CHAPTER 15: Layout and illustration

The aim of this chapter is to help teachers to design and illustrate their teaching materials. The first part of this chapter is aimed at teachers who are involved in writing booklets or manuals. But the second part, which deals with illustration, applies equally to manuals, handouts and even the chalkboard and overhead projector.

Sections 15.1-15.8 describe the decisions that have to be made in planning a manual or booklet, such as:

- page size
- margins
- headings
- typeface
- use of space.

All these decisions are to do with the layout of the material.

Sections 15.9-15.17 describe different kinds of illustrations that can be used and offer advice on when to use the different methods.

15.1 What is layout?

Layout is the use of spaces, different typefaces, headings, etc. to make the words on a page have more meaning and interest. Page after page full of words with no spaces would be almost impossible to read. So layout is an essential part in the design of any teaching material.

15.2 Page size

The size of page to be used in the handout or manual must be decided first. This controls the amount of space you have available for illustrations and for words. Charts and large tables will need a large page size. Booklets designed for reference in the field should, if possible, be small enough to fit in a pocket. The sizes which are commonly used are called A-sizes. A4 is often used for books and handouts. If you fold a sheet of A4 in half as shown below, you will get two pages of A5 size. If these are folded in half, you will get four pages of A6 size.

There are larger A-sizes (A1, A2 and A3), but these are not suitable for books or pamphlets.

Figure

The size of A4 is 297 mm x 210 mm. The ratio of these lengths has been chosen so that when the page is divided into two, the ratio of the long side to the short side stays the same, as shown below:

For A4 long side/short side = 297 mm/210 mm = 1.414

For A5 long side/short side = 210 mm/148.5 mm = 1.414

This property allows printers to enlarge or reduce a page produced in the A-sizes to fit exactly any other A-size. For example, if a page of A5 is enlarged by 141%, it will fit A4. If it is reduced by 141% (i.e., to 70% of its original size), it will fit A6.

A5 may be used for reference manuals, and is often used for booklets, since it will usually fit into a pocket. This makes the booklets easy to carry and easy to use for reference - but also means that less information can be included.

Earlier systems of page sizes such as quarto and foolscap are going out of use and should not be used because this will increase the cost of printing the material.

15.3 Margins

A margin must be left blank round all the writing and diagrams on the page. This helps to make reading easier because it holds the words in a block. Margins are also useful places for the reader to make notes and increase the usefulness of the book or handout.

The best size of margin is to some extent a matter of taste. For A4 paper the following size is suggested:

Figure

Note: The above example is of a right-hand page. For a left-hand page, the left margin would be 30 mm wide and the right margin would be 20 mm.

However, the modern tendency is to allow larger left-hand margins - as in this book. If you use ring-binding or spiral-binding for a manual, you also need to allow a generous margin along the side that is bound. Otherwise the holes for the binding may pass through text or illustrations.

15.4 Choice of typeface

The typeface is the set of letters used in the typewriter or composing machine used by the printer. Most authors will have little choice of typeface because their teaching material will either be handwritten or they will use the only typewriter available. In these cases, the only point to remember is that long strings of CAPITAL LETTERS (which are also called upper case letters) are less easy to read than lower case letters. Capital letters should only be used sparingly - for example, in headings.

If the manual is being printed, a much greater choice of typeface will be available. You will need to make choices about:

- size of typeface
- upper case or lower case
- italic or roman typeface
- density of typeface (bold or normal).

Most of the words will normally be in lower case, roman typeface. The size of typeface is usually 10 pitch or 12 pitch on typewriters. When a composing machine is used, the choice of size is much wider. Common sizes are 10 point or 12 point. The best way to choose the size of typeface is to look at examples of material prepared using different sizes. You should choose a size that is large enough to read comfortably.

If a typeface larger than necessary is chosen, the words will obviously take up more space. In a book, this could mean several extra pages and higher production costs.

If the teaching material is being printed and there is a wide range of typefaces to choose from, you should discuss the use of typeface with the printers and follow their advice.

If you want to emphasize a particular point, you can do this by using upper case letters, a bold typeface or a larger typeface.

However, you should use different typefaces sparingly. You should not use a lot of different typefaces, because this is confusing to the reader. Nor should you use upper case a lot. Upper case is more difficult to read and if all the words are written in upper case none of them is emphasized.

15.5 Use of headings

A solid block of writing on every page is very difficult and boring to read. It is also difficult to use the page for reference. Therefore most teaching materials use headings. These headings:

- break up the text so it is easier to read
- show what the next few paragraphs cover
- help readers to find their place again after they have been looking at a diagram
- help to give the page a pattern.

However, you should only use a few types of heading.

Most books should not need more than about four or five different types of heading. More types only confuse the reader - especially if they are not used consistently.

If you are writing shorter teaching material, then you may only need one or two different types of heading.

