Presented at 4S 2019 in New Orleans https://www.4s2019.org https://www.4s2019.org/program/

1. 1

2. Framing the problem
Aging adults:
↑ health information needs
↓ health & internet literacy
2
Instructional tools & tutorials
can help improve
Participatory Design
can be used to create
Interventions take place in public spaces
(i.e. libraries & community centers)
Public Spaces often present challenges
to conducting design research activities -- i.e.
lack of spaces separate from foot traffic; noise
from people talking
Xie, 2008; Xie, 2009; Kutner et al., 2006; Norman & Skinner, 2006; Xie et al., 2012

3. Study context:
3
eHiLLElectronic Health
Information for Lifelong
Learners
OnTOPOnline Tutorial Overlay Presenter
eHiLL OnTOP
Focus of study eHealth +
cognition
eHealth
n - participants 110 9
Ages 65-90 64-32
Libraries 3 0
Senior centers 4 1
Sessions per week 2 2
Length of each
session
3 months 2 weeks
Time of each
session
2 hours 2 hours
Total # sessions
(hours)
24 (48 hours) 4 sessions (8
hours)
PD methods Affinity diagrams,
personas,
storyboards
Affinity diagrams,
personas,
storyboards, paper
prototypes
Study aims:
● Help older adults (age 65+) learn to use computers and
the internet to access reliable health information.
● Engage older adults in participatory design (PD) of
eHealth tools and tutorials.
● Understand the relationship between computer/internet use
and cognition among older adults. *(eHiLL only)
2 NIH funded studies:
Collaborators:
Julie Bugg & Emily Streeper
Washington University in St. Louis
Collaborators:
Tom Yeh & Xu Han
University of Colorado Boulder

4. 4
eHiLLElectronic Health
Information for Lifelong
Learners
OnTOPOnline Tutorial Overlay Presenter
● 24 Modules
● Made with Adobe Captivate
● Flash shockwave (swf) files
● 2 parts - 16 goals
● Hosted on nickelled.com
● Installed as a Google Chrome extension

5. Toward Democratizing Design in Public Spaces:
Observations:
5
Design/usage of public spaces Directly impacts ability of researchers to
engage older adults in PD activities
Libraries and senior centers Have different affordances/limitations as
playful public spaces (for PD research)
Reflections:
Differences between libraries
and senior community centers
for PD research with
aging adults
Implications for the future design and usage
of these sites as (playful) social public spaces
to engage aging adults in
PD research activities

6. Research Questions:
● How do libraries and senior community centers differ in their approach to social engagement?
● How can public spaces such as these serve older adults to access, assess, and use electronic
health information?
● How can the characteristics of community spaces impact older adults’ perceptions and use of these
spaces as sites for access to eHealth information?
● How can the design of these spaces affect older adults’ social participation in design research
activities?
6

7. Methods/Results
7
Participatory Design
of eHealth tutorials*
Affinity diagramming
// Reflection
Libraries &
Senior Centers
2 researchers (ND,KS)
location:
activities:
Conducted
interventions
*Many artifacts generated. Data still being
organized/analyzed
(to be published in a future study)
Libraries vs. Senior Centers for Older Adults:
1. Approach to Social Engagement
2. Serving Older Adults eHealth needs
3. Older adults perspectives
4. Effects of layout/design on PD

8. Approach to social engagement:
Libraries vs. Senior Community Centers
How do libraries and senior community centers differ in their approach to social engagement?
8

9. Social Engagement:
Senior Centers
Focused (Aging Adults)
Focused (Age relevant)
Consistent
Lower
Focused
Libraries
Broad (General Public)
Broad range
Intermittent
High
Broad
← Community →
← Activities →
← Patronage →
← Turnover →
← Support →
9

10. Serving older adults to
access, assess, & use eHealth info
How can public spaces such as these serve older adults to access, assess, and use electronic health
information?
10

11. Accessing, Assessing & Using eHealth info:
Senior Centers
Often unreliable computers
Somewhat unlimited usage
Typically inconsistent tech support
(municipal, volunteers, 3rd parties, etc.)
Peer-learning
Education is often volunteer or non-profit
Continued support (formal or informal)
Libraries
Reliable computers
Time-limited (public)
Consistent tech support
(municipal)
Resource-based
Intermittent community
education/training
No continued support
← Access →
← Assess →
← Use →
11

12. Characteristics of community spaces:
Older adults perspectives of the space & impact on
perceived ability to access eHealth information
How can the characteristics of community spaces impact older adults’ perceptions and use of these
spaces as sites for access to eHealth information?
12

