Maryland

Results from CHAO ET AL., 2004. Tested 1311 Chinese.

Results from SHEIKH ET AL., 2010. Tested 534 Hmong.

Results from LIN S. ET AL., 2007. Tested 3163.

Results from LEE ET AL., 2008. Tested 609 Koreans.

Results from: LEE J. ET AL., 2008. Tested 567.

Results from HSU ET AL., 2007. Tested 380.

New York City Results from CDC, 2006. Tested 925.

Total number tested 361

1477

517

1029

169

80

3.6

1%

420

11.5

62

28

9

15

1016

1072

298

153

15

8.9

16.7

33.3

25.0

609

609

306

27

52

129

89

53

4.0

241

200

108

5.8

Percent of participants who tested HBsAg-Positive

566

290

69

4.5

10

14.8

21.4

20.0 16.4 13.4 11.3

11.5

10.7

11.1

11.1 9.6

7.8 5.8 4.7

4.3

2.8 1.4

3.8 2.2

4.6

U.S. born Asian

Other Asian

Korean

Chinese

Vietnamese

Korean

Chinese

Asian Indian

Other Asian

Vietnamese

Korean

Hmong

Chinese

Korean

Unknown

Other

United States

SE Asia/Pacific

China

East Asia

No response

Other

Thailand

Laos

Country of birth

United States

Chinese

Other Asian

Pacific Islander

Filipino

Japanese

Vietnamese

White

Ethnicity

6.5 5.4 4.0

5.5

4.0

0.7 Chinese

In the U.S., an estimated 10% of foreign-born Asian and Pacific Islander Americans have chronic hepatitis B, compared with less than 1% in the overall population.

1311

112


introduction the need production interpretation narrative

The Narrative

26

Asians comprise 42% of the total population of Hawaii. Of the stateâ&#x20AC;&#x2122;s 212,229 foreign-born

A snapshot of Asian American & Pacific Islander Health: Hepatitis B The following studies done across the country at participating health fairs and clinics have shown that Asian Americans and Pacific Islanders (AAPIs) are at high-risk of being infected with chronic hepatitis B.

residents surveyed in 2000, 73% were born in

More than one-third of Hmong who w

countries where hepatitis B is highly common,

infected have no primary care physicia

including China, Vietnam, the Philippines, and

nearly 92% of them were born outside

the South Pacific Islands.

United States.

Hawaii

California

San Joaquin Valley

Results from TSAI ET AL., 2010. Tested 3989 from July 2003 to April 2006.

Results from CHAO ET AL., 2004. Tested 1311 Chinese.

Results from SHEIKH ET AL., 2010. T

Total number tested 361

1%

1477

3.6

517

1029

169

80

1311

112

11.5

%

of all participants tested HBsAg-Positive*

Less than 1% of the U.S. population have chronic hepatitis B.

420

33.3

%

of all participants tested HBsAg-Positive

25.0

62

28

9

16.7

%

of all participants tested HBsAg-Positive

20.0

Early diagnosis of hepatitis B can reduce the risk of transmitting the virus, and prevent cirrhosis, liver failure or liver cancer.

16.4

An estimated 10% of foreign-born AAPIs in the U.S. are infected.

11.3

11.5

10.7

5.8 4.7

*HBsAg is the marker that detects the hepatitis B virus.

Other

Thailand

United States

Country of birth

Laos

Chinese

Pacific Islander

Other Asian

Filipino

Vietnamese

Japanese

Ethnicity

Chinese

For more information visit: Hepatitis B Foundation: hepb.org American Association for the Study of Liver Diseases: aasld.org Centers for Disease Control and Prevention: cdc.gov/mmwr Asian Liver Center: liver.stanford.edu

White

2.8 1.4


I had goals at the beginning of this project, but part of the way through, I realized I also wanted to tell a story no one has read before and will learn something new from it. Multiple readings are meant to be extracted, whether you are a close reader or someone who is just interested in the broadest sense. The process I derived from Mary Kelly was intended to build this narrative from hidden artifacts only a few people were aware of.

27

During this study over the course of 3 years, there More than one-third of Hmong who were

This study also shows that Asian Americans born

are still many Asian Americans who are very

infected have no primary care physician, and

in East Asia, Southeast Asia, or the Pacific Islands

reluctant to participate in clinical studies, even

The prevalence among participants in the

nearly 92% of them were born outside of the

were 19.4 times more likely to be chronically

when HBV screenings are free, calling for more

screening program was approximately 35 times

United States.

infected than those born in the U.S.

effective culturally-tailored education.

that of the overall U.S. population.

nia

San Joaquin Valley, CA

San Francisco Bay Area, CA

Colorado

Michigan

Maryland

CHAO ET AL., 2004. Tested 1311 Chinese.

Results from SHEIKH ET AL., 2010. Tested 534 Hmong.

Results from LIN S. ET AL., 2007. Tested 3163 total.

Results from LEE ET AL., 2008. Tested 609 Koreans.

Results from: LEE J. ET AL., 2008. Tested 567 total.

Results from HSU ET AL., 2007. Tested 380 total.

