What to include in a job aid

When you’re building a job aid, pay attention to how you present and structure the information. Job aids don’t usually explain why to do something; they guide the performer about when and how to do something.

I want to highlight features that nearly every job aid out to have. I’ll use some closeups from a job aid I’ve featured on the Ensampler: How to Do the Rapid Test for Malaria. It guides people as they conduct rapid-diagnostic tests for malaria.

(Although I’m discussing features in general, you can click here to open a copy of the entire job aid in a new window.)

By the way, this is a fairly large job aid; it’s meant to avoid page-turning and could easily be a poster mounted so that the tester can view it while conducting the test. Notice that “avoid page-turning” doesn’t mean “keep to a single 8.5 x 11 page.” Not every job aid has to fit into a 3-ring binder.

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A clear, task-focused title

rtm01 titleWhat makes this title good? For one thing, it passes the “hey, Dad” test:

Hey, Dad — watch me while I do the rapid test for malaria.

In other words, the title explains the job aid in terms of what the person using it will do. This approach is essential in a job aid guiding some task.  Consider alternatives like:

  • Using the Rapid Test
  • Basics of the Rapid Test
  • Steps in the Rapid Test

None of these has the directness of “how to.”

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First things first • Consistent emphasis • Graphic cues

rtm02 materials

Directly under the title of the job aid, you find a list of supplies needed for the test. This is the equivalent of the list of ingredients at the start of a cooking recipe.

Because the rapid-test job aid deals with a medical topic, it consistently calls attention to words like “new” and “unopened.” “New” is always in bold capitals here; “unopened” is always in bold.

The job aid does not depend on color alone to convey meaning in the text; if you reproduced these steps in black and while, the capitalization and bolding would still convey emphasis.

In addition, the job aid includes graphic illustrations of the materials, in part as a reminder for the community workers who will be conducting the tests. Some may have limited skill in reading, and so the illustrations and labels support their ability to recognize what the test packet is.

Often a drawing rather than a photograph is more effective; line art can retain essential information without bringing in unnecessary detail. It’s much more important for the community worker to recognize an unopened lancet than to be able to read on the job aid the printing on the lancet package.

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Numbered steps • Separation between steps

rtm03 steps

If you need to perform steps in a particular order, you have a sequence. Use numbering for the sequence. In general, a numbered sequence is easier to keep track of than one with letters.

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Performer’s point of view • Callouts

rtm04 graphics

Because the purpose of a job aid is to guide performance on the job, graphics need to show examples or technique from the point of view of someone doing the job.  Note the hands under step 2 in the illustration above: they look the way your hands would if you were putting gloves on.

This job aid makes careful use of callouts — they appear only when they’re important for a particular step.  At the beginning of the job aid, for instance, there’s an image of the test packet but no callout for the expiry date. It makes more sense to check the date right before you’re ready to start.

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Step size: can be done without rechecking

rtm06 step size

If you’re building a job aid to guide steps in a procedure, a good rule of thumb for any one step is that the performer should be able to complete it without having to refer to the job aid again.

It’s not that he shouldn’t refer to it. The point is to avoid overburdening him.

In this example, step 3 spells out what you’re removing from the test packet. That’s all that it contains. If the instruction read, “Remove everything from the packet,” though, the performer has no idea what the packet should contain.

What if there were no desiccant (say, due to a packaging error)?  Because step 3 tells me I need to remove the test cassette, the capillary tube, and the desiccant, if I don’t find those things, I’m pretty sure something’s wrong.

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Special emphasis for safety / hazard / high-risk information.

rtm05 safety highlight

This is a special case for the consistent emphasis mentioned earlier. Some procedures have steps that are highly important in the context of carrying them out. In this example, the entire sentence for “don’t set the lancet down” appears in bold.

By the way, preparing community workers to conduct the rapid diagnostic test involves more than the job aid. The training includes actual practice, including use of the lancet. The training would reinforce the importance of proper procedure and correct handling of the lancet and the capillary tube (which also goes into the sharps box).