15.6 Use of space, lines and boxes

A page of text is divided into paragraphs. This helps to give shape to the page and to make clear to the reader where topics are changed. Space can also be used to emphasize any points that are important. For example, the point made below stands out because of the lines and the space around it.

Use lines and space to emphasize important points.
But do be careful. Too much space is as bad as no empty space. It breaks the continuity of reading and therefore decreases the reader's concentration. Also, if lines or boxes are used all the time they will have less impact. So save lines or boxes for the most important points.

15.7 Use of numbering systems

It is common to number the chapters, sections and even paragraphs of manuals. This has some advantages in making clear to the reader that a new topic is starting and also helps when referring to other sections.

However, the numbering system should be kept fairly simple. In this book, the chapters and sections are numbered. For example, this is Section 15.7. This tells you that it is the seventh section of Chapter 15. Numbering systems which are more complicated than this are not advisable in manuals or teaching materials for health workers.

15.8 Exercise on layout

Exercise

Look at the layout of the double page reproduced overleaf. The layout has some good and some bad features. Make a list of the features that you think are good and those that you would like to improve.

Refer to the previous pages for guidance - then look at the comments below.

Comments

The title "skin diseases" is very clear, because it is large' in a bold typeface and surrounded by a lot of space. This is good. The use of upper case letters might be questioned, but it is satisfactory in a short title such as this.

The section "people who... on the skin" is given emphasis by using lines above and below the text This is good. On the other hand, the use of upper case letters all the way through the two paragraphs means that all the words are emphasized equally. They are also more tiring to read. This is poor. There is also no advantage in having the letters in italic script. It would have been better to use lower case, roman letters in a large typeface.

On the second page' the title is given emphasis by the use of upper case letters' underlining and space. This is good.

However, the underlining of "spots", "patches", "blisters"' end "scabs" seems unnecessary. The underlining draws attention to these words, but they are not especially important.

SKIN DISEASES

PEOPLE WHO HAVE SKIN DISEASES BUT NO OTHER SIGNS OF SICKNESS SHOULD WASH THEIR SKIN, COVER IT WITH A MEDICINE AND KEEP THEIR HANDS VERY CLEAN.

PEOPLE WHO HAVE A NIGHT TEMPERATURE AS WELL AS A SKIN DISEASE SHOULD BE GIVEN A MEDICINE TO BE TAKEN BY MOUTH OR TO BE INJECTED INTO THE BUTTOCKS AND ANOTHER MEDICINE TO PUT ON THE SKIN.

LEARNING OBJECTIVES

At the end of his training, the PHW should be able to:

1.	find out whether an accident has been the cause of the skin problem
2.	decide whether the skin condition covers a small or large area
3.	recognize when there is a lump (or a swelling) underneath the skin
4.	tell if the skin is covered with red spots, or red patches or blisters or scabs
5.	treat a patient who is feverish and has red spots covering a large area of skin
6.	treat a patient who is feverish and has blisters and scabs over a large area of skin
7.	tell whether a patient has been scratching his skin
8.	treat a patient who scratches his skin, when there are no scabs
9.	treat a patient who scratches his skin, when a large area of the skin is covered by scabs
10.	treat a patient who scratches a small area of his skin
11.	treat a patient whose skin is covered with small scabs that have fluid coming out from underneath there
12.	decide when a patient with a skin problem should be sent to the hospital or health centre
13.	talk with village people about how to prevent skin problems.

15.9 Use of illustrations

Illustrations such as drawings or pictures can be worth a thousand words of written explanation. They can help to make the explanation clearer and easier to remember. But, if they are not well done, they can also confuse. The following paragraphs describe some of the methods of illustration and give some guidelines on using illustrations effectively.

The various types of illustrations that are described here are:

- photographs
- shaded drawings
- line-drawings
- symbolic or stylized drawings
- cross-sections
- cartoons
- flow charts.

15.10 Photographs

Photographs can be very useful for showing students objects and people that cannot be brought into a classroom. They can also be very helpful in books or manuals.

However, photographs are not used very much because of the practical difficulties of obtaining suitable photographs and because they cannot be copied cheaply.

If you want to use photographs, try to choose photographs that have a blank background or else remove the background as shown in the example overleaf. Photo 1 is much clearer than photo 2.

You will also need to use printing - see Chapter 16. This will only be realistic when large numbers of handouts or manuals are required.

15.11 Shaded drawings

Shaded drawings may be the most useful way of illustrating a point. The drawing can be prepared to show only those features that are important. Yet they can be realistic enough for the health worker to recognize what is shown.

Shaded drawings can be prepared by tracing a photograph. Another way is to project a photograph onto a white sheet of paper using an epidiascope, then to draw around the projected photograph. This allows enlargement of the original photograph. The results of this process are shown opposite.

Of course, artists can prepare a drawing from real life or from imagination. You can then add labels or notes to it. Look at the example below.

