mhealth usability strategies for users with limited literacy skills from healthfinder.gov

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Conducting User Research on a Shoestring Budget

mHealth Usability Strategies for Users with Limited Literacy Skills from healthfinder.gov

Mary Ann Petti, MPH, CHES@MaryAnnPetti@CommunicateHlth

AcknowledgementsOffice of Disease Prevention and Health Promotion, HHSEllen Langhans, MALinda Harris, PhDThe CommunicateHealth team

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Presentation overviewWhy care about literacy and health literacy?What we know about users with limited literacy skillshealthfinder.gov mobile usability testingMethods and resultsImplications of the work

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UCD = gaining a deep understanding and deep empathy for users throughout the entire lifecycle of a project.

-The first step of the process is to define your users goals-Next step is to create solutions, or prototype and start building the thing youre working on-Finally (and do this iteratively) evaluate your work through usability testing

Why take a UCD approach? Just because you think your tool or product works, doesnt mean your users will. Youll never know until you observe, and you wouldnt believe the things you learn in testing. 4

Why care about literacy and health literacy?

LiteracyAn individuals ability to read and write.

6Full definition: The degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness.

Source: http://www.hrsa.gov/publichealth/healthliteracy/healthlitabout.html

Stress that literacy and health literacy arent just about reading.

Sources:http://www.health.gov/communication/literacy/quickguide/factsbasic.htmU.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In: National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.

Health LiteracyAn individuals ability to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.

7So,. Depending on the context, literacy is NOT just about reading.

Full definition: The degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions and services needed to prevent or treat illness.

Source: http://www.hrsa.gov/publichealth/healthliteracy/healthlitabout.html

Stress that literacy and health literacy arent just about reading.

Sources:http://www.health.gov/communication/literacy/quickguide/factsbasic.htmU.S. Department of Health and Human Services. 2000. Healthy People 2010. Washington, DC: U.S. Government Printing Office. Originally developed for Ratzan SC, Parker RM. 2000. Introduction. In: National Library of Medicine Current Bibliographies in Medicine: Health Literacy. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. NLM Pub. No. CBM 2000-1. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.

Literacy vs. health literacy

8Half of all adults struggle with literacy.

Literacy and health literacy arent the same thing. Even more people struggle with health literacy. Only 12% of American adults have proficient health literacy. In other words, nearly 9 out of 10 adults lack the skills needed to manage their health and prevent disease. Source: National Center for Education Statistics. (2006). http://nces.ed.gov/pubs2006/2006483.pdf

This is showing you some basic health literacy tasks mapped to peoples skill level. These are all skills that people need to stay healthy.

30% lack the skills to use an over the counter drug label70% lack the skills to read a vaccination chart90% lack the skills to calculate an employees share of health insurance costs for a yearSource:National Center for Education Statistics. (2006). http://nces.ed.gov/pubs2006/2006483.pdf

What we know about users with limited literacy skills

What we know about behaviors and how limited literacy users read on a screen

Low Lit chapter of the 2014 book Eye Tracking in User Experience Design9

Have trouble processing information on a screenProne to skip information and focus on the center of the screenTend to be easily overwhelmed and have limited short-term memoryUsually navigate in a linear fashion and back-track frequently

Source: Colter, A and Summers, K (2014). Low Literacy Users. In Bergstrom & Schall (Eds.), Eye Tracking in User Experience Design (p. 339). Waltham, MA: Elesvier.

Gaze path of a participant with limited literacy skills who reads only the text that looks easy to read.

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Likely to access web from a mobile device

2 out of 3 adults in the U.S. own a smartphone.1 in 5 adults in the U.S. rely on their phones for Internet access.

90% of U.S. adults own a smartphone and about 2 out of 3 U.S. adults owns a smartphone

1 in 5 rely on smartphone we call these Smartphone-dependents (limited ways online)

The smartphone dependents are younger, less educated, and have lower incomes. (all factors correlated to literacy levels)

This fact brings up a lot of questions in thinking about MOBILE UX EQUITY across user groups how do we design for limited lit, smartphone dependents who are more likely to have intermittent connections due to high data costs and limits???

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We all want to find health information whenever (and wherever) we need it most.

The fact of the matter is. 12

Designing for small screens is critical.

The healthfinder.gov team wanted to evaluate user experience on mobile

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Who here has heard of healthfinder.gov?

Healthfinder houses evidence-based, original content on prevention and wellness topics. There are more than 100 topics and they are written in plain language and reviewed by subject matter experts across the federal government.

Due to the rising influx of mobile devices among the target population (consumers with limited literacy skills) the site was migrated to a responsive template in 2012. 15

We reviewed literature.

Known challengsHierarchical navigation Using scroll bars within menusUsing a single button (like the iPhone menu button) for a variety of different purposes depending on contextUsing a small keyboard to enter text

Known benefits/improvements:Users with limited literacy skills find it easier to learn how to use mobile devices than desktop computers Mobile screens can make reading easier for users with reading disabilities.

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Hypothesis = users with limited literacy skills will have more success using healthfinder on a mobile device

Our methods

We recruited 8 participants in Massachusetts4 males4 females

5 Android users3 iPhone usersAll participants had limited literacy skills.

-Used their own devices

8 participants 4 males and 4 females from Western Massachusetts.Limited-literacy consumers Participants were recruited through an adult literacy center based in Northampton, MA.Most participants reported seeking health information from doctors or family. About half of participants also seek health information online (citing Google as the place they go to ask a question).Most participants use their phones to: search for information on Google, play games, listen to music, use social media, watch videos on YouTube, and read sports, news, and weather.5 participants had Android phones, 3 participants had iPhones.

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Limit think aloud allow more room for free exploration

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Explain set up21

Key findings

What was different on mobile?More successful navigating through health topic categories on mobile.Comfortable scrolling and tapping on their mobile devices. More difficulty finding the search feature and site navigation (menu).More difficulty navigating through health topic pagination.

Compared to previous testing done on desktop..

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Point out the search on both to show why it was more difficult to find on mobile24

In this task, Im asking him to find content thats on the second tab of the page (Take Action). The content is paginated which worked OK on desktop this was the first time we really evaluated it on mobile. I am trying to get him to go to take action and then click through pagination to find the answer. 25

Users had difficulty navigating through health topic pagination.

So what we saw is that users missed pagination

While on some websites it might be okay to have a long scroll or to let users scroll we know that limited literacy users are easily overwhelmed, so its important that the content looks aproachable. 26

Health Benefits Health Benefits Recommendation: contextual buttons for each page

Web users dont mind clicking if each click is meaningful.

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Whats next?

Updated guide coming this fall to health.gov!

This research informed HLO updates31

Thank you! Mary Ann Pettimaryann@communicatehealth.com

communicatehealth.com