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UX Research with Limited Literacy
Audiences
Tips and case studies
Mary Ann Petti, MPH, CHES
+ @MaryAnnPetti
+ @Communicate...
Presentation overview
① Why care about literacy and health literacy?
② What we know about limited literacy users
③ Sample ...
a question?
Which of the following is the strongest
predictor of a person’s health status?
 Income
 Employment
 Education level
 R...
Literacy
An individual’s ability to read and write.
Health Literacy
An individual’s ability to obtain,
process, and understand basic
health information and services
needed to...
Literacy vs. health literacy
Health literacy level by task
Why care?
Why care?
Household decision
makers
What we know about users with
limited literacy skills
Prone to skipping
information and focus on
the center of the screen
1
Prone to skipping & focus on the center of the screen
Gaze path of a participant
with limited literacy skills
who reads on...
Easily overwhelmed and
tend to have a limited
short-term memory
2
Easily overwhelmed & limited short-term memory
Gaze path of a participant
who does not have limited
literacy skills.
Sourc...
Easily overwhelmed & limited short-term memory
Gaze path of a participant
with limited literacy skills
attempting to read ...
Usually navigate in a linear
fashion and back-track
frequently
3
Are likely to access web
content from a mobile
device
4
Likely to access web from a mobile device
2 out of 3 adults
in the U.S. own a
smartphone.
1 in 5 adults in the
U.S. rely o...
What we know
Users with limited literacy skills are…
• Willing to use the web to access health information
• Able to accom...
ALL users benefit from improved readability and usability
Success Rate Original Site Rewritten Site
Lower literacy 46% 82%...
Research methods:
Considerations when working
with limited literacy audiences
Understand. Organize. Evaluate.
Case Study 1: Collaging
Collaging for positive patient-provider interaction
Goal: Find out what matters most to patients when
talking to a doctor ...
Sample Method: Collaging
SUCCESSFUL
METHOD!
“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 his
or ...
Case Study 2: Tree Testing
Remote tree testing for content organization
Goal: Evaluate how easy it is for limited literacy users to
locate informatio...
Practice!
 Go to my Twitter page: @MaryAnnPetti
 Click the link in the pinned tweet
 Take the 3-task test
 https://com...
Tree testing with professionals
Task: Where would you go
to learn what Wisconsin is
doing to support Healthy
People 2020?
...
UNSUCCESSFUL
METHOD
Tree testing with limited literacy users
Task: Where would you find
healthy snack ideas for kids?
 This chart represents ...
Case Study 3: Mobile Usability
Testing
Mobile usability testing
Goal: Evaluate mobile user experience of healthfinder.gov
Methods:
 In-person mobile testing wit...
SUCCESSFUL
METHOD!
Mobile usability testing
Health Benefits
Health
Benefits
Mobile usability testing
10 tips for involving participants
with limited literacy skills
Top 10 tips
① Partner with community organizations to recruit
special populations
② Screen for participants with limited h...
Top 10 tips
④ Develop screeners, consent forms, and
moderator’s guides in plain language
⑤ Use cash incentives when possib...
Top 10 tips
⑧ Pre-test your protocol with at least one
participant with limited literacy skills
⑨ Choose a moderator with ...
Why should I do user testing?
A dollop of toothpaste
on a toothbrush.
“It’s a swan. On a boat.
Floating down a river.”
Helpful resources
Thank you!
Mary Ann Petti
maryann@communicatehealth.com
communicatehealth.com
UX Research with Limited Literacy Audiences — Tips and Case Studies
UX Research with Limited Literacy Audiences — Tips and Case Studies
UX Research with Limited Literacy Audiences — Tips and Case Studies
UX Research with Limited Literacy Audiences — Tips and Case Studies
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UX Research with Limited Literacy Audiences — Tips and Case Studies

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Most of us eat and sleep with our smart phones. But there are still many people who find technology stressful and overwhelming. People with limited literacy skills are often included among this latter group.

By following a thoughtful, user-centered design process, you can overcome the common barriers to reaching and engaging people with limited literacy skills, such as:

• Complex information and navigation
• Unfamiliar tools
• New technology

Reaching out to and receiving meaningful feedback from audiences with limited literacy skills can be challenging and requires special considerations. This presentation will offer tips for conducting user testing with limited literacy audiences.

From our experience conducting usability research with hundreds of participants with limited literacy skills, we’ll share lessons learned and practical tips for a user-centered design process that leads to easy-to-use, accessible content and tools.

This presentation will detail proven strategies for:
• Recruiting participants
• Developing questions and prompts in plain language
• Moderating testing sessions

We’ll discuss user-centered design methods that are particularly effective in gaining insights from participants with limited literacy skills, including collaging, card sorting, and in-person usability testing. We’ll also talk about how to choose the right software and testing environment to meet this audience’s needs.

Lastly, we will explore — through case studies — the behaviors, habits, and preferences of limited literacy users.

