Table 4.

Developed guidelines for the implementation of medical Alternative and Augmentative Communication apps that target adults with mild learning disabilities.

ID	Guideline description
1	The overall consultation process should be broken down into manageable chunks by presenting small, closed questions that focus on solitary ideas.
2	Questions should focus on the health needs of target stakeholders rather than that of the general population as these may differ greatly.
3	Questions should aim to extract the symptoms experienced by patients, the duration and history of these symptoms, and the overall health of patients.
4	Information provided by stakeholders should be used to shape future questions in an attempt to limit the number of irrelevant questions being presented.
5	Information should be conveyed via a range of communication modalities including simplified text, immediately identifiable imagery, and speech.
6	The language and imagery used to convey information should be developed in conjunction with target stakeholders to ensure they are understood as intended. In general, medical jargon should be avoided but this may not be the case for all situations, for example, the use of brand names.
7	General pictures should be used to represent options that have a range of permutations. For example, a picture of eyes may be used to represent visual deficiencies.
8	Appropriate pain scales (such as the Wong Baker Smiley Face Pain Scale) should be used to distinguish if the patient is experiencing discomfort or is in pain.
9	The number of options available to the user should be limited. We recommend a maximum of 4.
10	Elements should be large in size and spaced far apart to accommodate for potential visual and motor deficiencies.
11	Key navigational and decision points should not be conveyed solely with the use of text.
12	A consistent layout should always be provided including the option to access a help feature. The user should be able to navigate across the interface, in both directions via skip and return buttons.
13	The aesthetics of such aids should be customizable; however, the content should remain the same.
14	A record should be kept of all the key activities made within the aid. Both patients and medical staff should have access to this information, represented in a format suitable to them.
15	The software should be portable to ensure stakeholders use the device most suited to their needs.