Range

1. A Health Literacy and Usability Heuristic Evaluation of a Mobile Consumer Health Application Basics Range Cause Helen Monkman & Andre Kushniruk August 22, 2013

2. Introduction Introduction Methods Results Discussion Closing Health Literacy and Usability • 1. Health Literacy – “the ability to access, understand, evaluate and communicate information” • (Rootman & Gordon-El-Bihbety, 2008, p. 11) 2. Usability– the extent to which “a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use." (ISO 9241-11)

3. Introduction Introduction Methods Results Discussion Closing Health Literacy and Usability Health Literacy Usability Consumer HISs • If consumers cannot understand the content, they may have difficulty achieving their goals • If the system is hard to use, consumers may have challenges accessing the information

4. Introduction Introduction Methods Results Discussion Closing The Health Literacy Challenge • The value of consumer HISs hinge on aligning consumers levels of health literacy with the demands these systems place on health literacy System Demands on Health Literacy Consumers with Low Health Literacy

5. Introduction Introduction Methods Results Discussion Closing Lowering Demands on Health Literacy • Validated measures for evaluating users’ levels of health literacy exist – however, they do not measure system demands on health literacy • Readability measures demands on health literacy – but do not assess the impact of system display and design • This study focused on lowering demands on health literacy through information display and design

6. Introduction Introduction Methods Results Discussion Closing Study Objectives • To develop a new set of evidence-based heuristics that evaluate both usability and demands on health literacy • Based on studies of usable health websites with participants who had limited health literacy • To determine the utility of these heuristics in identifying opportunities to improve the usability and decrease demands on users’ levels of health literacy in a mobile consumer health application

7. Introduction Introduction Results Discussion Closing Methods Heuristic Evaluation • Usability experts assess how well a system complies with design principles (i.e., heuristics) • Existing heuristics, such as Nielsen’s (1993), or new heuristics can be used • When the system violates a given heuristic it is assigned a severity rating • A new set of heuristics and severity scale were developed for this study

8. Introduction Introduction Results Discussion Closing Methods Severity Scale Development • Tan, Liu and Bishu’s (2009) severity scale was complemented with explanations of health literacy

9. Introduction Introduction Results Discussion Closing Methods Heuristic Development • Health Literacy Online: A guide to writing and designing easy-to-use health Web sites (HLO Guide) was parsed for design guidelines • U.S. Department of Health and Human Services, • Office of Disease Prevention and Health Promotion (2010) • Some guidelines were modified for mobile devices • Guidelines (e.g., paragraphs < 3 lines; use bulleted lists; avoid long words)  29 heuristics (e.g., Spacious)  5 categories (e.g., Content)

10. Introduction Introduction Results Discussion Closing Methods HLO Heuristics

11. Introduction Introduction Results Discussion Closing Methods Procedure • The mobile consumer health app was described as a clear and simple reference guide for everyone to understand his or her blood test reports • An evaluation table of the heuristics and their ancillary guidelines was used to evaluate the app • The investigator explored all of the app’s screens and recorded violations, assigned severity ratings and took screenshots of violations

12. Introduction Introduction Introduction Methods Discussion Closing Results Results Frequency of Heuristic Violations

13. Introduction Introduction Introduction Methods Discussion Closing Results Results Examples of Heuristic Violations

14. Introduction Introduction Introduction Methods Discussion Closing Results Results App Re-Design Buttons & Colloquial Orientation & Linear Navigation Headings Specific Font Spacious Link Linear Nav Print & Engage Accessibility Linear Nav

15. Introduction Introduction Methods Results Closing Discussion Discussion • Evidence-based heuristics were developed for assessing demands on health literacy and usability • These heuristics demonstrated utility in generating design recommendations to improve a mobile consumer health application • This set of heuristics provides specific and objective design recommendations based on studies on users with limited health literacy

16. Introduction Introduction Methods Results Discussion Closing Conclusion • Consumer health information systems should be designed with considerations for health literacy and usability • Design methods involving users with limited health literacy may help ensure these criteria are met • However, existing systems may benefit from inspection methods for adherence to guidelines for usability and health literacy

17. Introduction Introduction Methods Results Discussion Closing Thank You! Questions?

18. Introduction Introduction Methods Results Discussion Closing References • Rootman I, and Gordon-El-Bihbety D. A vision for a health literate Canada. Ottawa, ON: CPHA; 2008. • ISO 9241-11. Ergonomic requirements for office work with visual display terminals (VDTs) Part 11: Guidance on usability. International Organization for Standardization; 1998. • Tan W, Liu D, and Bishu R. Web evaluation: Heuristic evaluation vs. user testing. Int J IndErgonom 2009;39(4): 621-27. • U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Health literacy online: A guide to writing and designing easy-to-use health Web sites.Washington, DC. 2010.

19. Introduction Introduction Methods Results Discussion Closing Appendix – Screens Heuristics

20. Introduction Introduction Methods Results Discussion Closing Appendix – Content Heuristics

21. Introduction Introduction Methods Results Discussion Closing Appendix - Heuristics

22. Introduction Introduction Methods Results Discussion Closing Appendix - Heuristics

23. Introduction Introduction Methods Results Discussion Closing Appendix - Heuristics