Published in: Design
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UX Research with Limited Literacy Audiences — Tips and Case Studies

  1. 1. UX Research with Limited Literacy Audiences Tips and case studies Mary Ann Petti, MPH, CHES + @MaryAnnPetti + @CommunicateHlth
  2. 2. Presentation overview ① Why care about literacy and health literacy? ② What we know about limited literacy users ③ Sample UX research methods and case studies ④ 10 tips for involving participants with limited literacy skills in UX research
  3. 3. a question?
  4. 4. Which of the following is the strongest predictor of a person’s health status?  Income  Employment  Education level  Racial or ethnic group  Literacy skills
  5. 5. Literacy An individual’s ability to read and write.
  6. 6. Health Literacy An individual’s ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
  7. 7. Literacy vs. health literacy
  8. 8. Health literacy level by task
  9. 9. Why care?
  10. 10. Why care? Household decision makers
  11. 11. What we know about users with limited literacy skills
  12. 12. Prone to skipping information and focus on the center of the screen 1
  13. 13. Prone to skipping & focus on the center of the screen Gaze path of a participant with limited literacy skills who reads only the text that looks easy to read. 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.
  14. 14. Easily overwhelmed and tend to have a limited short-term memory 2
  15. 15. Easily overwhelmed & limited short-term memory Gaze path of a participant who does not have limited literacy skills. Source: Colter, A and Summers, K (2014). Low Literacy Users. In Bergstrom & Schall (Eds.), Eye Tracking in User Experience Design (p. 335). Waltham, MA: Elesvier.
  16. 16. Easily overwhelmed & limited short-term memory Gaze path of a participant with limited literacy skills attempting to read every word. Source: Colter, A and Summers, K (2014). Low Literacy Users. In Bergstrom & Schall (Eds.), Eye Tracking in User Experience Design (p. 336). Waltham, MA: Elesvier.
  17. 17. Usually navigate in a linear fashion and back-track frequently 3
  18. 18. Are likely to access web content from a mobile device 4
  19. 19. Likely to access web from a mobile device 2 out of 3 adults in the U.S. own a smartphone. 1 in 5 adults in the U.S. rely on their phones for Internet access.
  20. 20. What we know Users with limited literacy skills are… • Willing to use the web to access health information • Able to accomplish tasks when websites are designed well
  21. 21. ALL users benefit from improved readability and usability Success Rate Original Site Rewritten Site Lower literacy 46% 82% High literacy 68% 93% A health website compared to a revised prototype (designed to support users with limited literacy skills) High literacy users: 3x as fast with the revised site Source: Summers, K., & Summers, M. (2005). Reading and navigational strategies of Web users with lower literacy skills. Total Task Time Original Site Rewritten Site Lower literacy 22.3 min 9.5 min High literacy 14.3 min 5.1 min Satisfaction (1-5 scale, 5=best) Original Site Rewritten Site Lower literacy 3.5 4.4 High literacy 3.7 4.8
  22. 22. Research methods: Considerations when working with limited literacy audiences
  23. 23. Understand. Organize. Evaluate.
  24. 24. Case Study 1: Collaging
  25. 25. Collaging for positive patient-provider interaction Goal: Find out what matters most to patients when talking to a doctor about cardiovascular health Methods: Participants create a collage that represents the characteristics they would like to see in something, and the characteristics they would not like to see in something (in-person, n=8)
  26. 26. Sample Method: Collaging SUCCESSFUL METHOD!
  27. 27. “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 his or her help.”
  28. 28. Case Study 2: Tree Testing
  29. 29. Remote tree testing for content organization Goal: Evaluate how easy it is for limited literacy users to locate information on healthfinder.gov Methods: Users are given a task to complete using the sitemap — researchers are on-site for technical assistance (in-person with web-based tool, n=40)
  30. 30. Practice!  Go to my Twitter page: @MaryAnnPetti  Click the link in the pinned tweet  Take the 3-task test  https://communicate- health.optimalworkshop.com/treejack/uxpabos15
  31. 31. Tree testing with professionals Task: Where would you go to learn what Wisconsin is doing to support Healthy People 2020?  This chart represents an unsuccessful task on a website targeting low lit consumers
  32. 32. UNSUCCESSFUL METHOD
  33. 33. Tree testing with limited literacy users Task: Where would you find healthy snack ideas for kids?  This chart represents an unsuccessful task on a website targeting low lit consumers
  34. 34. Case Study 3: Mobile Usability Testing
  35. 35. Mobile usability testing Goal: Evaluate mobile user experience of healthfinder.gov Methods:  In-person mobile testing with 8 users  Mr. Tappy & iPEVO camera  Limit think aloud — allow more room for free exploration
  36. 36. SUCCESSFUL METHOD!
  37. 37. Mobile usability testing
  38. 38. Health Benefits Health Benefits Mobile usability testing
  39. 39. 10 tips for involving participants with limited literacy skills
  40. 40. Top 10 tips ① Partner with community organizations to recruit special populations ② Screen for participants with limited health literacy using proxy measures ③ Ask participants to bring their mobile phones if testing on mobile — and be sure to have WiFI access
  41. 41. Top 10 tips ④ Develop screeners, consent forms, and moderator’s guides in plain language ⑤ Use cash incentives when possible ⑥ Limit the number of tasks ⑦ Be cautious using remote and online testing
  42. 42. Top 10 tips 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
  43. 43. Why should I do user testing?
  44. 44. A dollop of toothpaste on a toothbrush.
  45. 45. “It’s a swan. On a boat. Floating down a river.”
  46. 46. Helpful resources
  47. 47. Thank you! Mary Ann Petti maryann@communicatehealth.com communicatehealth.com

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