The Basics
These guidelines have discussed several methods to test
your Web site with users. This section addresses some of the lessons learned
from conducting user testing with people with limited literacy skills.
Refer to the section A Brief
Introduction to User-Centered Design for a brief overview of iterative
design methods.
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Actions
6.1. Recruit users with limited literacy
and limited health literacy skills.
Most screening tools designed to measure health literacy
skills (such as the Test of Functional Health Literacy in Adults and the Rapid
Estimate of Adult Literacy in Medicine) must be administered in person and
intended for patients in a clinical setting.55
These options may not be practical or very useful for Web
and health content developers, especially those who are using a private
company's recruitment database. Instead, a proxy for health literacy can be
used based on commonly collected demographic data.55
ODPHP used the following proxy for identifying Web users
with limited health literacy skills:
- High school education or below
- Below the poverty threshold (a household income of
$40,000 or below)
- Have not searched for health information online in the
past year
- Recruit from community contexts (e.g.,
adult learning centers, federally qualified community health centers, senior
centers) using trusted community recruiters. You're more likely to get
participants from your target populations.
Consider having the community recruiter or representative
attend the focus group testing session in an informal capacity, such as a
greeter.
 |
Pretest your protocol with at least one participant
with limited literacy skills to fine-tune tasks and timing. |
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6.2. Choose experienced moderators.
Whenever possible, use moderators who have experience
working with people with limited literacy skills or with people with limited
experience on the Internet. Local colleges and universities may be a good place
to find experienced and affordable moderators.
Expect testing sessions with users with limited literacy
skills to progress at a slow pace. It's strongly recommended that you pretest
your protocol with participants with limited literacy skills to fine-tune tasks
and timing.
- During sessions, have the moderator
both read tasks aloud and provide them in writing (one task per sheet). This
will remind users of the task you are asking them to accomplish.
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6.3. Test comprehension in multiple
ways.
To evaluate user comprehension:
- Have participants think out loud as
they complete tasks.
- Ask participants to describe what
they've read in their own words.
- Ask participants to describe what
action they would take after reading the content.
Participants with limited literacy skills tend to focus on
the specific task—sometimes to a fault. Remind users that you're less
interested in the answer and more interested in where and how they would look
to find the answer.
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6.4. Consider user engagement and
self-efficacy.
Ultimately, you want users to act on the important health
promotion messages in your content. User engagement and self-efficacy are two
important predictors of adopting healthy behaviors. Similarly, characteristics
of the content itself—such as relevance, coherence, and tone—may
increase the likelihood that users will take action.38
In addition to standard measures of usability and
comprehension, consider using a mix of quantitative and qualitative measures
(defined in Appendix B) designed to assess the
following:
- User engagement
- User self-efficacy
- Acceptability of the content
- Applicability of the content
These measures can be adapted for online health promotion
content.
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6.5. Create plain-language testing
documents.
Write your screeners, consent forms, and moderator guides
in plain language. See Appendix C for sample testing
documents.
- As a general rule, limit the number of
tasks and questions when conducting usability testing with users with limited
literacy skills. Be realistic about what can be accomplished in the time
designated for each session.
In addition to providing easy-to-read consent documents,
consider using a consent process that does not rely on participants' health
literacy skills or English proficiency. See the
AHRQ Informed
Consent and Authorization Toolkit for Minimal Risk Research [PDF file, 107
pages, 300 KB] from the Agency for Healthcare Research and Quality (AHRQ) for
more information.56
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Iterative Design Methods and
Tips
Methods
- Clickable prototypes
- Usability testing
Tips for designing and testing your Web site with users
- Pretest your protocol with at least one
participant with limited literacy skills to fine-tune tasks and timing.
- If participants get stuck on a task,
redirect them by asking where and how they would look to find the answer.
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