Mary Ann Petti works for CommunicateHealth which is a team of content and usability experts dedicated to designing better health information. Here she discusses the importance of health literacy, shares her knowledge about limited literacy users and considerations when working with this audience and she gives 10 tips on how to involve participants with limited literacy skills.

1. User-Centered Design with Limited
Literacy Audiences
What you need to know
Mary Ann Petti, MPH, CHES
+ @MaryAnnPetti
+ @CommunicateHlth

2. Presentation Overview
① Why do we need to care about health literacy?
② What we know about limited literacy users
③ Sample methods: considerations when working
with limited literacy audiences
④ 10 tips for involving participants with limited
literacy skills

3. Which of the following is the strongest
predictor of a person’s health status?
 Income
 Employment
 Education level
 Racial or ethnic group
 Literacy skills

4. Health Literacy
An individual’s ability to obtain,
process, and understand basic
health information and services
needed to make appropriate health
decisions.

5. Literacy vs. Health Literacy

6. Health Literacy Level by Task

7. What we know about
users with limited literacy
skills

8. 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
• More likely to use a mobile phone to access the Web
than a desktop

9. 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.

10. Easily Overwhelmed & Limited Working 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.

11. Easily Overwhelmed & Limited Working 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.

12. 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.

13. Sample methods:
considerations when working
with limited literacy
audiences

14. 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

15. “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.”

16. Sample Method: Tree Testing
• 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

17. 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

18. 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

19. Sample Method: Usability Testing
• Participants use a website or
app to complete tasks while
observers listen, observe, and
take notes
• Avoid think-aloud protocols and
allow more room for free
exploration

20. Usability testing with limited
literacy users

21. Use this tool to get recommendations based on
your age and sex

22. Where would you go if you were looking for a new
place to take your kids to the doctor in Janesville?

23. 10 tips for involving
participants with limited
literacy skills

24. Top 10 Tips
① Partner with community organizations to recruit
special populations
② Screen for participants with limited health literacy
using proxy measures
③ Screen for participants for limited technology use
④ Develop screeners, consent forms, and moderator’s guides in plain
language
⑤ Use cash incentives when possible

25. Top 10 Tips
⑥ Limit the number of tasks
⑦ Be cautious using remote and online testing
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

26. Why should I do user testing?
• When it come to understanding your product —
your users are the experts.
• All products have problems. (Some more than
others.) Your users will almost always find them.
• ROI

27. The Bottom Line?

28. Helpful Resources

29. Thank you!
Mary Ann Petti
maryann@communicatehealth.com
communicatehealth.com