1. Writing and Designing Easy-to-Use Web Sites
Steven Sparks Health Literacy Director

2. Half of adults read at the 8th grade level or below, yet…
Most web sites are written at the 10th grade level or higher

3. What we know about limited literacy web site users
Scanning is hard
Focus on narrow field of view
Skip chunks of text
When see long dense text, skip chunks, often skipping over the very content they want
Sometimes skip right over headings and lists and land in middle of paragraph
Triggered most by:
Long paragraphs of dense text
Long pages requiring scrolling
Numbers contained in the text
Difficult, long or unfamiliar words,
Parenthetical text.

4. What we know about limited literacy web site users
Decide “enough is enough” quickly
Skip from link to link
Get distracted easily
Avoid “search”
Search requires spelling and typing; not all search engines accommodate spelling errors
Format of search results challenging for limited literacy—text-heavy list of page titles with confusing, extra words, excerpts
Limited literacy: click on page title that is (1) first in results or (2) looked simple and matched their search string closest

5. Impact of aging on web site use
Vision
Field of View
Visual-motor coordination
Hearing
Cognitive decline may interfere with user experience
Vision:
difficulties seeing and processing cluttered online content
Difficulties reading screen
Field of View
Difficulties detecting items in periphery of screens
Visual-motor coordination
Using keyboard, mouse
Selecting links (positioning cursor)
Scrolling page
Hearing
Detecting high frequency alerting sounds (beeps or pings)
More seniors are using the web. But those with difficulty navigating or understanding are not.

6. ALL users benefit from improved readability and usability
High Literacy Users:
3x as fast with the revised site
93% success rate on revised site (compared to 68% with original)
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%
Source: Summers, K., & Summers, M. (2005). Reading and navigational strategies of Web users with lower literacy skills.

7. Involving Your Audience: User-Centered Design

8. Why involve your audience?
Just because you think your material is awesome doesn’t mean that your audience does.
You can waste a lot of time and money developing messages and materials that nobody uses.
It’s the only way you can be sure that your messages will be understood.

9. Why involve your audience?
Target audience members will be empowered and invested in the success of your product.
It will make you a better communicator.
Credit: CommunicateHealth

10. Testing Methods Surveys Focus Groups Collaging Interviews
Interviews, Surveys, Focus Groups with key audience
Collaging: Participants create a collage that represents the characteristics they would like to see in a new Website
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

11. Click testing – only 5 users needed!
Source: Jakob Nielsen, Why You Only Need to Test with 5 Users, 2000

12. Strategies for Writing and Designing Easy-to-Use Web Sites
Keep content concise
Shorter articles; to the point
Avoid long paragraphs and sentences
Use plain language
Readability Test Tool:

13. Strategies for Writing and Designing Easy-to-Use Web Sites
Keep content concise
Actionable

14. Strategies for Writing and Designing Easy-to-Use Web Sites
De-clutter your site
White space
Readable font
Useful, not excessive color

15. Strategies for Writing and Designing Easy-to-Use Web Sites
Start with a clear home page
Communicate the big picture
Be clear: “What’s in it for me?”
Limit number of elements and graphics (buttons, boxes, lists, text)
Use links and short descriptions

16. Strategies for Writing and Designing Easy-to-Use Web Sites
Simplify your navigation
Clear and consistent on every page, including “back”

17. Strategies for Writing and Designing Easy-to-Use Web Sites
Organize and label clearly (Information architecture)
Make it intuitive (How will you know?)

18. Strategies for Writing and Designing Easy-to-Use Web Sites
Organize and label clearly Put most important information first

19. Strategies for Writing and Designing Easy-to-Use Web Sites
Make it interactive
Personalized content
Interactive tools:
Printing information
Share
Take a poll/quiz
Calculator (e.g., BMI)

20. Resources Usability.gov Health.gov/healthliteracyonline
U.s Dept. of Health and Human Services
Usability.gov
Health.gov/healthliteracyonline

21. A case study:
MyHealthWI.org Web Site
Usability Testing

22. Purpose and Methods Purpose
Evaluate usability and improve the user experience
Methods
Development of moderator’s guide
3 remote and 3 in-person usability testing sessions
Usability review of MyHealthWI.org
Participants
6 adults (including 2 LEP) with limited literacy skills and 1 with above average literacy skills

23. Impressions of MyHealthWI.org
Participants said the site related to finding insurance, a clinic or healthcare provider, or a health care job
Participants noticed the video and the pictures first

24. What worked well for participants
Understood the color system for the ratings
In general, were able to use the “Your Location Search” box
Successful with the horizontal menu and drop-down navigation
Successful using the “Search Again” button on the search results page

25. What Worked Well
Participants felt the site offered useful information
All 6 participants said they would recommend the site to their family and friends
— Participant #2 “
Is the website on-line and ready to be used? I could use it right now.”

