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Sandy Williams Hilfiker - Involving People with Limited Literacy Skills in Co-Creation of Health Information: Notes from the Field


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Presented by Sandy Williams Hilfiker, MA, on March 12, 2015 at the fifth Center for Health Literacy Conference: Plain Talk in Complex Times.

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Sandy Williams Hilfiker - Involving People with Limited Literacy Skills in Co-Creation of Health Information: Notes from the Field

  1. 1. Sandy Hilfiker, MA Plain Talk 2015 Involving Users with Limited Literacy Skills in Co-Creation of Health Websites
  2. 2. 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
  3. 3. What is User Centered Design?
  4. 4. UCD: Involving end-users (your audience) in the design and development of a product or campaign  Co-creation  Participatory Design
  5. 5. User-Centered Design Process ① Research the user/audience ① Design a prototype ① Test it ① Tweak it ⑤ Test it again
  6. 6. User-Centered Design Process v
  7. 7. 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.
  8. 8. What’s the point?
  9. 9. You want your design to be:  Usable  Useful  Appropriate  Appealing
  10. 10. 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
  11. 11. 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
  12. 12. 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?
  13. 13. Appealing Appeal: people’s emotional feelings about a product or design  Is it attractive?  Do people want to interact with it?
  14. 14. 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]
  15. 15. What we know about users with limited literacy skills
  16. 16. 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
  17. 17. 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.
  18. 18. 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 skills Gaze path of a participant with limited literacy skills attempting to read every word
  19. 19. Do I need to worry about health literacy? About 9 in 10 Americans have limited health literacy skills.
  20. 20. 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.
  21. 21. Who is your audience?
  22. 22. 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
  23. 23. Methods  Interviews  Surveys  Focus Groups  Collaging
  24. 24. 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
  25. 25. “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.”
  26. 26. 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.
  27. 27. What do you do with the information?
  28. 28. Create a user-centered product!  Create a persona  Create use-cases or user scenarios  Inform product design and/or delivery  Fine-tune your messages
  29. 29. Create a Persona Persona: a pretend user who represents a population  Typically a combination of several real people  Used to drive product design
  30. 30. Sample Persona: Laura
  31. 31. 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…
  32. 32. 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
  33. 33. What’s the best way to organize your content?
  34. 34. Methods  Card sorting  Tree testing  Click testing
  35. 35. 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.
  36. 36. 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
  37. 37. Click Testing: Sample Results
  38. 38. Click Testing: User Interface
  39. 39. Demonstration
  40. 40. 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
  41. 41. 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
  42. 42. 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.
  43. 43. How do I know if my product is usable?
  44. 44. Methods  Prototype and usability testing  Eye tracking  A/B testing
  45. 45. 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.
  46. 46. Paper Prototype Testing
  47. 47. Prototype Testing: Before/After  6 pages were redesigned based on prior user research findings  Developed as clickable web prototypes Before After
  48. 48. Usability Testing in Action
  49. 49. Involving Participants with Limited Health Literacy
  50. 50. 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
  51. 51. 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
  52. 52. Wrap Up
  53. 53. 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.
  54. 54. Helpful Resources
  55. 55. Thank you! Sandy Hilfiker