1. Writing for the Web: What the Research Tells Us Writing for the Web: What the Research Tells Us Plain Language Workshop April 1, 2008 Sandra Williams Hilfiker Office of Disease Prevention and Health Promotion U.S. Department of Health and Human Services

2. healthfinder.gov healthfinder.gov is an award-winning Federal Web site for consumers, developed in 1997 by the U.S. Department of Health and Human Services together with other Federal agencies. healthfinder.gov links to carefully selected information and Web sites from over 1,500 health-related organizations.

3. healthfinder.gov Redesign Redesigned to be easier for the public to use Redesigned to be easier for the public to use Includes new prevention and wellness information that is actionable and easy to understand Includes new prevention and wellness information that is actionable and easy to understand Provides links to reliable health information and resources from trusted sources Provides links to reliable health information and resources from trusted sources healthfinder beta available to the public in April 2008 healthfinder beta available to the public in April 2008

4. Rationale More Americans are expected to take responsibility for managing their health. More Americans are expected to take responsibility for managing their health. Current online health information landscape creates more stress than support. Current online health information landscape creates more stress than support. People cannot find the information they seek on Web sites about 60% of the time. People cannot find the information they seek on Web sites about 60% of the time.

5. Challenges  Adults with limited health literacy skills: – Are not accustomed to using the Internet as a health resource – Prefer mass media or interpersonal sources of health information – Are typically unable to handle many of the multiple and complex tasks in e-health tools – Have difficulty reading and understanding most online health content

6. Evidence Base Existing research-based recommendations from HHS Existing research-based recommendations from HHS Leading theories of health behavior change and health communication Leading theories of health behavior change and health communication Original research conducted using an iterative design process with more than 600 participants ages 18-84 Original research conducted using an iterative design process with more than 600 participants ages 18-84

7. Original Research –Descriptive Analysis –Expert Panel Review –Structured Interviews –Mental Models Research –Card Sort Study –Prototype Evaluation (Web-based and in person) –Usability Studies

8. Guiding Principles 1. Information on a Web site must be easy to locate, navigate, and use. 2. Health information written for the public should improve understanding, build knowledge of the body and the causes of disease, and facilitate healthy decisionmaking. 3. To influence behavior change, information must be relevant, motivating, and include specific steps for taking action. 4. Web sites & content designed for those with limited literacy will benefit everyone.

9. What we Learned… 1. Writing content 2. Navigation and site structure 3. Features and tools 4. Page layout and design 5. Usability testing & Iterative Design

10. Writing Content

11. Tone and Style Users want “just the basics” about a topic. Users want “just the basics” about a topic. Use everyday language and examples. Use everyday language and examples. Give users positive reasons to change their behavior. Give users positive reasons to change their behavior. Avoid blanket recommendations – be specific. Avoid blanket recommendations – be specific. Tell users how to do the behavior. Break it down into small steps. Tell users how to do the behavior. Break it down into small steps. Don’t dwell on barriers. Provide tools and encouragement. Don’t dwell on barriers. Provide tools and encouragement.

12. Audience Segments Based on User Motivations Users shift frequently between segments. “I want information about a topic.” “Should I be concerned?” “I want to do something.”

13. Formula: Basics, Benefits, Action

14. Everyday Language: Be Succinct, Small ‘Chunks’

15. Actionable Information: Small Steps Approach Instead of: Eat a diet rich in fruits, vegetables, grains, and low-fat milk products. Eat a diet rich in fruits, vegetables, grains, and low-fat milk products. Avoid saturated fats, sodium, and added sugars. Avoid saturated fats, sodium, and added sugars. Give action steps:

16. Small Steps Approach, cont’d Include simple actions that users can do right away. Include simple actions that users can do right away. This reinforces behavior and improves self-efficacy. This reinforces behavior and improves self-efficacy.

17. Using Everyday Language: Avoid Jargon Healthful Healthful Physical Activity Physical Activity Moderate Intensity Moderate Intensity Vigorous Vigorous Supplement Supplement Reduce the Risk Of Reduce the Risk Of

18. Be Positive and Motivational “Can protect you” “Can protect you” “Losing just 10 pounds” “Losing just 10 pounds” “Make time just 3 times a week” “Make time just 3 times a week” “Help you look and feel your best” “Help you look and feel your best” “It feels good to know you are making changes…” “It feels good to know you are making changes…”

19. User Feedback “It actually tells you what to do!” “I like this Web site because it gives you the information you want right away. It gives the basics, not too much to read.” “It’s easy for everyday people like me to read. No big words or medical terms.” “ This [Web site] makes me want to get busy today. “

20. Navigation and Site Structure

21. Simple Home Page Design

22. Old Design

23. Stay “Above the Fold” “Above the fold” refers to the portion of a Web page that is visible without scrolling. Fold

24. Linear Information Paths

25. Web Features and Tools

26. Interactive Tools Provide access to interactive tools: –Customized calculators –Quizzes –Activity logs –Menu planners –Personal assessments

27. my healthfinder

28. Quizzes, Calculators, Planners

29. Printer & Email Friendly Content

30. User Feedback “I would like to print this page and share it with family members who need this information.” “[This is] good information because a lot of times, I take information to the doctor and ask questions about diet issues, what to avoid, and medications.”

31. Page Layout and Design

32. Using Graphics Users prefer pictures of ‘real people’ and pictures that aid in understanding..

33. Make Content Easy to Scan & Digest

34. Early Prototype

35. Usability Basics

36. Improve Search

37. Usability Testing

38. Iterative Design & Usability Testing You do not have to have a finished product to start testing! You do not have to have a finished product to start testing! The only way to develop an eHealth tool that is usable, easy to understand, and engaging is to involve the target audience early and often. The only way to develop an eHealth tool that is usable, easy to understand, and engaging is to involve the target audience early and often.

39. Going Beyond Traditional Usability: Sample Questions Where would you click to learn more about risk factors? (navigation) Where would you click to learn more about risk factors? (navigation) Would you print out any of these pages to give to someone? (relevance) Would you print out any of these pages to give to someone? (relevance) Would a dictionary be helpful? (plain language) Would a dictionary be helpful? (plain language) Does the information on this page inspire you to take action? If so, what action would you take? (actionable, engaging) Does the information on this page inspire you to take action? If so, what action would you take? (actionable, engaging)

40. Recruiting People with limited health literacy are more likely to: –Have only a high school diploma/equivalent or less –Live below the poverty threshold –Be uninsured or have public insurance –Have limited English proficiency –Be older than 65 –Not actively seek out health information –Not use the Internet for health information

41. Iterative Design: Developing ‘my healthfinder’

47. my healthfinder Results: U.S. Preventive Services Taskforce Recommendations

49. Additional Considerations Content Review: Communication Science vs. Health Science Content Review: Communication Science vs. Health Science Accessibility—508 Compliance & Privacy Accessibility—508 Compliance & Privacy Continual Quality Improvement—Your Work is Never Done! Continual Quality Improvement—Your Work is Never Done! Build partnerships to incorporate Web sites into contexts where people ‘are’ Build partnerships to incorporate Web sites into contexts where people ‘are’

50. Thank You! Sandy Hilfiker Sandraw.hilfiker@hhs.gov 240-453-8268