26. “ Room for Improvement Main Purpose of Site:
Participants had difficulty understanding the main purpose of the site.
Participants misinterpreted ratings — two thought that the ratings were based on reviews from other consumers.
— Participant #3 “
I would use this site like Yelp — if I moved somewhere and I needed to find a doctor, I could find a pretty good one.”

27. Main purpose of site Recommendations
Clarify site purpose on homepage to expectations; use new language: “Search and compare doctors’ offices in Wisconsin based on how well they care for their patients.”
Keep the site content focused on cost and quality data; reduce stock photos

28. Who sponsors the site Findings
Participants struggled to identify the sponsor
One participant thought the sponsor was “My Health Wisconsin”

29. My Health Wisconsin Who sponsors the site Recommendations
Make top header box simpler, more open space
Delete “Choosing your healthcare with confidence”
Change configuration of sponsor and site name
Use stronger type style for “MyHealth” and spell out Wisconsin so it doesn’t look like a logo, or
Use WHIO’s logo before website name as one unit
New WHIO logo will help
My Health Wisconsin

30. Homepage
Findings
Participants noticed the pictures and video first — before search feature
Took too long to figure out what the purpose of the site is
Recommendations
Move search feature to the top of the page so users see it first
Enhance readability by left-aligning text and using title case for headers

31. Clinic Search Findings
Label of the search form was confusing (“Find and Compare Quality…”)
Participants had difficulty spelling cities
Participants did not know what the different provider types were (Family Medicine, etc.)
Recommendations
Rename the search form “Find a Clinic”
Make search button a different color
Add ? icon next to “Choose Provider Type”
Search
Find a Clinic

32. “ Clinic Search Map Findings
Participants preferred the search box to the map
Map too small
Recommendations
Modify the map; make clickable by county
Include big cities on the map
— Participant #2 “
I was looking for Madison and I don't see well — my eyes couldn't see the map. I think Madison's somewhere at the bottom.”

33. Search Results, Ratings
Findings
Participants were confused by headings on the rating columns
Participants were confused by meaning of “Not Rated”
Participants weren’t easily able to compare two clinics
Participants were surprised and momentarily confused by what happened when they clicked the header

34. Search Results, Ratings
Recommendations
Add total number of results to page (e.g., “X of Y results”)
Revise rating headers for plain language
Add hover text with definitions to tab headers and rating headers
Add click to “group by rating”
Use different icon for “Not Rated” (like an X)

35. FAQ and Quality Measures
Findings
Participants had difficulty comprehending, finding, and scanning content on both pages
Recommendations
Add headers to group questions — put the most important questions first
Revise content for plain language

36. Content
Findings
Participants had difficulty interpreting many labels (e.g., FAQ, Consumer Resources, Pediatrics)
Participants did not understand key terms on the site like healthcare quality, efficiency, and primary care provider
— Participant #1 “
I’m not really sure what FAQ stands for.”

37. Content Recommendations Use plain language principles
Actionable headers; most important information first
Be brief and to the point
Revise top-level navigation labels:
FAQ, Consumer Resources
Define difficult terms like primary care physician

38. Navigation and Architecture
Tab names and landing page names must be consistent.
FAQ can be a secondary page.
Your Location Search is not currently in navigational structure.

39. Visual Design Too many fonts are used throughout the site.
The website template horizontal image is large and pushes content too far down the page.
Bulleting styles are inconsistent throughout the site.
Translucent images with text on top are distracting and hard to read.
Low color contrast is not good for website accessibility.

40. Writing and Designing Easy-to-Use Web Sites
Steven Sparks Health Literacy Director