- Although the problem remains largely invisible,
millions of Americans have a hard time reading. As many as half of U.S. adults
have limited literacy skills.2
- Even more Americansas many as 9 out of
10have limited health literacy skills. This means they have trouble
understanding complex health information.2 As more health information and services
move online, Web developers and professionals must find new and better ways to
communicate health information to the public.
- The number of older adults using the Internet continues
to grow. A significant number of older Web users are searching for health
information. However, age-related changes in vision, hearing, and cognition
affect older adults' use of the Internet.3
Taken individually, each of these factors presents a
challenge for Web developers and health professionals. Taken together, they
represent an urgent need for innovative designand redesignof health
content on the Web.
Several factors affect how well users can find,
understand, and use information on the Web, including:
- Access to computers and experience online
- Ability to read and understand printed text
- Complexity of information on the Web
- Usability of the Web in general and Web sites
specifically4,5
Clearly written content, uncluttered Web sites, and simple
navigation dramatically improve the performance and experience of Web users,
including those with limited literacy skills.
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Building On the Principles of Usability
The latest research in Web design supports creating
easy-to-use Web sites. This guide builds on the principles of Web usability and
adds to existing best practices by providing research-based strategies for
writing and designing health Web sites that are accessible to users with
limited literacy and limited health literacy skills.
Drawing on experience with healthfinder.gov, this guide
synthesizes lessons learned from ODPHP's original research with more than 700
Web users and the small but growing body of literature on the Web experiences
of users with limited literacy skills. The strategies outlined in this guide
are supported by the Research-Based Web Design and Usability Guidelines,
2nd edition (Usability Guidelines),8 developed by the U.S. Department of
Health and Human Services in partnership with the General Services
Administration. The relevant chapters of the Usability Guidelines are
listed at the end of each section.
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Terminology: Literacy and Health Literacy
- "Literacy" is a person's ability to read, write, speak,
and solve problems at levels needed to function in society.9
- "Health literacy" is a person's capacity to find,
understand, and use basic health information and services needed to make
appropriate health decisions.10
Although literacy and health literacy are distinct
constructs, they are closely related. Literacy has been found to be a predictor
of health literacy.11 Roughly 1 in 3
adults has limited literacy skills; however, a far greater number of adults (as
many as 9 in 10) struggle with complex health information.2,11 In other
words, a person may be extremely literate and still have difficulty
interpreting and acting on health informationwhether it's online or in
print.
The aim of creating easy-to-use health Web sites is to
reach as many Web users as possible, especially those adults who are
overwhelmed by everyday literacy tasks. For this reason, this guide refers to
Web users with limited literacy skills; it's assumed that these Web users, and
millions more, likely have limited health literacy skills as well.
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A Note on the Research
Most of the recommendations in this guide are based on
original research studies conducted on behalf of ODPHP (detailed in
Appendix D). ODPHP used proxy measures to identify a
sample of adults with limited literacy and limited health literacy skills based
on statistics from the health literacy component of the 2003 National
Assessment of Adult Literacy. Individuals included in many of the studies
referenced in this guide met the following criteria:
- High school education or below
- Below the poverty threshold
- Have not searched for health information online in the
past year
Participants were recruited from community settings likely
to serve people with limited literacy and health literacy skills, including
federally funded community health centers.
ODPHP's studies pertain specifically to the delivery of
online health promotion and disease prevention content. Much of the research
focused on communicating actionable information and motivating users to adopt
healthy behaviors. The communication and usability strategies outlined in this
guide also apply more generally to the delivery of health information on the
Web.