Sandy Hilfiker, MA

Plain Talk 2015

Involving Users with Limited

Literacy Skills in Co-Creation of

Health Websites

Presentation Overview

1. What is UCD?

2. What we know about limited literacy users

3. Getting to know your audience

4. Organizing your information

5. Testing a draft

6. Involving participants with limited literacy

What is User Centered Design?

UCD:

Involving end-users (your audience) in the

design and development of a product or

campaign

Co-creation

Participatory Design

User-Centered Design Process

① Research the user/audience

① Design a prototype

① Test it

① Tweak it

⑤ Test it again

User-Centered Design Process

v

5 Reasons to Involve Your Users

1. Just because you think your material is awesome doesn’t mean

that your audience does.

2. You can waste a lot of time and money developing messages and

materials that nobody uses.

3. It’s the only way you can be sure that your messages will be

understood.

4. Target audience members will be empowered and invested in the

success of your product.

5. It will make you a better communicator.

What’s the point?

You want your design to be:

Usable

Useful

Appropriate

Appealing

Usable

Usability: ease of use (and satisfaction with)

a product, website, or material

Does it work?

Can the user get from A to B?

How easily can the user accomplish the task?

Goal: find problems in a design in order to make it better

Useful

Usefulness: level of value that a product has for

the user

Is it helpful?

Is it what the user expected?

Will users want to interact with the design?

Goal: understand how a design aligns with user needs

Appropriate (Suitable)

Suitability: extent to which a design matches users’

skills and experience

Is it easy to understand?

Is it motivating?

Is it familiar?

Is it accessible to your audience?

Is it culturally relevant?

Appealing

Appeal: people’s emotional feelings about a

product or design

Is it attractive?

Do people want to interact with it?

How long do you have to grab a user’s attention on your

website?

5 seconds

15 seconds

25 second

45 seconds

60 seconds

Web pages with clear value to the user will

hold a her attention longer.

[Source: Nielson Norman Group, 2000]

What we know about users with

limited literacy skills

What We Know

Users with limited literacy skills are…

Willing to use the Web to access health information

Able to accomplish tasks when Web sites are designed

well

More likely to use a mobile phone to access the the

Web than a desktop

Prone to skipping & Focus on the center of the screen

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

low literacy skills who reads only

the text that looks easy to read.

Easily overwhelmed & Limited working memory

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 who does not

have low literacy skillsGaze path of a participant with limited literacy

skills attempting to read every word

Do I need to worry about health literacy?

About 9 in 10 Americans have limited health literacy skills.

ALL users benefit from improved readability and usability

Comparing time-on-task on the original site with a prototype (designed

to support users with limited literacy skills):

Time on Task

(Mean)

Original Site Prototype Improvement

High literacy 14:19 5:05 +182%

Lower literacy 22:16 9:30 +134%

All users 17:50 6:45 +164%

High Literacy Users:

3x as fast with the

revised site

93% success rate

on revised site

(compared to 68%

with original)

Source: Summers, K., & Summers, M. (2005). Reading and navigational

strategies of Web users with lower literacy skills.

Who is your audience?

Know your users

Who are they?

What motivates them?

Talk to them!

Never assume you understand your audience

Hold an informal focus group

Conduct 1-on-1 interviews

Methods

Interviews

Surveys

Focus Groups

Collaging

Sample Method: Collaging

Participants create a collage

that represents the

characteristics they would like

to see in a new Website

Result: Provides insights into

users’ needs normally not

revealed in interviews and

focus groups

“This is how I feel, free and full of energy. I

want my doctor to understand that this is how

I want to feel with her help.”

Practice

+ Circle 2-3 images that represents qualities of your ideal work

environment.

+ Circle 1-2 images the represents the qualities you would NOT want

in your work environment.

+ Write a brief description why you chose each image.

What do you do with the information?

Create a user-centered product!

Create a persona

Create use-cases or user scenarios

Inform product design and/or delivery

Fine-tune your messages

Create a Persona

Persona: a pretend user who represents a

population

Typically a combination of several real people

Used to drive product design

Sample Persona: Laura

How to use Personas

Will Laura use/understand this website?

Will this design appeal to her? Is she likely to

notice it?

What about Laura — we need to make sure this

website reaches her…

Practice

Create a brief persona that represents one of your

key target audiences.

Include information on:

Demographics

Information Needs

Health Literacy Skills

Technology Use/Savviness

What’s the best way to organize your content?

Methods

Card sorting

Tree testing

Click testing

Sample Method: Card Sorting

Participants organize topics

from a website or app into

categories that make sense

to them.

Provides insights into a site

structure and labels that will

be intuitive for users.

Sample Method: Click Testing

A technique for gathering quick feedback on wireframes

or mock-ups of webpage designs

Provides a ‘heat map’ of where participants expect to

find specific types of information on page mock-ups

Provides the ability to gather feedback on specific labels

and visual design elements

Click Testing: Sample Results

Click Testing: User Interface

Demonstration

Tree Testing: Word of Caution

A technique for evaluating how

easy it is for people to locate

information within a material or

website structure

Participants are given a topic to

find within a text version of a site

map or table of contents

May not be an effective method

with limited literacy participants

due to the lack of visual cues

Tree Testing: Case Study

Task: Where would you find healthy

snack ideas for kids?

Participants nominated 14 different

pages as the correct answer.

Participants did very little

backtracking

Typically, we see more blue

indicating participants have gone

down multiple paths before selecting

an answer

Tree Testing: Case Study

Task: Where would you go to

learn what Wisconsin is doing to

support Healthy People 2020?

This chart represents an

unsuccessful task in on a

professional website

The blue dots indicate where

participants went down a

path and backtracked to look

for the right answer.

How do I know if my product is usable?

Methods

Prototype and usability testing

Eye tracking

A/B testing

Sample Method: Prototype Testing

Participants use a paper version of an app or

website to provide feedback on 'flow' and

navigation.

Provides helpful feedback early in the process

before valuable resources have been spent on

development.

Paper Prototype Testing

Prototype Testing: Before/After

6 pages were redesigned based on prior user research findings

Developed as clickable web prototypes

Before After

Usability Testing in Action

Involving Participants with Limited Health Literacy

Top Ten Tips

① Partner with community organizations to recruit special

populations

② Screen for participants with limited health literacy using

proxy measures

③ Develop screeners, consent forms, and moderator’s

guides in plain language

④ Limit the use of Likert-style questions

⑤ Use cash incentives when possible

Top Ten Tips

⑥ Screen for participants for limited technology use

⑦ Limit the number of tasks

⑧ Pre-test your protocol with at least one participant with

limited literacy skills

⑨ Choose a moderator with experience conducting

research with limited literacy participants

⑩ Conduct testing sessions in a setting that is familiar and

accessible to participants

Wrap Up

Why should I do user testing?

When it comes to understanding your materials/website

– your users are the experts.

All materials have problems. (Some more than others.)

They may not obvious to you. But your users will almost

always find them.

Investing in user-friendly products pays dividends;

ignoring usability issues can be costly – affecting

DASH’s effectiveness and reputation.

Helpful Resources

Thank you!

Sandy Hilfiker

sandy@communicatehealth.com

communicatehealth.com