1. Improving Health Literacy Online: Lessons Learned from Iterative Design Sandra Williams Hilfiker, MA September 14, 2009 AHRQ Annual Conference

2. healthfinder.gov: Old Site

3. healthfinder.gov: New Site

4. Prevention Content Research Timeline 2003 200420052006 20072008 Project Concept 2009 Literature Review Mental Models Content Analysis Segment Validation Card Sorts Research Translation Final Build Final/Site Prototype Usability Launch More Usability IA Card Sorts More Content Spanish Content Prototype Usability

5. Project Rationale More Americans are expected to take responsibility for managing their health. Current online health information landscape creates as much confusion as support. Searching returns a lot of irrelevant results. Much of the health content on the Internet is not focused on prevention.

6. Iterative Design & Lessons Learned

7. Prevention Prototype 1.0

8. Prototype 1.0 Usability Test, N=300 Tested with a diverse, nationwide sample, 260 remotely & 40 in-person (limited health literacy) Participants randomly assigned to 3 audience segments Measured appropriateness, acceptability, applicability, engagement, motivation, & self-efficacy

9. Prototype 1.0 Key Findings: Audience Segments “What can I do?” “I want information about a topic.” “Should I be concerned?” Basics Benefits Action

10. Prototype 1.0 Key Findings: To increase engagement & self efficacy we needed: Shorter content chunks with increased use of Plain Language A small steps approach to adopting healthy behaviors Content organized so users can shift quickly between audience segments An interface design based on “progressive disclosure” that allows users to easily “drill down”

11. Prevention Prototype 2.0

12. Prototype 2.0 Usability Test, N=40 Adult women with limited health literacy, recruited from a community health center system in Baltimore Not just Web usability, also focused on content usability Study was designed to: – Learn if changes to the content and interface design would positively impact self-efficacy and engagement measures – Test out organizational framework Measured appropriateness, acceptability, applicability, engagement, motivation, & self-efficacy

13. Prototype 2.0 Key Findings: Basics, Benefits, Action

14. Prototype 2.0 Key Findings: Small Steps Approach Simple actions that users can do right away Reinforces behavior and improves self- efficacy

15. Prototype 3.0 Usability Test, N=20 Prototype tweaked and additional content sets added Adult women with limited health literacy recruited from a community health center system in Baltimore Test was performed to validate changes from the first test

16. Users didn’t read this Users did read this Usability Test 2 Key Findings: Writing Style

17. Where We Are Today & Next Steps

18. Quick Guide to Healthy Living

19. Current Topic page

20. Reusing Content in Many Ways: New Media

21. Reusing Content: Community Health Centers Electronic Medical Record Posters Conversation Scripts Small Step Rx

22. Next Steps Continual quality improvement Spanish Quick Guide to Healthy Living More content & tools Explore new channels

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