In the Empowering Nurses to Empower Their Patients project, 8D collaborates with the University of Twente, Isala Clinics, and Windesheim University of Applied Sciences to address a pressing healthcare issue: how can we support healthcare professionals in recognising limited health literacy among patients? And just as crucial: how do we ensure that existing knowledge actually makes its way into their daily routines?
People with limited health literacy often struggle to understand information about their condition or treatment. They may fail to follow instructions, miss critical details, or avoid care altogether due to uncertainty or fear. This is often linked to limited digital skills or low literacy levels, which aren’t always immediately visible. The consequences? Misunderstandings, medication errors, missed appointments, or low adherence to treatment; ultimately leading to poorer health outcomes and increased healthcare costs.
Healthcare professionals don’t always pick up on these signals. Not due to unwillingness, but because of time pressure, lack of training, or simply the absence of practical tools. Meanwhile, research has produced extensive frameworks and guidelines to help identify low (digital) health literacy and improve communication. But how do you bring that knowledge into a work environment where even taking a break is a rarity?
By the time 8D joined the project, a solid foundation had already been laid. In earlier co-creation sessions, nurses, researchers, and students explored how to translate academic insights into practical tools. The outcome: the concept of a card set with concrete assignments that nurses can use during their shifts – accessible, applicable, and grounded in both research and real-world experience. A seemingly simple solution that turned out to be surprisingly complex once we began to develop it in detail. And that’s exactly what made it so compelling. Because how do you design something that doesn’t just contain the right information, but also fits seamlessly into the everyday context of its users?
Together, we explored a wide range of practical and strategic design questions:
Is the card too small to fit enough information? Too large, and it ends up forgotten in a drawer instead of slipping into a uniform pocket. Should it be used in teams or individually? We want it to work for both nurses and vocational students… but what does that mean for tone, format, and accessibility? Is that even feasible, or desirable?
What about adding a QR code to link to more information? Great idea – until someone pointed out that hospital phones often can’t scan them. And perhaps the most pivotal question of all: are we developing a research prototype, or aiming for a scalable product that could be used across different hospitals? That choice influences every design decision that follows.
8D mapped out all these questions and helped the consortium make informed choices through co-creation and critical design thinking. These aren’t minor details – they shape the entire design trajectory and determine the product’s relevance, usability, and long-term impact. By visualising the available options and clarifying their implications, we helped guide well-informed decisions about context, depth of content, and strategic direction. Lastly, we didn’t just design the card set – we also created a flexible system around it. The base template we developed allows researchers to easily add new content, expand the set, and print new editions. Not just a PDF and “good luck,” but a foundation for continuous development, further research, and broad implementation.
ENEP is a powerful example of design as a strategic thinking tool: not just about delivering a polished end product, but about steering the process through co-creation, critical questioning, and making abstract decisions tangible. The project is still in development. The card set is currently being tested in healthcare settings, and an adapted version for vocational nursing education is underway. Want to know more? Get in touch with giel@8d.nl
Giel likes to think along!
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