13. Older Adult’s Perception of the spaces:
Senior Center: “Internet not working (twice) does cause problems.”
Senior Center: “In future studies class need to be held in a confined
space. Too many interruptions from people at [site]. Too noisy”
Public Library: “The library setting was depressing, dirty and poorly
maintained.”
13
Only a few mentions about the
spaces themselves
(from participant feedback)
● All negative
● Not enough for analysis
“Good ideas to evaluate health websites, importance of checking privacy policy,
updates, authors. Very good.”
“Taking the training sessions does encourage one to go to the web for health care
information for myself and spouse.”
“Facilitator was very good at encouraging us and never making us feel wrong or
foolish.”
“I enjoyed making new friends and learning new skills.”
“Heartful appreciation for awesome opportunity learning very helpful things under great
teaching”
Countless examples of
positive general feedback
Conclusion = need more data

14. Layout and design of community spaces:
Effects on older adult participation in design research
How can the design of these spaces affect older adults’ social participation in design research activities?
14

15. Effects of space on participation in research activities:
Senior Community Centers:
Lively/active (often not quiet)
Typically integrated / multi-function
Familiar people coming & going
High sense of belonging
High likelihood of gaining participants from
observing others involved in the study
Libraries
Quiet
Siloed/separated
Strangers coming & going
Low sense of belonging
Low likelihood of gaining
participants from observing
others involved in the study
← Sound →
← Location →
← Foot Traffic →
← Belonging →
← Intrigue →
15

16. Discussion:
16
● Each have limitations and affordances for:
○ Accessing health information online
○ Conducting PD research
● Both have proven to be useful as sites where playful
research (i.e. PD) can be conducted
● The unique affordances and limitations of these public
spaces can either contribute to, or deter from, the sense of
empowerment for aging adults to engage in playful
research activities
Libraries
Senior
Community
Centers
Each have their own unique characteristics
as playful public spaces

17. As sites for Aging Adults (to access eHealth info & participate in PD)
Pros Cons
Senior Community
Centers
● Tech (can be) catered toward aging
adults (i.e. big/bold keyboards and other
assistive tech.)
● More likely to have health information
specialists on site
● Researchers often become part of the
extended community
● Higher levels of peer support
● Lively / familiar faces (second home)
● Often have transportation assistance
● Higher visibility (intrigue for participants)
● Often lack consistent: computers,
internet access, tech support
● Lack a wider audience (i.e. no
younger users for peer-to-peer
information exchange)
● Often loud or distractions
Libraries ● More extensive resources (especially
computer, internet, tech support, etc.)
● More space (for bigger libraries)
● Potential broader reach (marketing)
● Have to share with a larger
population of users
● Less sense of community (baked in)
● Higher turnover (more limited
computer/internet time)
● Less visibility
17

18. ● Only conducted in the greater Austin, Texas area
● Based on reflection by researchers
● This research is still top-down, even though it works to include
and empower aging adults
18
Limitations
Future
Research
● Consider other settings where participatory design research
has and/or can be conducted with aging adults (and other often
overlooked social groups)
● Especially the creation of new & novel spaces -- within or
beyond these traditional spaces (maker spaces, design labs,
etc.)
● Look toward how playful public spaces can serve to
democratize design research for aging adults to access and
contribute toward the creation digital tools (i.e. eHealth
tutorials)

19. References:
Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The Health
Literacy of America’s Adults: Results From the 2003 National
Assessment of Adult Literacy (NCES 2006-483). U.S. Department of
Education. Washington DC: National Center for Education Statistics.
Norman, C. D., & Skinner, H. A. (2006). eHealth literacy:
essential skills for consumer health in a networked world.
Journal of Medical Internet Research, 8(2), e9.
Xie, B. (2008). Older adults, health information, and the
Internet. ACM Interactions, 15(4), 44-46.
Xie, B. (2009). Older adults' health information wants in the Internet
age: Implications for patient-provider relationships. Journal of Health
Communication, 14(6), 510-524
Xie, B., Yeh, T., Walsh, G., Watkins, I., & Huang, M. (2012).
Co-designing an e-health tutorial for older adults. In Proceedings of the
2012 iConference (pp. 240-247). ACM.
19
NIH Grants:
2017 - 2019: Developing an eHealth Tutorial for Older Adults to
Use Online Health Resources (R21AG052761), National Institute
on Aging, NIH. Principal Investigator: Bo Xie.
2016 - 2019: Boosting Older Adults' Cognition by Training
Real-World eHealth Skills (R21AG052060), National Institute on
Aging, NIH. Principal Investigator: Bo Xie (with MPI Julie Bugg)
Acknowledgements:
Research reported in this publication was supported by the
National Institute on Aging of the National Institutes of Health
under Award Numbers: R21AG052060 and R21AG052761. The
content is solely the responsibility of the authors and does not
necessarily represent the official views of the National Institutes of
Health.
Research sites/partners: Thanks to all of our research partners
(libraries and senior centers) and participants (aging adults) who
made this possible.