Improving Health Literacy Online: Lessons Learned from Iterative Design
Sandra Williams Hilfiker, MA September 14, 2009
AHRQ Annual Conference
healthfinder.gov: Old Site
healthfinder.gov: New Site
Prevention Content Research Timeline
2003 2004 2005 2006 2007 2008
Project Concept
2009
Literature Review
Mental Models
ContentAnalysis
SegmentValidation
Card Sorts
ResearchTranslation
Final Build
Final/SitePrototypeUsability
Launch
MoreUsability
IA CardSorts
More Content
Spanish
ContentPrototypeUsability
Project Rationale• More Americans are expected to
take responsibility for managing their health.
• Current online health information landscape creates as much confusion as support.
• Searching returns a lot of irrelevant results.
• Much of the health content on the Internet is not focused on prevention.
Iterative Design & Lessons Learned
Prevention Prototype 1.0
Prototype 1.0 Usability Test, N=300
• Tested with a diverse, nationwide sample, 260 remotely & 40 in-person (limited health literacy)
• Participants randomly assigned to 3 audience segments
• Measured appropriateness, acceptability, applicability, engagement, motivation, & self-efficacy
Prototype 1.0 Key Findings:Audience Segments
““What can I do?”What can I do?”
““I want information about a topic.”I want information about a topic.”
““Should I be Should I be concerned?”concerned?”
Basics
Benefits
Action
Prototype 1.0 Key Findings:
To increase engagement & self efficacy we needed:• Shorter content chunks with increased use of
Plain Language• A small steps approach to adopting healthy
behaviors• Content organized so users can shift quickly
between audience segments• An interface design based on “progressive
disclosure” that allows users to easily “drill down”
Prevention Prototype 2.0
Prototype 2.0 Usability Test, N=40
• Adult women with limited health literacy, recruited from a community health center system in Baltimore
• Not just Web usability, also focused on content usability Study was designed to:– Learn if changes to the content and interface design
would positively impact self-efficacy and engagement measures
– Test out organizational framework• Measured appropriateness, acceptability, applicability,
engagement, motivation, & self-efficacy
Prototype 2.0 Key Findings: Basics, Benefits, Action
Prototype 2.0 Key Findings: Small Steps Approach
• Simple actions that users can do right away
• Reinforces behavior and improves self-efficacy
Prototype 3.0 Usability Test, N=20
• Prototype tweaked and additional content sets added
• Adult women with limited health literacy recruited from a community health center system in Baltimore
• Test was performed to validate changes from the first test
Users didn’t read this
Users did read this
Usability Test 2 Key Findings: Writing Style
Where We Are Today & Next Steps
Quick Guide to Healthy Living
Current Topic page
Reusing Content in Many Ways:New Media
Reusing Content: Community Health Centers
• Electronic Medical Record
• Posters• Conversation Scripts• Small Step Rx
Next Steps
• Continual quality improvement• Spanish Quick Guide to Healthy
Living• More content & tools• Explore new channels