Total number tested 420

33.3

25.0

62

28

9

1016

1072

298

153

15

609

306

129

89

53

of all participants tested HBsAg-Positive

241

200

108

566

69

10

%

%

of all participants tested HBsAg-Positive

290

14.8

4.5

%

%

of all participants tested HBsAg-Positive

52

27

5.8

4.0

%

%

of all participants tested HBsAg-Positive

Results from CDC, 2006. Tested 925 total. Total number tested

8.9

16.7

of all participants tested HBsAg-Positive

of all participants tested HBsAg-Positive

21.4

20.0 16.4 13.4 11.3

11.1

11.1 9.6

7.8 4.3

6.5 5.4 4.0

5.5

4.0

3.8 2.2

4.3 4.6

U.S. born Asian

Other Asian

Korean

Chinese

Vietnamese

Korean

Chinese

Asian Indian

Other Asian

Korean

Vietnamese

Hmong

Chinese

Ethnicity

Korean

Other

United States

SE Asia/Pacific

East Asia

China

Other

Country of birth

Thailand

0.7 United States

%

ants g-Positive

Laos

5

New York City


introduction the need production interpretation narrative

Next Steps Next steps would include user testing from stakeholders and persons involved in hepatitis B awareness programs. This project can further be expanded to include broader topics in health that people can receive regularly in the mail. This was not my intention in the beginning, but now the need is more about bringing general health information to people that they are unaware of, but can be helpful to them through visually informative design. Similar to Mary Kelly, I had almost an obsessive relationship to the studies I researched in order to interpret them in simplified terms. Translating these materials into different languages and adapting them into an online interactive medium will further bridge the gap between people and information.

28

San Francisco Hep B Free Campaign

Hepatitis B Infection Status

summary of organization

Based on reports from the SFHBF testing and

method The data at right provides a summary of selected demographic and health-related characteristics of clients who tested for hepatitis B at seven standalone SF Hep B Free sites during the first two years of the campaign. The sites only represent a small subset of individuals and do not include those who visited their own health care provider as a result of SFHBF. Following the campaign’s goals, the clients were mostly of Asian or Pacific Islander background, but still included a wide range of ages, ethnicities, languages, and immigration histories, and included the insured and uninsured, thus meeting the objective of ensuring access to testing, vaccination, and treatment for all individuals.

Total clients

vaccination sites, of the nearly 2,000 clients

Up to two-thirds of clients with chronic hepatitis

found to be susceptible, 52% received at least

B were previously unaware of their infection.

the first shot of hepatitis B vaccine, and 49% of

Reports state 69% of infected clients were

these completed the three-shot vaccine series.

enrolled in follow-up clinical care.

2,227 Immune

1,962 Susceptible

238 Infected

Tested anti-HBs+ and HBsAg−

Tested anti-HBs− and HBsAg−

Tested HBsAg+

The following list includes 40 organizations who participated as active partners in monthly meetings to plan strategies, implement activities, share resources and best practices, report on progress, and request assistance when needed.

newspaper public service announcments (PSAs)

55% Chinese

4427 Total

television PSAs

80% Asian/Pacific Islander 56% Chinese

51% Chinese

73% Chinese Race/Ethnicity

Race/Ethnicity 82% Asian/Pacific Islander

75% Asian/Pacific Islander

95% Asian/Pacific Islander Age

Age 18-30

31-40

41-50

51-60

61+

18-30

31-40

41-50

51-60

61+

18-30

31-40

40% Male

51-60

61+

53% Male Region of birth

Region of birth 45% East Asia

39% East Asia

63% East Asia

58% East Asia

54% East Asia

71% East Asia

59% East Asia

57% East Asia

74% East Asia

54% Asian language only

46% Asian language only

80% Asian language only

37% No

36% No

52% No

49% No

44% No

65% No

Mother’s region of birth

Mother’s region of birth

Father’s region of birth

Father’s region of birth

Primary language

Primary language

Have current health insurance

Have current health insurance

Have current medical provider

An additional design if part of a series of mailers about hepatitis B

41-50

Sex

Sex 36% Male

280 488 62 1240 72 63 260,000 bilboards & bus panels

Have current medical provider

Alison Public Relations, American Legion Cathay Post 384, American Liver Foundation, Asian Health Foundation, Asian Liver Center at Stanford University, Asian & Pacific Islander Health Parity Coalition, Asian Pacific Islander Wellness Center, AsianWeek Foundation, Brown & Toland Physicians Group, California Pacific Medical Center, Catholic Healthcare West, Chinatown Public Health Center, Chinese American Physicians Association, Chinese Community Healthcare Association, Chinese Hospital, City College of San Francisco, DAE advertising, Excelsior Health Services, Glide Health Services, interTrend Communications, Inc., Kaiser Permanente San Francisco, Laotian American National Alliance, Miss Asian American Pageant, NICOS Chinese Coalition, Niwa Public Relations, North East Medical Services, Office of Mayor Gavin Newsom, Office of California Assemblywoman Fiona Ma, Saint Francis Memorial Hospital, San Francisco Board of Supervisors, San Francisco Community Clinic Consortium, San Francisco Department of Public Health, San Francisco General Hospital Liver Center, San Francisco Giants, San Francisco Hep B Collaborative at Berkeley, San Francisco Hospital Council, San Francisco Medical Society, San Francisco State University, South of Market Health Center, St. Luke’s Hospital, St. Mary’s Medical Center, St. Anthony’s Free Medical Clinic, Subaru of America, Sunset Health Services, Sutter Health, University of California, San Francisco Liver Center, University of California, San Francisco Hepatitis B Collaborative, University of California, San Francisco Vietnamese Community Health, Promotion Project, Walgreens

radio PSAs

newsletters

website banners & advertisements

readers reached through email


Eva Hesse Untitled Statement (1968)

â&#x20AC;&#x153;What I want of my art I can eventually find. The work must go beyond this. It is my main concern to go beyond what I know and what I can know.â&#x20AC;?

* Eva Hesse, untitled statement (1968), in Theories and Documents of Contemporary Art, eds. Kristine Stiles and Peter Selz (Berkeley: University of California Press, 1996), 594.

29


Christy Bui DES 191c Designing Information Prof. Susan Verba Spring 2011 UC Davis

Workbook typeset in Myriad Pro & Minion Pro Designed by Robert Slimbach at Adobe Systems


Hepatitis B Informational Graphics