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The features mentioned here are not a complete list, and not every one is essential for every job aid. On the whole, though, if a job aid doesn’t include most of these features, it’s likely to be less effective in supporting performance.

 

 

WHO: How to Do the Rapid Test for Malaria

About this job aid

Malaria is transmitted to humans through the bites of infected mosquitos. WHO (the World Health Organization) estimates 219 million cases of malaria, and 660,000 deaths, in 2010 alone (last page in this summary).

Rapid diagnostic tests (RDTs) provide a quick alternative to clinical-based diagnosis, testing for specific proteins produced by malaria parasites. Different tests have different capabilities; some can detect only only species of parasite, such as Plasmodium falciparum (hence “Pf test”). These tests are often conducted by local-community health workers.

A key reason for the RDT is to shorten the time between the onset of symptoms and the beginning of treatment. This WHO job aid is a guide to performing such tests.

rtm entire big

Click the image to view in a separate window.
Based on training materials at the
Malaria Rapid Diagnostic Tests website.

What’s the accomplishment?

Correctly performing the generic Pf test for malaria.  This involves using the materials in a medically correct and safe manner, as well as correctly interpreting the results to determine whether the test is positive (indicates malaria), negative (no malaria), or invalid (need to repeat the test).

Who’s the performer?

Health workers, often “in rural areas with limited access to health and laboratory facilities.” These workers may have low literacy and little formal training in the use of the RDT. They may also have minimal supervision in the field.

Comments / critique

  • Note that this job aid is a model; it would be modified to fit the local language, culture, and the specific RDT test. Thus in step 11, a callout reads “count correct number of drops” (of a buffer solution). In the field, location-specific job aids would presumably give the actual number of drops.

I haven’t seen other examples, though. It may be that the buffer bottle spells out the number of drops clearly, and that the training stresses checking that number.

  • Size: this is a large job aid. It wouldn’t fit on a typical letter-size or A4 sheet of paper. Instead, it seems intended as a poster, and could be mounted on a wall where the health worker conducts the testing.

You’ll often see arguments that a job aid should be brief. That’s a relative term and often misleading. The essential characteristic of a job aid is that it successfully guides performance by specific kinds of performers. If they can’t succeed with a five-step job aid, maybe you need more steps.  If you can’t fit the steps into a given size, then maybe that’s not the right size for that bunch of steps.

Consider: two pages, a larger page, a reframing of a big job aid into three smaller ones (How to Set Up the Widget Modifier; How to Modify a Widget; How to Check Modified Widgets).

  • A combination job aid: How to Do the RDT is mainly a procedure. Step 14, however, takes up 20% of the space, and supports the key accomplishment: a decision in the form of a diagnosis. That’s why, for the Ensampler, I’ve tagged this job aid under both categories.
  • Step 14 provides specific examples for the two kinds of positive results (the line near T can be strong or can be faint), and for the two kinds of invalid results (no line at C and no line at T; no line at C and a line at T). Showing these examples is more useful in the context of this job aid than relying solely on “and / or” language in the text. 
  • One quibble about terminology: step 3 of the job aid refers to the test, not the cassette or the test cassette. The only place cassette appears is in step 16.

(Note: with the following point, I’m musing about job aid design in general. I am not trying to second-guess the developers of this particular job aid.)

I might have made different choices for steps 15 and 16.

rtd step 15 16

Those steps seem to involve three chunks of behavior:

  • Discard the gloves, swab, desiccant, and packaging (step 15).
  • Record the test results (first part of step 16).
  • After recording, discard the cassette (second part of step 16).

I assume that good practice says “write down the results before you discard the test cassette.” If that’s the case, it might make sense to underscore discard-write-discard with a new step 17. It would look like step 15 but with an image of the cassette.

Other resources

  • The home page for the Malaria Rapid Diagnostic Tests.
  • A field report on developing and testing a job aid for RDTs, prepared by the Quality Assurance Project in collaboration with the World Health Organization (2004).