PTSD is a growing concern for Veterans and their families. About 1 in 5 Iraq and Afghanistan Veterans has PTSD or depression. This creates an ongoing need for clear, easy-to-use PTSD information and support. The VA is interested in improving their PTSD website to better meet the needs of their target audiences, particularly Veterans who have PTSD or are concerned they may have it. To inform an upcoming redesign, the National Center for PTSD (NCPTSD) worked with [Company] to conduct extensive formative and usability research with Veterans with PTSD, their family and friends, and clinicians who treat PTSD. In this session, we’ll talk about our research process from beginning to end, highlighting the voices of Veterans and their families. We’ll share lessons learned and address the knowledge gained from our human-centered design process.

1. Sandy Hilfiker, MA
Principal, Chief Experience Officer
UX Design for Vets

2. About us
Small, woman-owned, mission-based health
communication company
National leader in health literacy
Create digital health tools that can be accessed,
understood, and used by people in their daily
lives
Support state, federal, and private organizations

3. Agenda
Warm up
PTSD website redesign overview
Methods
Key findings
Lessons learned

4. Lifetime Prevalence of PTSD
Vietnam Vets: 30%
Iraqi Freedom: 11-20%
Gulf War: 12%
Almost 25% of women Vets report being sexually
assaulted while in the military
55% of women and almost 40% of men report
experiencing sexual harassment while in the military
https://www.ptsd.va.gov/public/ptsd-overview/basics/how-common-is-ptsd.asp

5. Warm up
Imagine you’re creating a website on PTSD for
Veterans and family members
Write down one word or phrase that comes to mind
when you think about what this website should be
Turn to the person next to you, share your word and
why you picked it

6. Project Overview

7. Goal
Redesign the VA’s National Center for PTSD
website to be more user-friendly for Vets,
family members, and clinicians who treat
PTSD.
Make the site more patient-centered.

9. A tale of two websites

10. Our challenge
Working within the Vets.gov template
Multiple and sometimes competing audience
needs
Recruiting Vets with PTSD
Understanding the unique online information
needs of Vets with PTSD

11. Health Literacy

12. We struggle with
complex health
information.

13. Living with PTSD
Common complaints from people living
with PTSD include issues with
concentration, attention, and memory.

14. health.gov/HealthLiteracyOnline

15. Methods

16. Methods
Analytics analysis
Content and usability audit
Focus groups with Veterans and family members
IDIs with clinicians
Baseline usability testing with eye tracking
Card sorting with Veterans and clinicians
Click testing
Prototype testing
Total Participants: 152

17. Focus Groups with Collaging

18. Highlights
Wanted to see more in-depth and tailored content (by war, branch, and
type of trauma)
Seek out online information about PTSD, mostly from institution and
government websites
Identified resources such as self-help tools and support groups as the
highest priorities
Identified “You are not alone” as a key message or theme they would want
to see on a PTSD website

19.
“I think that when
dealing with PTSD, I
feel like sometimes
civilian PTSD is way
different than military
PTSD, and a lot of
information out there is
on civilian PTSD. Even
in the military, the type
of PTSD I experience as
a Navy Vet is totally
different than someone
in the Army.”

20.
“I’ve found a support
group on Facebook
— I have an OTH
discharge. It’s pretty
much like the VA,
there’s not a lot of
support so we have
to find support in
other places.”

21. Collaging
Par+cipants
create
a
collage
that
represents
the
characteris+cs
they
would
like
to
see
in
a
new
Website
Result:
Provides
insights
into
users’
needs
normally
not
revealed
in
interviews
and
focus
groups

22.
We can do this
together

23.
Support, there
can be life

24.
Feeling small,
feeling alone.

25. Baseline Usability Testing with
Eye Tracking

26. Highlights
Strengths:
Wealth of material
Information is research-based
Video and text formats available
Apps available for self-help
Videos production is high quality
Weaknesses:
Duplicative content, and sometimes outdated
Public/Professional structure causes confusion
Content is hard to find—even after being found once
Systematic or thorough exploration of the site is difficult
Visual design and page layout do not guide visual search
PTSD search functionality not easy to find

29. Order
AOI
%
views
Median
TTFF
1
Carousel
image
100%
0.39
2
Content
tabs
93%
2.25
3
Public
header
75%
3.92
4
Main
nav
87%
4.28
5
Local
search
50%
5.29
6
Main
content
93%
11.95
8
Right
column
50%
70.36

30. Card Sorting

33. Homepage
Understand
PTSD
Get
Help
and
Treatment
For
Families
and
Friends
Professional
Training
and
Tools
PTSD
Research
About
Us
En
Español

34. Click Testing

36. Veterans often used multiple
paths to get to the same
content — for example,
using the left navigation
items and links on the main
page (much more than
clinicians).

37. Veterans overwhelmingly
understood that the Get Help
and Treatment page was
intended for consumers. They
also understood where they
could find provider-oriented
treatment content.

38. 5/20/17 OBXtek Inc., Proprietary
Most participants missed the PTSD
Search bar. Many went to the VA
site-wide search instead.

39. Design

41. Voice and Tone
Welcoming and supportive, promoting a sense
of community and of trust in VA services
Incorporates language recognizing the holistic
and complementary approaches that many
people take to treatment and recovery
Before:
Effective treatments for PTSD exist.
Learn about treatment options and care
after trauma. (NOTE: The National
Center for PTSD does not provide direct
clinical care or individual referrals.*)
After:
Treatment works. Learn about
treatments that are proven to help people
with PTSD. Find out how treatment can
help you heal from trauma — so you can
live the way you want to.

42. Lessons Learned

43. There is still stigma around PTSD which can make recruitment
difficult
Important to screen for computer use; some participants were very
unfamiliar with technology
Participants needed time to ‘vent’ and establish rapport with the
moderator
Vets wanted to connect with other vets during sessions
Bottom line: Allow more time for recruitment, testing, and relationship
building
Recruitment and testing

44. Remote testing is not always ideal
In-person testing can be easily combined with
online software (and is more efficient)
Eye tracking doesn’t work well with participants
who wear bifocals or have a lazy eye
Logistics

45. Take the time to go through IRB or get an
exemption
Include help resources as part of consent
IRB and consent

46. Is problematic, assumes users know what group they belong
to and only want content targeted at this group
Users typically think in terms of topics, not identity
Forcing people to self-identify increases cognitive effort
Users can feel anxious that the information they are seeing is
incomplete or incorrect
Can be appropriate when a group is totally distinct (e.g.
separating family support content)
Audience-based navigation

47. Redesigning in a bad template can only take you so far
Eye-tracking and click testing are powerful tools for
demonstrating template issues in a quantitative way
You have to advocate!
Working within a template

48. communicatehealth.com/blog

50. Thank you!
@ CommunicateHlth