Close up of two hands. One is holding the hand of a patient in a hospital bed for support.

Living with RA

Context

Rheumatoid Arthritis is an invisible condition that causes joint pain and inflammation. It’s a chronic autoimmune disease and people with RA are often on drugs to limit the progression of the disease for much of their life. It’s a long-term condition and can have a lasting impact on both mental and physical health.

See NHS information on RA
CDL (Content Design London) logo

This project was researched and completed during a 2-day Content Design course with CDL (Content Design London).

My role

As the sole content designer for this study project I followed these steps:

  1. Completed desk-based research
  2. Gathered language insights
  3. Constructed a user journey and user stories
  4. Organized content into clear sections and defined content hierarchy
  5. Wrote copy for the whole page with a focus on clarity and plain English
  6. Tested the content for readability and against user stories

Challenge

Write a comprehensive and factual web page for a UK-based ‘Living with RA’ website, addressing the concerns of women who have Rheumatoid Arthritis and want to start a family.


Research

Desk-based research

We were given a short amount of time (just 30 minutes!) to complete desk-based research into our chosen subject. Time was spent beforehand talking about various tools that could help, the first of which was as simple as… Google!

The Google search engine values:

  • relevant content
  • popular content
  • authority

So, it seemed like a good place to start.

Google’s ‘people also ask’ section provided valuable insight. It shows clearly the questions people are asking and, in this case, highlighted some concerns they typically have. High on the list were concerns about a greater risk in pregnancy.

People also ask: Will RA affect pregnancy? Does RA cause high-risk pregnancy? What helps RA whilst pregnant?

The related searches section showed many of the same concerns, as well as signposting where people went for information. This included forums, blogs as well as NHS and guidelines.

Google related searches. Key words highlighted are High-risk, NHS, Guidelines, Forum and Blog.

Terminology

I then considered the language commonly used when talking about Rheumatoid Arthritis online. My research into the disease raised questions about the suitability of the word ‘arthritis’. It seemed many preferred the term ‘Rheumatoid Disease’. Debate raged in healthcare forums, with posters saying they felt dismissed by friends and family that didn’t understand the impact the disease had on their life. Many regard it as ‘a few aches and pains’ and ‘an old person issue’, confusing it with Osteoarthritis. I tested which term was most used and recognised, in order to improve the reach of the article.

A quick look at Google trends made it very clear that the term Rheumatoid Arthritis is used far more commonly than Rheumatoid Disease. This was backed up by the difference in search results for both terms. Rheumatoid Disease and pregnancy delivered 34,900,000 results, compared to 53,600,000 for Rheumatoid Arthritis.

Google search results. 34,900,000 results for Rheumatoid Disease and pregnancy.
Google search results. 53,600,000 results for Rheumatoid Arthritis and pregnancy.
Line graph showing search interest relative to the highest point on the chart for the given region and time. A high volume of searches for Rheumatoid Arthritis is shown (between 50 and 100) and minimal searches for Rheumatoid Disease (fewer than 10 over time).

Looking at the language

I used healthcare forums (My RA Team and HealthUnlocked) to examine the tone and vocabulary used in this space. They clearly illustrated the many acronyms and abbreviations often used. Some were related to drug treatments (MTX, DMARDS, Meds) and some to co-occurring issues or similar conditions (MI, RSI).

Forum posts clearly showed the depth of feeling on this subject. The language used was highly emotive. So much fear. Fear of miscarriage, fear of pain and repeating history, passing the disease on to their children. I gained a clearer view of the concerns and the state of mind of these women. They may well be distressed, definitely concerned and wanting definite answers.

Recurring forum questions were:

  • Will my disease or medication affect my baby’s development?
  • Will my symptoms worsen during pregnancy?
  • Will arthritis affect my delivery?

Another common complaint was not feeling heard by professionals, or given enough time to fully discuss concerns.

Forum posts clearly showed the depth of feeling on this subject. The language used was highly emotive. So much fear.

Fear and misinformation

Next, I reviewed keyword suggestions provided by the Moz SEO keyword explorer. As expected, many of these suggestions were highly emotive and related to the fears that future parents would have. There was also some misinformation and misunderstanding about the possible dangers, which are important to address.

