Creating trauma-informed content

How has your background shaped your work?

I studied English at university, with plans to write a great novel. Instead, my first job was in reference services at the National Library in Scotland.

I spent 14 years at the Scottish Parliament, in roles including internal comms, public engagement, finally, senior content designer. My job was to help make sure the website reflected what people needed and their user journeys rather than the organisational structure. I hadn’t heard of content design but when I started, I realised I’d been doing it for years.

After that project ended, I moved into consultancy and eventually  joined Content Design London – the mothership of content design – in 2022.

What’s different about content design for health information?

All public service information has to consider people’s potential emotional state, but this is especially true for health. I worked on a project for people who had experienced abuse in care. At the time, people were applying trauma-informed principles and practice to face-to-face interactions, and I got thinking about how this should play across to written communication.

Trauma can act as a cognitive impairment. It lowers your brain function, making it harder to take in information. Your audience may already be disadvantaged – for example, with lower literacy levels or situational disabilities (like having to read information off their phone in a busy doctor’s office). And health content is going to trigger adrenaline and cortisol that then lower their reading age even further.

This year I experienced this in person, when my 14-year-old became ill with non-Hodgkins lymphoma. The cancer was stage 4 so she was taken into hospital the same day, had very aggressive chemo and was an inpatient for several months. It was one of those classic ‘life changes overnight’ moments.

Sitting by my daughter’s bed, I was living the experience but could also take a detached view of what was happening. I’d been talking for years about stress and content, and now it was actually happening to us. I learned the importance of mobile-optimised content and of subtitles or transcripts so that she didn’t hear me watching videos about her condition.

Today, she’s in remission, gradually getting stronger and doing a lot of activism and fundraising, although the end of treatment is also hard, with the ongoing worry of whether it comes back and the longer-term effects of the chemotherapy drugs. So it doesn’t end.

What is the most important principle for you when developing health content?

There’s an explicit connection between content design and human rights. Everybody’s got a right to information that they can understand, in a format that they can use, so we can all have a say in decisions that matter to us.

And we need to incorporate trauma into that.  People come to health content when they’re scared, nervous, stressed or have already experienced a trauma. We need to help them as much as we can – not by adding extra words and platitudes, but by making it clear and easy to do what they need to do or understand.

I’d recommend listening to the NHS content episode of Michael Rosen’s Word of Mouth on BBC Radio 4, where consultants are encouraged to word letters for patients rather than to the other doctors.

What are the biggest misconceptions you see in your work?

That health information is ‘one size fits all’. We need to separate it out into trauma and post-trauma content. In the moment of crisis, you need clear, directive language explaining what you need to do now. Post-trauma is where you need to start bringing in the softer, more supportive content. When my daughter was in hospital, I couldn’t even understand simple signage. Now, a few months on, I want that understanding, sympathy and softness.

So, for each piece of content, you have to really understand where the person is on their journey.

What’s on the horizon for you?

I’m spreading awareness about the book. The beautiful thing is that since I started writing and talking about trauma-informed content, loads of other people have started to as well. So now, instead of just me and my experience, it includes 15 different people explaining how to develop trauma-informed content for children and young people, crisis communications, government comms and more.

So for the time being I’m enjoying sharing that, while working on some content design projects and spending time with my family.

Three tips from Rachel:

1. Think about your audience’s context when they access your information. You might be sitting in your office with a cup of tea, but they may be unwell, terrified, or holding a screaming child. All that changes how they can take in information.

2. Tailor information to the stage of the person’s journey. When you’re in crisis, you need really clear, simple instructions. You may need the softer, supportive stuff too, but that comes later.

3. Don’t use a content warning as a disclaimer. If you want to be trauma informed, think about what choices you can give someone about when and how they access your content. That’s going to help them more than a one-line statement at the top of the page.

Head and shoulders portrait of a woman with grey hair, denim shirt and glasses.
1920 1920 Articulate Health
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