Improving Health Literacy Online: Lessons Learned from Iterative Design (Text Version)

On September 14, 2009, Sandra W. Hilfiker made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (5.21 MB) (Plugin Software Help).

Slide 1

Improving Health Literacy Online:
Lessons Learned from Iterative Design

Sandra Williams Hilfiker, MA
September 14, 2009
AHRQ Annual Conference

Slide 2

healthfinder.gov: Old Site

Screen shot of healthfinder.gov site before it was redesigned.

Slide 3

healthfinder.gov: New Site

Screen shot of healthfinder.gov after redesign.

Slide 4

Prevention Content Research Timeline

Time line of 5 years of consumer research that informed the new healthfinder.gov.

• 2003
  • Project Concept.
• 2004
  • Literature Review.
• 2005
  • Mental Models.
  • ContentAnalysis.
  • Segment Validation.
• 2006
  • Segment Validation.
  • Card Sorts.
• 2007
  • Content Prototype Usability.
  • Final/Site Prototype Usability.
• 2008
  • Final Build.
  • Launch.
  • IA Card Sorts.
• 2009
  • More Usability.
  • More Content.
  • Spanish.

Slide 5

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.

Picture of a confused guy with a question mark over this head.

Slide 6

Iterative Design & Lessons Learned

Slide 7

Prevention Prototype 1.0

Screen shot of first prototype tested through iterative design.

Slide 8

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.

Slide 9

Prototype 1.0 Key Findings:
Audience Segments

"What can I do?" Basics
"I want information about a topic." Benefits
"Should I be concerned?" Action

Slide 10

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."

Slide 11

Prevention Prototype 2.0

Screen shot of the second iteration of the healthfinder.gov prototype.

Slide 12

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.

Slide 13

Prototype 2.0 Key Findings:
Basics, Benefits, Action

Screen shot of second iteration of healthfinder.gov protoype with tabs circled, Basics, Benefits, & Get Started.

Slide 14

Prototype 2.0 Key Findings:
Small Steps Approach

• Simple actions that users can do right away.
• Reinforces behavior and improves self-efficacy.

Screen shot of a small steps box titled "What do you want to do today?"

Slide 15

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.

Slide 16

Usability Test 2 Key Findings:
Writing Style

Screen shot of healthfinder.gov prototype with three paragraphs of text. Users didn't read this.
Screen shot of healthfinder.gov prototype with bulleted text. Users did read this.

Slide 17

Where We Are Today & Next Steps

Slide 18

Quick Guide to Healthy Living

Screen shot of healthfinder.gov's Quick Guide to Healthy Living landing page. Shows content categories available such as nutrition and fitness, cancer screening and prevention, and pregnancy.

Slide 19

Current Topic page

Screen shot of current iteration of the healthfinder.gov topic page, Get Active.

Slide 20

Reusing Content in Many Ways:
New Media

Screen shot of healthfinder.gov Twitter page.
Screen shot of 'Be Active Your Way' widget.
Screen shot of myhealthfinder widget.
Screen shot of 3 front covers of healthfinder.gov E-cards.

Slide 21

Reusing Content:
Community Health Centers

• Electronic Medical Record.
• Posters.
• Conversation Scripts.
• Small Step Rx.

Screen shot of the Baltimore Medical System Web site.
Poster of healthfinder.go 'Quit Smoking' content.
Reminder cards with small steps for quitting smoking and weight management.

Slide 22

Next Steps

• Continual quality improvement.
• Spanish Quick Guide to Healthy Living.
• More content & tools.
• Explore new channels.

Slide 23

Thank You!

Sandy Hilfiker
Sandraw.hilfiker@hhs.gov
240-453-8268