1. 8 Improving Health Literacy
TIPS to make your health
websiteEffective Communication
through easier to use
Ana Tellez, MA
Xanthi Scrimgeour, MHEd, CHES
Stacy Robison, MPH, CHES

2. CommunicateHealth

3. Agenda
+ Overview: Online health information seeking
+ Usability + health literacy
+ User-centered design
+ The 8 tips
+ Website check-up

4. We are online
+ 80% of adults
– 83% White
– 71% Black, Non-Hispanic
– 71% Hispanic (English- and Spanish-speaking)
+ 93% of teenagers
– 94% White
– 87% Black
– 95% Hispanic
+ 62% of adults have high-speed broadband connection in their home

5. …looking for health information
+ 8 in 10 Internet users (roughly 60% of adults)
– Slightly behind using a search engine, email, driving directions, and weather
– More than news, online shopping, watching videos, social networking, banking
+ 6 in 10 say their most recent search had an
impact on their health or the way they care for
someone else
– 60%: affected a decision about how to treat an illness or condition
– 56%: changed their overall approach to maintaining their health
– 53%: led them to ask a doctor new questions

6. We struggle with complex health
information.
+ As many as 9 out of 10 American adults have limited
health literacy skills.
+ The number of older adults using the Internet
continues to grow. They are affected by age-related
changes in vision, hearing, and cognition.

7. Usability + Health Literacy

8. Users with limited literacy skills are…
+ Willing to use the Web to access
health information
+ Able to accomplish tasks when
websites are designed well

9. More often than not, it‟s poorly
designed Web sites – more than
limited literacy skills – that
contribute to users‟ challenges
online.

10. Usability:
How well users can learn and
use a website to achieve their
goals and how satisfied they are
with that process.
(function/properties of a website)

11. Usefulness:
How well the basic
services, features, and functions
match user needs and goals.
(rational response to information on a website)

12. Appeal:
User‟s subjective, spontaneous
feelings about the website.
(emotional response to a website)

13. User-Centered Design

15. The 10 Tips…

16. ① Involve your users.

17. Neighbor Nudge
1. Identify your users:
Who are they?
• Literacy skills
• Health status
• Experience with the Internet
2. Understand their motivations:
Why are they here?
• Looking for themselves or someone else
• How did they get here?

18. User Testing Methods to Try
+ Individual interviews
+ Focus groups
+ Personas and scenarios

19. Focus Groups
+ Small group (5-8 people)
+ React to designs and ideas
+ Group process (react to others‟ opinions)
+ Good for quick gauge of users‟ feelings and opinions
+ (Not good for testing a final product or website)

21. ② Develop a content strategy.
The practice of planning for the creation,
delivery, and maintenance of useful,
usable content.

22. + First, create quality health content.
+ Then take care of it!
your awesome
content

23. Do you know?
Existing content:
1. Who created it?
2. What does it say?
3. Is it useful?
4. How is it maintained?
New Content:
1. Who will create it?
2. Who will approve it?
3. Who will put it on the website?
4. Who will update it?

24. ③ Write clearly.

25. Neighbor Nudge
Change is hard.
Some changes are harder than others.
Why are changes/decisions about
health so difficult?

26. Create quality health content
+ Get to the point. Use plain language.
– Use active voice
– Avoid jargon; use the language of your audience
Plain language is not enough!
+ Make it actionable.
– Include specific action steps
– Give users tools (directions, maps, calculators, printable
checklists)
– Be positive and motivating

27. Actions at a Glance
1. Put the most important info first.
2. Describe the health behavior. Just the basics.
1. Provide specific action steps.
2. Write in plain language.
3. Check content for accuracy.

28. Writing for Action
Which page would be most helpful if your
child had asthma?
① “About asthma”
① “Asthma symptoms”
② “Prevent asthma attacks at home”

29. Prioritize the Behavior
Asthma makes breathing difficult for more than 34
✗ million Americans.
Asthma in children is on the rise, but with proper
✗ treatment for symptoms of asthma, kids and adults
can live well.
If someone in your family has asthma, start by
✓ getting rid of these common causes of attacks:
– Mold or dampness
– Cockroaches
– Secondhand smoke

30. User Testing Methods to Try
+ Use card sorting to find out how users rank content
by most useful/least useful or most likely to do/least
likely to do.
+ Build a paper prototype to find out what content
users are most likely to “click” on.
+ Test user comprehension using content in a paper
prototype.