Some examples were:

  • rheumatoid arthritis pregnancy complications
  • rheumatoid arthritis during pregnancy symptoms
  • rheumatoid arthritis treatment in pregnancy
  • will rheumatoid arthritis affect pregnancy?
  • does rheumatoid arthritis cause high-risk pregnancy?
  • what helps rheumatoid arthritis while pregnant?
  • rheumatoid arthritis and pregnancy medication
  • can people with rheumatoid arthritis have children?
  • why does rheumatoid arthritis cause stillbirth?
  • is it safe to get pregnant with rheumatoid arthritis?
  • is it hard to get pregnant with rheumatoid arthritis?

It was clear that answering these questions, and correcting the misinformation, was a priority.


User journey

Using post-it notes, I created a quick user journey. This helped me to piece together, and better understand, the end-to-end journey taken by the user. People they’ve had contact with in-person (busy Rheumatologist, consultant, midwife etc) at each stage, and any follow-up questions they may have.

Considering the volume of information and questions, and changing concerns of the user throughout the journey, I chose to split the information into clear sections based on the user, and pregnancy journey. Avoiding information overload on one page.

We’re all only human and naturally concerned with what’s coming up next. Always looking to the future, particularly when there is fear involved. With that in mind, I chose to focus my article on those planning and hoping to start a family. As that’s what the majority of search results and forum posts were concerning.

Section of a user journey: colourful post-its on a table.

Job stories and acceptance criteria

Now that the focus of the article had been narrowed down to the early ‘pregnancy planning’ stage, job stories were created based on common concerns discovered through the research.

Job story: When I am thinking of starting a family, I want to find out what impact my RA may have on a future pregnancy, so that I can plan ahead. This story is done when I understand how the disease could affect a pregnancy.
Job story: When I am considering starting a family, I want to find out if my RA drugs are safe for pregnancy, so that I can talk to a professional and change them if I need/want to. This story is done when I know what RA drugs are safe to take in pregnancy.
Job story: When I am thinking about having children, I want to know if my disease is hereditary, so that I can make an informed decision. This story is done when I understand if the disease could affect my future children.

Writing

Using job stories enabled me to focus my writing where I felt it would be most useful. They provided structure and a sort of checklist so that I knew I’d covered what was necessary.

I found the language discovery really valuable. It helped me to consider the tone, style and structure of the article, being sure to explain abbreviations as necessary.

The section detailing common RA drugs and their suitability for pregnancy includes icons to help readers to get information quickly. These icons are colour coded, but the use of icons and colour together should improve accessibility for people with limited vision or colour vision deficiency.

Read the article on Google docs

At a highly emotional time, providing clear information in a format that’s easy to read is so important.

Result

The article was researched and written by myself and is fundamentally a learning project. It won’t be published online. Because of that, I don’t have metrics or data for comparison or to prove ROI.

What I can say with confidence is:

  • the structure of the article is clear and addresses user concerns at the time they need it
  • it answers common questions that women with RA have
  • the content is clear, readable and written in plain English

This project helped me to understand the content design process, and the steps you can take to improve your content, making it more human-centred.

The purpose of the article is to be informative, rather than conversational. It’s clear and factually accurate, with a view to avoiding misinformation and scaremongering. At a highly emotional time, providing clear information in a format that’s easy to read is so important.

Comparing my article with one on the same subject from NRAS (National Rheumatoid Arthritis Society) using Hemingway App, I was pleased to see that it scored highly with a grade 8 for readability. Although that’s not a direct comparison, it was a pleasing result.

Screengrab of Hemingway readability app showing grade 8 readability for my article, compared to grade 12 for the published NRAS article..

What would I do differently?

Despite my best research efforts, I was working alone on this and the article is the result of my work only. I have no doubt it could be improved with input from a subject-matter expert.

Note. This was originally written in January 2020, before the launch of the Versus Arthritis rebrand and their powerful TV ads, which aired in October 2020. They would be considered the experts in this subject at the point of writing this case study, meaning my article may not even be needed.

Photo by Jon Tyson on Unsplash