Communicating the environmental health risk assessment process: formative evaluation and increasing comprehension through visual design.

The environmental health risk assessment process informs clean-up activities at hazardous waste sites. Ensuring this process is accessible and transparent to communities is crucial for environmental health literacy initiatives. The goals of this project were to develop plain language and effective visuals that can be used when communicating the risk assessment process and methods used to predict excess cancer risk(s) due to environmental exposures. In this study, a community factsheet entitled, "Understanding Environmental Health Risk Assessment" was developed and a participatory design and formative evaluation approach was implemented with a set of representative users (n = 11). Community members living in the vicinity of two Arizona hazardous waste sites as well as three public health professionals/researchers were asked to evaluate the functionality and accessibility of the factsheet, particularly the graphics and whether the text was written in plain language. Participant responses revealed the following major findings: 1) form follows function, 2) graphic elements should outweigh text, 3) line of sight and layout is critical to information accessibility, 4) color coding dramatically aids the reader, 5) content should be strategically grouped, 6) concepts per figure should be minimized to ensure comprehension, 7) interactive content is preferred over static content, and 8) communication efforts need to interweave new information with the targeted audience's past and current environmental health understandings to aid in their ability to retain new concepts. Based on participant feedback, new and improved layout decisions, infographics and accompanying text were designed and prepared. This research demonstrates the need and importance of participatory design, information design prototyping, formative evaluation, and a cultural model of risk communication.