Technology continues to change how people access health information and services. In the United States, there are more people with access to the internet than access to primary health care.1, 2 And considering the prevalence of smartphones (owned by 9 in 10 Americans)3 and the proliferation of online health content, it’s no surprise that most people turn to the internet for health information.4
But finding accurate health information online, avoiding misinformation, and accessing health care services can be a challenge. Finding the right information requires an increasingly complex and evolving set of skills and knowledge, collectively referred to as “digital health literacy” (more on this in Section 1).
Health Literacy Online is about broadening access to user-friendly digital health information and services. This research-based guide discusses why and how to design health websites and other digital health information products for a range of audiences, including the millions of people in the U.S. who don’t have strong literacy, health literacy, or digital literacy skills — as well as those who don’t have a lot of time (or patience!) to find and process complex health information.
Many people struggle with even the most basic digital tasks — for example, using search, navigating from a drop-down menu, and scanning a page for relevant information.5 Ultimately, how easily users can find health information and accomplish health-related tasks online depends largely on the quality of the websites we create.
Health Literacy Online is written for anyone involved in writing and designing digital content and tools. This includes writers and editors, content strategists, user experience professionals, web designers, developers, and others. Health Literacy Online represents more than a collection of recommendations — it reflects an approach to responsible digital design and development that:
- Advances digital health literacy
- Prioritizes the information needs and preferences of audiences who might have limited literacy skills or have different information needs
- Involves people from the intended audience as co-creators of web products
- Recognizes that designing for people with limited digital health literacy skills is designing for everyone
Many of the principles in this edition are unchanged from the last, but much of the context has shifted — including the digital landscape, consumer expectations of technology, and perceptions of public health and science. At the time of publication, we see:
- Efforts to broaden access to digital health information and tools
- Renewed calls in government (and private sector) technology to prioritize the customer experience
- Growing concern about the spread of misinformation online
- Rapid development of artificial intelligence (AI), especially generative AI, and uncertainty surrounding its implications for digital health information
In writing this edition, we’ve given greater consideration to these trends and their impact on digital health literacy.
Expanding access to digital health information
Being able to access and use digital health content and tools has the potential to improve health. A lack of easy access to digital health information can contribute to poor health and intensify differences in health outcomes between population groups.
In many cases, the groups most likely to benefit from digital health innovations (such as people with disabilities and rural communities with fewer health care providers) are the same groups that are most likely to be excluded from the digital world.6 Common barriers to access include slow internet connections, limited digital skills and experience with technology, health literacy challenges, and lack of accessibility features. We’ve intentionally broadened the language we use in this third edition — beyond literacy skills — to account for the breadth of (often overlapping) barriers to digital access.
Designing websites and other digital tools that are usable, accessible, and easy to understand can break down barriers and improve health literacy for everyone, not just people with limited digital and health literacy skills. Digital tools must be designed to work for all people. This includes adopting a human-centered design approach that considers users’ unique information needs and preferences — and enlists them as collaborators in the design and development process.
Designing for different information needs can impact everything from the quality of content to the design of digital health solutions and tools themselves, resulting in greater access. In Section 1, we talk about persistent disparities in access to online health information. In Section 2 and Section 3, we talk about how to involve end users and make digital products better for everyone.
Prioritizing the customer experience
The scope of this guide aligns most closely with user experience (UX): the experience that people have interacting with a website or digital product. That said, UX sits within a broader bucket of customer experience (CX): the totality of interactions that people have with an organization over time.
This focus on CX has implications for government public health agencies specifically — and for providers of online health information and services more broadly. It reflects a culture shift toward designing technologies and processes with a human-centered lens (see Section 2 for more). Whether searching for vaccine safety information or applying for health insurance online, people expect websites and other digital services to be responsive to their needs. A focus on CX has benefits beyond improved service delivery and UX — it can also lead to increased levels of trust, a critical factor in digital health transformation.
Addressing health misinformation
Health misinformation (information that is false, inaccurate, or misleading according to the best available evidence at the time) poses a serious threat to public health. During the COVID-19 pandemic, health misinformation — much of it spread online — contributed to people rejecting public health measures and using unproven treatments.7 Misinformation spreads especially quickly on social media and via search engines.
Barriers to accessibility, health literacy, language constraints, and the quality of online content (or lack thereof) can all exacerbate the negative effects of health misinformation. For example, limited literacy skills can affect how people search for information online — and whether their chosen search terms match the complex language frequently used by public health officials. This type of mismatch can lead to increased exposure to misinformation.8
Fortunately, there are steps digital content creators can take to help address misinformation. For example, we can work to understand people’s information needs, concerns, and questions — and create content to proactively address them (see Section 2). We can also cite credible sources and direct our audiences to a broad range of trustworthy sites, including community organizations (see Section 7).
Leveraging emerging technologies like AI
Artificial Intelligence (AI), which is technology that simulates human intelligence and problem-solving skills, has the potential to enhance digital health communication, including improving website usability and accessibility. This is especially true for generative AI (AI that can be used to create new content, like the ChatGPT application that answers questions with detailed written responses). For example:
- AI can automatically generate captions and transcripts for audio and video content and descriptive text for images.
- AI-driven translation can improve access to online health information.
- AI chatbots and virtual assistants can provide immediate help to people who are having trouble using a service, understanding health information, or finding health information online.
- AI programs can generate health content quickly, reducing costs and saving time.
But AI has significant limitations as well. These include:
- Accuracy and reliability. AI can sometimes invent “facts” and sources.
- Voice and tone. Digital health content often has a nuanced, emotional component that AI algorithms miss.
- Bias. The source content and data for generative AI was created by humans, meaning it can carry over some of our biases and stereotypes. This could lead to AI systems inadvertently discriminating against certain groups.
- Transparency. When it comes to trusting health information, it matters whether it’s created by a person or a “bot.” Many people are asking: Should organizations like public health departments use content created by AI at all? At a minimum, it’s critical to label AI-generated content and images as such (see Section 7 for more on content governance).
As AI-created content continues to improve, the ethical considerations of using it in health communication will likely increase in volume and complexity. At this point in time, it’s too soon to give comprehensive guidance or develop best practices about using AI to create digital tools and content. But one thing is certain: for the foreseeable future, when it comes to generating quality health content, human input is essential.
A note on the research and updates to the third edition
The first edition of Health Literacy Online (published in 2010) synthesized lessons learned from the Office of Disease Prevention and Health Promotion’s (ODPHP) original research with more than 700 web users and the small but growing body of literature on the web experiences of people with limited literacy skills. It was built on the principles of web usability described in the Research-Based Web Design and Usability Guidelines [PDF - 20.8 MB] developed by HHS in partnership with the General Services Administration.
In the second edition (published in 2018), we updated the recommendations to reflect findings from a more robust body of literature related to the cognitive processing and online behavior of adults with limited literacy skills, as well as additional original ODPHP research. We also included new considerations for mobile devices and tips for involving people with limited literacy skills in the design and testing of health websites.
In this third edition, we have:
- Included new sections on human-centered design, accommodating users with a range of communication needs, and content governance
- Expanded our focus on people-first design and accessibility for all web users, rather than only focusing on adults with limited literacy skills
- Incorporated references to search engine optimization (SEO) throughout to reflect the importance of Google and other search engines
- Broadened our guidance to apply across digital platforms — including social media, digital ads, online forms, videos, and infographics
- Updated our guidance on user experience (UX) best practices to reflect the latest research and consensus in the field