31. ④ De-clutter your site.

32. Web users want to quickly and easily:
1. Understand the health problem or behavior
1. Find out how to take action
27 seconds

34. Nielson Norman Group
Typical F pattern

35. Design for Scanning
+ Create a visual hierarchy
– Prominent (BIGGER) = important
+ Use web conventions
– Example: Search in the upper right
+ Minimize noise
– Clean and readable

36. Users with limited literacy skills are
easily overwhelmed
Even content written in plain language can be
overwhelming too much text is together in one
paragraph or there is not enough white space on the
page.
Bulleted lists minimize the amount of text on the
screen. White space makes text easy to read.

38. Users with limited literacy skills skip
instead of scan
+ Skip over entire chunks of dense text
– > 3 lines of text triggered skipping
– Numbers, %, big words triggered skipping
+ Start clicking on links instead of reading the content
Whenever possible, use bulleted lists and short
sentences. Limit text to 3 lines.

39. Actions at a Glance
1. Limit paragraph size. Use headers, bullets, lists.
2. Use familiar font in at least 12 points.
3. Use white space and avoid clutter.
4. Use images to facilitate learning.
5. Use bold colors with contrast.
6. Use bold face instead of CAPITALS and italics.
+ Keep content in the center of the screen and
above the fold.

40. Font Style
Consider sans-serif fonts
+ This is Verdana, a sans-serif
font
+ This is Georgia, a serif font

41. Line Length
✗ 20-24 words per line
✓ 9-12 words per line

42. ⑤ Start with the Home page.

43. The Home page
+ Show your name and logo prominently (upper left corner).
+ Consider including a tagline that summarizes what you do.
+ Emphasize the highest priority tasks so that users have a clear
starting point. (Hint: think back to your 3 main tasks)
+ Use consumer-focused language.
+ Use visuals and examples to reveal the site‟s content, rather than
just describing it.
+ Don‟t over-design. Leave plenty of white space.

47. ⑥ Simplify your navigation.

49. Site ID
(and tagline) Search
Primary Navigation

50. Secondary
navigation Breadcrumbs
‘you are here’ Print, email, share
Page Name

51. Easy access to home and menu pages
Make sure the “Back” button works

53. The Trunk Test
+ Site ID
+ Page Name
+ Primary navigation (sections)
+ Secondary Navigation
+ Search
+ You are Here

57. Users with limited literacy skills have
difficulty searching
+ Avoid searching.
+ Prefer to browse topics using an alphabetical or
topic list (even if the list is long).
Include both a search function and other ways to
browse content (topic or A-Z list).
Be sure to compensate for misspellings in the
search box and limit the number of results.

58. Simple Search and Browse

60. ⑦ Organize and label your
content.

61. Content Organization: the Basics
+ Information architecture is the way information
is categorized on a Web site.
+ It typically involves a category structure
(taxonomy) and labels.
+ Good content organization enables users to
find information quickly.
Tip: Use labels that reflect the language of your users.

63. Using Labels
Which link will have info on asthma triggers?
① Air Pollution & Respiratory Health
① Indoor Air Quality
① Asthma and Allergies

64. Labeling Links
4 rules to follow when using links:
1. Make links obvious (underline them)
2. Make links long enough to “grab” easily
3. Use descriptive link labels
4. Limit the number of links on the page

65. If you are HIV-positive, click here for information on how to protect your
partner(s) so that you don‟t pass the virus on to them. If you are
pregnant or thinking about getting pregnant, you can help prevent
passing HIV to your baby. Learn more.

66. Website Check-up

67. ⑩ Test and tweak often.

68. Paper Prototype Testing
Nielson Norman Group
If you are building a new
feature, start with a paper
prototype test.
Forum One

69. Usability Testing

70. What is usability testing?
+ Conducted 1 on 1
+ Watch someone use your website
– Ask them to figure out what the site is
– Have them use the site to do a typical task
+ Have them „think aloud‟
+ Note where they get stuck

71. Wisdom of Steve Krug
You are not trying to prove or disprove
anything (e.g., label A is better than label B).
You are trying to improve your website.

72. 15 studies
750+ users
Recruited adults w/
limited literacy skills
Best practices in:
• Web design
• usability
• accessibility
http://www.health.gov/healthliteracyonline/

73. Thank You!!
Contact Information:
+ Ana Tellez
ana@communicatehealth.com