Figure

15.12 Line-drawings

The figure overleaf is a line-drawing - there is virtually no shading. This kind of drawing is almost as easy to recognize as the shaded drawing and is usually easier to print using a stencil duplicator.

This kind of drawing can be prepared in the same way as shaded drawings.

It looks easier to draw, but often artists say that this kind of drawing requires even more skill than shaded drawings.

A line-drawing

A stylized drawing

15.13 Symbolic or stylized drawings

This style of drawing is the easiest to reproduce, but it does require skill in drawing. Also it may not be easily understood by the health workers, so you should always add an explanatory legend or note. For example, look at the stylized drawing above.

15.14 Cross-sections

A cross-section is a very useful way of showing what is inside a machine or the human body. But understanding a cross-section is a skill that must be learned. People who are not used to looking at cross-sections will have a lot of difficulty understanding them until they are taught how to do this. For example, the cross-section opposite will be extremely simple for a sanitary engineer who is familiar with cross-sections and the symbols used.

Fig.: ANAEROBIC SLUDGE DIGESTION FOR WARM CLIMATES

On the other hand, a nurse or doctor might find it more difficult to understand, because they might not know what the symbols represent. Students who have not seen cross-sections before would probably also be confused until the diagram was explained to them.

15.15 Cartoons

Cartoons are not just funny pictures. The word cartoon is also used to describe line-drawings, especially those showing people saying something.

Cartoons can be very useful for emphasizing important points. They are especially helpful because students are often used to seeing cartoons in newspapers.

The cartoon overleaf helps to make the point more dramatically than a paragraph of words. The words spoken by the people help to make sure that the health workers remember the important points.

Figure

15.16 Flow charts

Illustrations are usually thought of as pictures or diagrams. But teaching materials can also be made clearer by using flow charts. These are charts showing what has to be done in different circumstances.
For example, look at the written instructions opposite. You may agree or disagree with the clinical advice given. But this point of the example is that it is rather difficult for the health workers to find out what to do in a specific case. They must go through the whole page to find out how any one patient should be treated.

Example - Written instructions for treating people with a cough.

Take the patient's temperature.

1.1 The patient's temperature is less than 38°C. Other symptoms:

- a runny nose (with a discharge like water or a thicker discharge like milk) or - a sore throat.

Give the patient aspirin for 3 days and tell him or her not to cough on other people (especially children) or spit on the floor.

See the patient again on the 4th day:

- the patient is better. Tell the patient to come back to the clinic if he or she becomes feverish.
- there is no improvement and the patient is feverish - see 1.2.

1.2 The patient's temperature is over 38°C. Other symptoms:

- difficulty in breathing or
- a very sore throat or
- discharge from one ear or
- red spots all over the body and a runny nose and eyes.

Give the patient penicillin. If penicillin is not available, give the patient sulfadiazine.

See the patient again on the 3rd day:

- the patient is better.
- there is no improvement, send the patient to the hospital or health centre.

Now look at the flow chart overleaf. This gives exactly the same information as the written instructions in a much clearer and more economical way.

Example - A flow chart for "cough"

Flow charts are most useful in handouts or manuals where there is a need to describe a decision-making process, such as deciding what treatment to give patients with certain symptoms.

They are not useful when the task always follows the same sequence: for example, preparing a syringe for injections would not be a good topic for a flow chart.

15.17 General points

1. Students must learn how to read diagrams and pictures

Pictures are not understood automatically by everybody. People who are not used to looking at pictures just do not understand what they represent. Most students will be familiar with pictures - but the use of diagrams, symbols, cross-sections and flow charts is a skill that must be learned.

2. Be careful to explain the scale of pictures

There are a lot of stories about people who are shown pictures of mosquitos and say "There is nothing like that around here". They have not realized that the drawing which is 15 cm long is showing something that is actually less than 1 cm long. This kind of misunderstanding is very common and often occurs when teachers show drawings of objects that can only be seen under a microscope.

3. Test your illustrations

Find out whether your students really do understand the illustrations. Several studies have shown that health workers often do not realize what an illustration is meant to show.

For example, most health workers will understand that the message of this illustration is that drugs and tablets can be dangerous. They will remember the message well because it is drawn in a dramatic way, using the gun as a symbol of danger, and compares tablets with bullets.

Figure

However, some health workers might just see a gun and some tablets. Others may not even recognize the gun.

So you must test what the health workers understand and remember from the illustrations.

4. Keep illustrations simple

Only show the things that are necessary. Too much detail can distract readers and confuse the point of the illustration. Simple illustrations will be easier to reproduce.

For example, this illustration shows the important points, but it is still very simple to draw and copy.

Figure

15.18 Summary

1. Layout is very important. It helps the reader to understand the words and helps to emphasize the most important points. Think about:

- page size
- margins
- use of space
- headings
- typescript.

All these things must be used to help the reader learn from the teaching material.

2. Illustrations make teaching material and manuals more effective - if they are used correctly.

3. Check that readers can understand the illustrations that you use.