Using Medical Illustration to Improve Understanding and Communication of Skin Neglected Tropical Diseases

Neglected tropical diseases related to the skin (skin NTDs) are a significant public health problem in Africa, which have disabling and life changing consequences. Poignantly, the skin NTDs Buruli ulcer (BU) and yaws can be treated early with antibiotics, which can prevent the severe stages from developing. Healthcare workers (HCWs) that include trained community members who operate at the front line of health care, need clear guidance to help early disease detection through identifying potential cases that can then be referred to specialist clinics. Currently such guidance is usually in the form of photographs. One drawback of this approach is that people using them tend to try and pair up the clinical lesions with the photo rather than using them to think through the detection process. Hence, there is an opportunity for medical illustrations to give the most benefit when used at the initial stages of detection and health care. Thus, it is the intention that supplementing photography methods with professional medial illustrations will help to distinguish disease features that are not always obvious within a photograph. This thesis consists of three empirical studies using a multi-method, qualitative and quantitative approach. Study 1 involved discussion with skin NTD experts at the World Health Organization (WHO), Geneva, to develop a set of medical illustrations based upon their feedback concerning medium preference, usefulness, and clinical accuracy. This resulted in a set of clinically approved medical illustrations ready for use in the field and by the medical profession. Study 2 tested whether these illustrations could enhance the detection of Buruli ulcer by designing a survey that randomised participants to an educational visual guide that had photographs alone or photographs with illustrations. The visual guides were assessed by a sample of student health care professionals (n = 26) and showed no difference for detection, but the students provided useful feedback about the usefulness of both illustrations and photographs. To complete the project, study 3 used a qualitative Think Aloud design to explore HCWs in Ghana experiences of managing BU and the role of the five senses. The results describe the development of new illustrations incorporating the five senses, the findings from which act as a guide for the five senses to be used in practice by medical illustrator practitioners. Taken together the results from this thesis have demonstrated the possibility of establishing an illustrative method to support BU case detection and management, supporting low-resourced interventions for these underfunded diseases, with the first set of clinically approved medical illustrations of BU worldwide. Finally, it has provided key information for the medical artist profession on the creation process for medical illustrations with cultural preferences and skin NTDs on dark skin, and the illustration medium. An innovative illustration method has been established using the five senses to provide a 5-dimensional perspective (coined ‘5D’) for health education.